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Complexity and Barriers to Vision Care: A Narrative Review Informed by a Mobile Eye Program
Valeria Villabona-Martinez1,2, Anne Schulman2, Bharadwaj Chirravuri2
1Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA.
International Journal of Environmental Research and Public Health
|December 30, 2025
Summary
Structural barriers in urban eye care lead to preventable vision loss for underserved patients. Flexible models like mobile clinics and patient navigation are crucial for equitable access and timely treatment.
Area of Science:
- Ophthalmology
- Public Health
- Healthcare Systems Analysis
Background:
- Underserved populations face significant barriers to ophthalmic care, including language, immigration status, insurance, and financial hardship.
- Complexity theory offers a lens to understand the dynamic interactions within healthcare systems that impact patient access.
- Patient navigation and adaptable care models are essential for addressing healthcare disparities.
Purpose of the Study:
- To identify and describe structural and systemic barriers to ophthalmic care for underserved urban patients.
- To analyze these barriers using a complexity-informed framework.
- To integrate literature findings with real-world case examples from a mobile eye care initiative.
Main Methods:
- A narrative literature review focused on healthcare disparities, patient navigation, and care delivery complexity in ophthalmology.
- Integration of literature findings with case vignettes from the Eyes on Wheels (EOW) mobile eye care program.
- Analysis of EOW cases to illustrate systemic barriers in real-world care pathways.
Main Results:
- Recurring system-level issues include misclassification of time-sensitive care as non-urgent, patient disengagement due to cumulative barriers, and system inflexibility.
- These patterns align with documented challenges faced by underserved urban populations.
- Case vignettes exemplify how systemic issues manifest, leading to delayed or missed ophthalmic care.
Conclusions:
- Addressing eye care inequities requires understanding the complex interplay of healthcare system components affecting timely treatment.
- Rigid or fragmented systems contribute to preventable vision loss; flexible models like mobile clinics are needed.
- Improving outcomes necessitates adaptable care models, patient navigation, social needs assessment, and policy changes.
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