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Toward Universal Eye Health Coverage—Key Outcomes of the World Health Organization Package of Eye Care InterventionsA Systematic Review

To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What essential evidence-based eye care interventions for common eye conditions should be covered in universal health coverage?

Findings  In this systematic review of clinical practice guidelines and expert consultation, 98 high-quality guidelines were identified and 64 essential eye care interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) targeted at 15 priority eye conditions were selected for inclusion in the World Health Organization Package of Eye Care Interventions.

Meaning  The Package of Eye Care Interventions may reduce inequities in eye care by enabling countries to identify and incorporate essential eye care interventions into universal health coverage.

Abstract

Importance  Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed.

Objective  To describe the key outcomes of the PECI development.

Evidence Review  A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review.

Findings  Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI.

Conclusions and Relevance  This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.

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Article Information

Accepted for Publication: September 22, 2022.

Published Online: November 17, 2022. doi:10.1001/jamaophthalmol.2022.4716

Corresponding Author: Stuart Keel, PhD, Department of Noncommunicable Diseases, World Health Organization, Ave Appia 20, 1211 Geneva, Switzerland (keels@who.int).

Author Contributions: Drs Lingham and Keel had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Keel and Lingham are considered co–first authors of this paper.

Concept and design: Keel, Misra, Block, Bourne, Cheng, Furtado, Khanna, Mathenge, Mueller, Rabiu, Wormald, Evans, Cieza.

Acquisition, analysis, or interpretation of data: Keel, Lingham, Misra, Calonge, Friedman, Khanna, Mariotti, Mathenge, Rabiu, Rasengane, Resnikoff, Evans.

Drafting of the manuscript: Keel, Lingham, Friedman, Mueller.

Critical revision of the manuscript for important intellectual content: Keel, Lingham, Misra, Block, Bourne, Calonge, Cheng, Friedman, Furtado, Khanna, Mariotti, Mathenge, Rabiu, Rasengane, Resnikoff, Wormald, Evans, Cieza.

Statistical analysis: Lingham.

Administrative, technical, or material support: Lingham, Misra, Bourne, Calonge, Cheng, Khanna, Mueller, Rabiu, Rasengane.

Supervision: Keel, Bourne, Furtado, Mariotti, Wormald, Cieza.

Conflict of Interest Disclosures: Dr Friedman reported receiving personal fees from Thea Pharmaceuticals outside the submitted work. No other disclosures were reported.

Group Information: The Package of Eye Care Interventions Development Group members appear in Supplement 2.

Additional Contributions: We thank Susan Norris, MPH, from the World Health Organization Guideline Review Committee Secretariat for her valuable support in the development of the protocol. No financial compensation was received for this contribution.

Additional Information: Templates and data may be made available upon reasonable request to the corresponding author.

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