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Abstract

PURPOSE: Neuro-ophthalmology is a highly specialized subspecialty at the interface of neurology and ophthalmology. Globally, workforce shortages and geographic maldistribution limit access to neuro-ophthalmic care. Although Brazil has a large ophthalmology workforce, regional disparities may restrict access to subspecialty services. The national distribution of neuro-ophthalmologists has not previously been quantified. This study aimed to characterize the geographic distribution of neuro-ophthalmologists in Brazil and identify potential gaps in access to neuro-ophthalmic care.
METHODS: This cross-sectional, population-based study used data from the registry of the Brazilian Neuro-Ophthalmology Association (Associação Brasileira de Neuro-Oftalmologia [ABNO]) to identify practicing neuro-ophthalmologists (data extracted on January 1, 2026). Municipal- and state-level population estimates were obtained from the Brazilian Institute of Geography and Statistics. Specialist density was calculated as the number of neuro-ophthalmologists per million inhabitants. States were classified according to the presence or absence of at least one specialist and were further grouped into Brazil's five macroregions for comparative analyses. Descriptive statistical analyses were performed.
RESULTS: A total of 66 neuro-ophthalmologists were identified across 14 of Brazil's 27 states. Thirteen states had no registered neuro-ophthalmologists, representing approximately 49.4 million people (23.2% of the national population). Five states—São Paulo (n=31), Rio de Janeiro (n=6), Minas Gerais (n=6), Pernambuco (n=4), and Paraná (n=4)—accounted for more than two-thirds of all specialists. Specialist density ranged from 0 to more than 0.7 per million inhabitants, with higher concentrations in the Southeast and no specialists in several states in the North and Northeast. The distribution was highly clustered in metropolitan areas.
CONCLUSION: Brazil exhibits marked geographic maldistribution of neuro-ophthalmologists, with nearly one-quarter of the population lacking local access to specialized care. The concentration of specialists in urban and economically developed regions mirrors international trends and may exacerbate inequities within the public health system. Expanding the workforce and integrating teleophthalmology into neuro-ophthalmic services may help reduce regional disparities and improve access to specialized care.

Keywords: Ophthalmologists; Public health; Health policy; Workforce; Professional practice location; Telemedicine; Teleophthalmology; Brazil