Eye care interventions that reduce access inequities for women, rural residents and older people in low-middle-income countries: A scoping review

Magnolia Cardona^1,2,3*Kennedy Alwenya⁴Atiq Ur Rehman⁵Sarah Olalo⁴An Thai⁶Mediya Rangi⁷Yadira Perez⁷Ling Lee^7,8,9

• ¹Research Advisory Team, Fred Hollows Foundation, Melbourne, Australia
• ²School of Population Health, The University of New South Wales, Sydney, Australia
• ³Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia
• ⁴The Fred Hollows Foundation Kenya, Melbourne, Australia
• ⁵The Fred Hollows Foundation Pakistan, Melbourne, Australia
• ⁶The Fred Hollows Foundation Vietnam, Melbourne, Australia
• ⁷Fred Hollows Foundation, Melbourne, VIC, Australia
• ⁸School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
• ⁹National Vision Research Institute, Australian College of Optometry, Melbourne, VIC, Australia

Women, older people and rural residents in low-middle-income settings are mainly impacted by the economic and psychosocial consequences of preventable blindness from undiagnosed and untreated cataracts, diabetic retinopathy, and uncorrected refractive error. This review of PubMed 2002-2023 and the grey literature aimed to identify strategies effective in reducing access inequities to eye health screening and treatment for the above vulnerable groups. Thirty-nine publications from 16 countries were included. Fifteen focused on cataract, 17 on diabetic retinopathy, and seven on general ophthalmology. This article focuses on the twenty-four studies of moderate or high quality as assessed by the modified Hoy risk of bias tool. Rural residents were more likely to benefit (16 studies) while direct effectiveness among women were reported in seven studies. Only three studies reported actual benefits for older people. Outreach services and teleophthalmology were effective interventions increasing screening attendance and referral rates for women and rural residents. Health financing to enhance cataract surgery acceptance and actual surgical rates reported effectiveness for rural residents but showed only modest improvements. Digital technology improved overall appointment uptake and referral adherence for rural residents but not significantly for women. Teleophthalmology was successful in building local capacity for accurate diagnosis but its impact on referral compliance was not demonstrated. Limited evidence was found for the effectiveness of health education alone to boost screening attendance for either subgroup. The evidence for effectiveness in reducing inequities is not always direct, uses mixed outcomes, and had heterogenous designs. Yet, the results of the higher quality publications in this review indicate modest improvements worth pursuing further.