Paediatric eye health in low- and middle-income countries: a scoping review of disease burden, service delivery, screening programs, and barriers to care

Childhood visual impairment and blindness remain significant yet largely preventable public health problems, particularly in low- and middle-income countries (LMICs). Children in these settings experience a disproportionate burden of eye conditions such as uncorrected refractive error, amblyopia, congenital cataract, retinopathy of prematurity, infectious eye diseases, and ocular trauma. When left undetected or untreated, these conditions can lead to lifelong visual disability, negatively affecting educational attainment, psychosocial development, future employment opportunities, and overall quality of life. Despite the availability of effective and often low-cost interventions, many children in LMICs do not receive timely eye care due to weaknesses along the continuum of care. This research project aims to comprehensively map and synthesize the existing evidence on pediatric eye health in LMICs through a scoping review. The primary purpose of the review is to describe what is currently known about the burden and patterns of pediatric eye conditions, the screening and service delivery models that have been implemented to address these conditions, and the barriers and facilitators influencing access to and uptake of eye care services. Rather than focusing on a single condition or intervention, the project adopts a broad, systems-oriented perspective that reflects the complexity of pediatric eye care pathways in resource-limited settings. The review is guided by a conceptual framework that views visual and developmental outcomes as the result of interconnected stages along the care pathway: disease burden and risk identification, screening and early detection, referral and access to services, treatment provision (including spectacles, surgery, or medical therapy), and follow-up and adherence. These stages are shaped by health system factors such as workforce availability, infrastructure, financing, service organization, and governance, as well as family and community factors including awareness, health literacy, socioeconomic constraints, geographic accessibility, cultural beliefs, and gender norms. By organizing evidence within this framework, the project seeks to move beyond isolated findings and provide a coherent picture of how pediatric eye care functions—or fails to function—in LMIC contexts. Specifically, the review addresses three key objectives. First, it aims to summarize evidence on the burden and epidemiology of pediatric eye conditions in LMICs, including reported prevalence and incidence, geographic and socioeconomic variation, risk factors, and the populations that have been studied. Second, it seeks to describe and classify screening and service delivery models, such as school-based screening programs, community outreach initiatives, facility-based services, and integrated models, including who delivers these services, how they are organized, and what outcomes have been reported. Third, it aims to synthesize evidence on barriers and facilitators to care, including factors influencing referral completion, spectacle wear, attendance for surgery, and long-term follow-up. The expected outcomes of this project include a comprehensive mapping of the pediatric eye health research landscape in LMICs, highlighting areas of strong evidence as well as critical gaps. The review will identify conditions, age groups, geographic regions, and components of the care pathway that are understudied relative to their public health importance. It will also generate a structured typology of screening and service delivery models and a multi-level synthesis of barriers and facilitators to care. These findings are expected to inform future primary research priorities, support the design and strengthening of eye health programs, and provide policymakers, program implementers, and global eye health stakeholders with an accessible evidence base to guide decision-making. Ultimately, by clarifying what is known and where evidence is lacking, this project aims to contribute to more equitable, effective, and child-centered eye care systems in low- and middle-income countries, helping to reduce avoidable visual impairment and improve long-term outcomes for children most at risk.