A man walks on a path that twists and tangles on itself on the way to a hospital.

Barriers to Healthcare in Rural America

A common complaint in the chronic dry eye (CDE) community revolves around access to healthcare. The most common barriers are lack of insurance or underinsured, financial constraints, and lack of services in a geographic area. This is my story.

When first diagnosed with chronic dry eyes, I assumed I would find a doctor specializing in dry eyes, take medication or get a treatment, and all would be well. Wrong! Here are the barriers I encountered.

Lack of services

The first barrier I ran into was geographical. I live in rural Oklahoma, where access to doctors is limited. I am fortunate to have a great optometrist, but finding a specialist is difficult. The closest clinic specializing in the treatment of chronic dry eyes is 200 miles away.

Unfortunately, I also have intermediate stage dry macular degeneration, making driving difficult for me. We have no public transportation in rural areas unless you are on Medicaid; transportation is provided to medical appointments for patients on Medicaid.


I soon learned that private insurance or Medicare have these wonky rules about care for the eyes. If you need eye surgery you are in luck. Need a treatment for chronic dry eyes? You most likely will pay for that out of pocket.

My optometrist recommended intense pulsed light therapy (IPL) to treat my clogged meibomian glands. It would require travel to a distant city and cost appropriately $800 for each treatment. It would not be covered by insurance. Enter the first barrier (transportation) and this second barrier (insurance).

Financial constraints

After my optometrist diagnosed me with meibomian gland dysfunction, I soon ran into barrier #3: financial constraints. Like many in our country, I am a retiree living on Social Security. It made the cost of IPL  too steep for me.

Remember my great optometrist? When he learned I could not have IPL treatment as he recommended, he came up with Plan B. As I said before, insurance rules are wonky. No, they won’t pay for a treatment like IPL. They will, however, pay for my optometrist to manually express the meibomian glands. While effective, this process is painful and less effective as the IPL treatment.

The cost of eye drops

As everyone with chronic dry eyes knows, eye drops are essential to soothe and treat our eyes. They come in tiny little vials and are pricey.

Prescription drops are especially expensive. Restasis and Xiidra offer relief for many. However the high price tag put them out of reach for some. A one-month supply may run as high as $700 a month. Even with my prescription drug plan, the price for Restasis was more than I felt I could afford.

Over-the-counter (OTC) drops are the main tool for keeping my dry eye symptoms under control. Basic lubricant eye drops cost between $8-12 a vial and may last less than a month. As my symptoms have worsened, I now use GenTeal gel drops twice a day. They offer longer periods of relief but cost close to $20 a bottle.

We all face barriers

My story is not unique. Whether you live in rural America or a major city, we all face barriers to getting the healthcare we need for our eyes. I dream of a day eye care will be covered by affordable insurance for all of us.

What barriers do you face? Leave a comment below to share your barriers.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The ChronicDryEye.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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