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29 to 1.9. The presence of an ophthalmologist was significantly associated with a greater proportion of individuals with a college degree and health insurance, and more developed healthcare infrastructure. From 1990 to 2017, the density of optometrists increased from 11.06 to 16.16 optometrists per 100,000 individuals. Conclusions and Relevance Over the last two decades, the national density of ophthalmologists has decreased and the workforce has aged. In contrast, the density of optometrists has increased. Rural counties continue