Improving access to eye care in low and middle-income countries – challenges, opportunities, and the way forward

ABSTRACT

Introduction

Vision loss is a public health challenge adversely affecting over a billion people worldwide. Low and middle income countries (LMICs) have a disproportionately higher prevalence of vision loss compared to high-income countries. Over 80% of vision loss can be addressed with either spectacles or cataract surgery. Both of these interventions are low cost and cost effective. Despite this, several barriers prevent individuals from accessing eye care.

Areas covered

This paper covers various elements of access (approachability, acceptability, affordability, availability and appropriateness) and presents barriers that prevent access to eye care services in LMICs. Disease-specific barriers and various models and strategies that address the accessibility challenges are presented with a special reference to the use of technology to improve access.

Expert opinion

Strategies such as providing free eye care, lowering direct and indirect costs, improve access to cataract surgery. While access-related challenges related to cataract surgery are well studied, there is inadequate information on access to refraction services for refractive errors and other conditions. Future research can focus on addressing this information gap. This can then help develop strategies to address the burden of uncorrected refractive errors and other causes of vision loss and contribute towards achieving universal eye health coverage.

Search strategy used

A literature search was carried out to identify the relevant articles reporting barriers to seeking eye care in the Medline, CINHAL and PsycINFO databases between 20 and 27 May 2023. From this search, the relevant articles were shortlisted for data extraction.

KEYWORDS:

• Access to eyecare
• Barriers
• vision impairment
• service delivery models
• universal eye health

Article highlights

• Access is a multidimensional concept defined as those dimensions that describe the potential and actual entry of a given population group into the health care delivery.

• The five basic elements of access include approachability, acceptability, affordability, availability and appropriateness.

• A larger proportion of vision loss in low and medical income countries is avoidable with cost-effective intervention. Despite this, several barriers prevent individuals from accessing eye care.

• Strategies such free surgeries and minimizing direct and indirect costs improve access to eye care in LMICs.

• Technology including teleophthalmology and mobile application are addressing geographical distance and improving access to eye care.

• Research using mixed methods is recommended to assess the impact of various eye care models in addressing the elements access in LMICs.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Authors thank Tejah Balantrapu and Neha Hassija for the language inputs on the earlier versions of the manuscript.

Additional information

Funding

This paper was not funded.