Primary eye health services for older adults as a component of universal health coverage: a scoping review of evidence from high income countries

Abstract

In pursuit of Universal Health Coverage (UHC) for eye health, countries must strengthen services for older adults, who experience the highest prevalence of eye conditions. This scoping review narratively summarised (i) primary eye health services for older adults in eleven high-income countries/territories (from government websites), and (ii) the evidence that eye health services reduced vision impairment and/or provided UHC (access, quality, equity, or financial protection) (from a systematic literature search). We identified 76 services, commonly comprehensive eye examinations ± refractive error correction. Of 102 included publications reporting UHC outcomes, there was no evidence to support vision screening in the absence of follow-up care. Included studies tended to report the UHC dimensions of access (n=70), equity (n=47), and/or quality (n=39), and rarely reported financial protection (n=5). Insufficient access for population subgroups was common; several examples of horizontal and vertical integration of eye health services within the health system were described.

Funding: This work was funded by Blind Low Vision New Zealand for Eye Health Aotearoa.

Keywords: Eye health service; Healthy ageing; Older people; Universal health coverage.

Figure 1

Network diagramme illustrating the types of services offered by the included 76 eye care programmes across 11 high-income countries/territories. Each programme is illustrated by a single circle: colour indicates the country that offers the programme (see key); size indicates the programme scope (small circles=state or provincial, large circles=national programmes; letters indicate eligible population: E=Elderly, SD=socially disadvantaged, CS=condition specific, GP=general population, MG=multiple groups). Each programme offers one or more of eight services, illustrated by text labels: size of the text represents the relative proportion of programmes offering that service. Services: Refractive error correction (RE correction; n=44), eye exams (n=42), low vision services (n=13), diabetic retinal screening (n=10), prosthetic eye services (n=8), surgery (n=8), glaucoma screening (n=3), visual acuity (VA) screening (n=1). *Indicates parallel services offered within England, Northern Ireland, and Wales; **Indicates parallel services offered within England, Northern Ireland, Scotland, and Wales.

Figure 2

PRISMA flow diagram summarising the screening and selection of evidence to answer Question 2 of the review.

Figure 3

Network diagramme illustrating the Universal Health Coverage dimensions of eye health services reported by the included publications (n=102). Each publication is illustrated by a single circle: colour indicates the vision condition that the published evidence described (see key). Each publication reported one or more UHC dimensions, illustrated by text labels, whereby the size of the text illustrates the relative proportion of publications reporting that dimension. UHC dimensions: access (n=70), equity (n=47), quality (integration (n=39), efficiency (n=28), timeliness (n=18), safety (n=11), people-centredness (n=10), change in vision impairment (n=7), financial protection (n=5); Quality dimensions are shown in italics; VI=vision impairment, DR = diabetic retinopathy, AMD=age-related macular degeneration; URE=uncorrected refractive error.