Opinion | Emergency eye care is disappearing when patients need it most

Opinion editor’s note: Strib Voices publishes a mix of guest commentaries online and in print each day. To contribute, click here.

•••

Most people take their eyesight for granted — until it is suddenly at risk. Retinal emergencies such as retinal detachment, severe eye trauma, or serious eye infection often require urgent surgery to preserve vision. Even short delays can result in permanent vision loss.

As a retinal specialist practicing in Minnesota, I am frequently called when patients present with vision-threatening emergencies. Patients reasonably assume that if they need urgent eye surgery, an operating room (OR) will be available. Increasingly, that assumption is no longer safe.

A stark example is the 2023 closure of Allina Health’s Philips Eye Institute (PEI) in Minneapolis. For decades, PEI functioned as a dedicated eye hospital — one of the only such centers in the Midwest — designed to manage complex and unpredictable ophthalmic emergencies. It maintained 10 eye-specific ORs with 24/7 availability, allowing patients across the Twin Cities and greater Minnesota to receive urgent care when minutes mattered.

The closure of PEI was described as a relocation to Abbott Northwestern Hospital. In practice, however, this represented a substantial reduction in emergency eye surgery capacity. Ophthalmic surgery is now limited to two eye-designated ORs within a general hospital operating suite, with more limited overnight and weekend availability. For patients with time-sensitive eye conditions, this was more than a change in address; it represented a meaningful loss of dedicated access.

At the same time, broader health-system consolidation, staffing shortages and increasing competition for hospital OR time have made it more difficult to accommodate urgent eye surgery. As Minnesota’s population continues to age and eye disease becomes more common, demand for timely emergency eye care is increasing.

Staffing realities further compound the problem. Labor costs in health care — particularly for anesthesia and specialized nursing — have risen sharply, while Medicare reimbursement has not kept pace. For hospitals and ASCs alike, this has made it increasingly difficult to justify maintaining anesthesia and nursing teams for overnight and weekend emergency coverage. In practical terms, limited reimbursement translates directly into limited after-hours access.

Medicare policy unintentionally reinforces these constraints. While recent Medicare updates have provided modest annual increases tied to inflation, they do not address the mismatch between payment and the realities of urgent, resource-intensive emergency eye surgery. Because Medicare operates under budget-neutrality constraints and growing demands on limited health-care dollars, simply “paying more” without rethinking how emergency procedures are valued risks shifting care locations rather than preserving access.

This challenge is not unique to Minnesota. National Practice and Trends surveys of retina specialists show that more than 70% report difficulty securing OR access for emergency retina cases, particularly during nights and weekends.

Delays in emergency eye care have real consequences. Longer intervals between retinal detachment and surgical repair are associated with worse visual outcomes. Vision loss increases fall risk, accelerates loss of independence and can force patients out of the workforce. It also carries substantial societal and health-care costs — including increased medical utilization and loss of independence — much of which can be avoided with timely, effective eye surgery that consistently provides high value relative to its cost.

This is not about physician compensation, nor is it a criticism of individual hospitals or ASCs. It is about recognizing that current payment structures and workforce realities were not designed with emergency eye care in mind.

U.S. Sens. Amy Klobuchar and Tina Smith of Minnesota, and U.S. Rep. Kelly Morrison, a physician representing the state’s Third Congressional District, have an opportunity to address this growing problem before more patients lose vision unnecessarily. Few things are more fundamental to independence and quality of life than eyesight. Emergency eye care should be available when patients need it — not only when the system makes it easy.