Despite more than 200 000 eye doctors in practice around the globe, capacity is not keeping pace with the growing demands of ageing populations and the current needs of developing countries, finds research published online in the *British Journal of Ophthalmology*.

The authors base their findings on an International Council of Ophthalmology survey sent to 213 specialist ophthalmic societies, covering 193 countries between March and April 2010.

The survey was designed to find out the headcount of practising ophthalmologists in each country and the growth rate of the profession.

The responses (192 countries) showed that there were 205,000 ophthalmologists in 2010, half of whom were in China, USA, Russia, Japan, Brazil, and India.

The number of ophthalmologists by country ranged from zero to more than 28,000 in China. Some 131 countries had less than 5% of the total number between them.

The average number of ophthalmologists per million of the population varied according to the level of economic development, ranging from 9 per million in low income countries to 79 per million in high income countries―an eightfold difference.

The lowest average number was in Sub-Saharan Africa (2.7), while the highest numbers were in former communist regimes (83.8)―a 30-fold difference.

There were fewer than one ophthalmologist per million of the population in 23 countries and one to four per million of the population in 30 countries. In 48 countries there were four to 25 per million of the population, and 25 to 100 in 74 countries.

Just 18 countries had more than 100 ophthalmologists per million of the population.

Seventy three countries, representing more than half of the world's population, provided data on those entering and leaving the profession in 2009.

Of these, two thirds (48) showed an increase; in five countries the numbers fell; while in 20 countries the numbers remained static.

Overall, in 2010 the number of ophthalmologists increased by 1.2%, most of which occurred in low income countries. While the overall capacity is increasing faster than the general population, this is not the case in high income countries where the reverse is true.

And the numbers of those in the 60+ age bracket is growing at a faster rate than the numbers of ophthalmologists who will be needed to care for them, say the authors.

For example, in the same 73 countries, the proportion of those aged 60 and above grew by 2.9% between 2009 and 2010, yet the proportion of ophthalmologists only increased by 1.2%.

This means that, on average, this sector of the population is growing more than twice as fast as the profession, particularly in high income countries, say the authors.

"The implication [is] that in a number of countries, both developing and developed, it will be extremely challenging to train enough ophthalmologists to provide the care that will be needed in the years to come," they write.

They go on to say that their data "delineate a dire situation," adding: "It is necessary to begin aggressively training eye care teams now to alleviate both the current shortfall in developing countries and the anticipated shortfall in developed countries."

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