Teleophthalmology Programs in Underserved Communities in the United States: A Narrative Review

Underserved communities in the United States continue to face substantial barriers to accessing eye care, leading to preventable vision loss. This review synthesizes United States-based teleophthalmology programs designed to expand eye care access among under-resourced populations, including older adults, Indigenous communities, children, veterans, people experiencing homelessness, and patients in safety-net systems. Most programs used asynchronous nonmydriatic fundus photography captured by trained technicians in community or primary care settings, with remote specialist interpretation and frequent integration into electronic health records. Across studies, teleophthalmology increased diabetic eye screening rates by 15-40% and identified ocular disease in 20-25% of participants. Many initiatives partnered with community organizations to address cultural and logistical barriers unique to the populations they served. Despite these gains, challenges persist, particularly poor follow-up adherence, financial instability, limited technical capacity, and workflow integration. Emerging opportunities include artificial intelligence-assisted automation, sustainable reimbursement mechanisms, home-based screening, and virtual eye clinics to enhance equitable, population-level vision care.