Key messages

1. Outreach (a community-based approach to provide eye care in various settings, which are often not permanent locations), and school-based service delivery approaches were mainly used to provide eye care in the community, while vision centres were mainly used in primary care (first-line health care).

2. In the World Health Organization (WHO) South-East Asia region, eye care was most often delivered using outreach and vision centres, whereas in the African region, school-based delivery and outreach were mainly reported. In the Americas, outreach was mostly used.

3. We need more information from the WHO Eastern Mediterranean region, and we need research to evaluate which approaches are most effective.

Why is it important to provide eye tests and spectacles?

Many sight problems are easily solved by wearing spectacles (eye-glasses). However, millions of people around the world don’t have access to the tests and facilities they need to get the correct spectacles. This is a problem for many people because eye care services may be expensive, or located far away. Poor vision can affect children’s ability to learn at school, and lead to people being unable to work.

Governments, health services, eye care organizations, and charities use different approaches to provide eye care services to a wide variety of people. This might be by bringing services to people in the community or by providing accessible primary eye care services locally.

What did we want to find out?

The World Health Organization (WHO) is working on advice to countries to help them improve their eye care services. The first step is to understand what eye care services are currently available worldwide, where they are based, and how they work. This information allows us to find the gaps in the evidence, to see where future research should be focused, and will help with the WHO guidance.

What did we do?

We searched for evidence about the different ways people can access eye tests and get spectacles in the community and at local health centres or doctors’ clinics (primary care) anywhere in the world. We needed as much information as possible, so we gathered evidence from medical studies, and also from annual reports and websites of eye care organizations. We grouped the evidence according to the different ways eye tests and spectacles were provided, and we described how and where the services were delivered.

What did we find?

We found 175 studies, 146 records from eye care organizations and 81 records from websites (402 resources in total), which reported the ways eye care services were delivered in the community or in primary care. Most eye care services included eye tests, assessing the need for spectacles, and providing spectacles. The services were mainly carried out by eye care providers and sometimes with other people, like nurses, doctors and teachers.

Community eye care services are provided where people live or work.

• Schools (154 resources): teachers are trained to give vision tests in school, or eye care workers visit the school to conduct tests. Sometimes a van or bus, equipped as an eye test centre, visits the school. Spectacles are usually prescribed if needed, and follow-ups or referrals for further eye care can be arranged. Schools sometimes partner with community or primary healthcare centres to provide eye care services.

• Pharmacies (3 resources): community pharmacies provide vision tests and spectacles.

• Outreach (157 resources): eye care providers go out into the community to provide care, for example in workplaces or homes. Outreach services are not in a permanent place but may be somewhere for a short period. They often visit very remote areas. They may offer free eye tests and spectacles.

In primary care, patients visit a permanent location to receive eye care services.

• Vision centres (53 resources) are eye care clinics staffed by trained eye care workers. They carry out tests and provide spectacles. Patients usually pay for spectacles, but they may get a voucher to help with the cost.

• Health centres (16 resources) are healthcare facilities but not eye care clinics. They usually provide eye tests and spectacles.

• Vision and health centres plus door-to-door delivery (11 resources): a combination of services provided by vision and health centres and home visits.

In the WHO South-East Asia region, the outreach and vision centre approaches were most common. In the WHO African region, the school-based and outreach approaches were mainly reported. In the WHO Americas region, the outreach approach was mostly used.

What are the limitations of the evidence?

We found very few reports of how eye care services are delivered in the WHO Eastern Mediterranean region, so our picture of services there is limited. There was limited information about how well the delivery methods worked, so more research is needed about this.

How up to date is this evidence?

The evidence is up to date to November 2022.