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Eliminating Uncorrected Refractive Error by 2030: A Sequential Framework for Evidence-Based Action in LMICs.

Indra Prasad Sharma1,2, Kovin S Naidoo2,3,4, Khathutshelo Percy Mashige2,3

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Summary
This summary is machine-generated.

Uncorrected refractive error (URE) is a major cause of vision impairment globally, especially in low-income countries. A new five-phase framework is proposed to improve refractive error coverage and achieve global targets by 2030.

Keywords:
cost‐effectivenessevidence‐based approachframeworklow‐ and middle‐income countries (LMICs)refractive error

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Area of Science:

  • Public Health
  • Ophthalmology
  • Global Health

Background:

  • Uncorrected refractive error (URE) is a leading cause of vision impairment (VI) globally, disproportionately affecting low- and middle-income countries (LMICs).
  • The 74th World Health Assembly set a target to increase effective refractive error coverage (eREC) by 40% by 2030, but progress is insufficient, with LMICs lagging.
  • Barriers such as limited resources, fragmented services, and inadequate policy hinder effective refractive error care in LMICs.

Purpose of the Study:

  • To introduce a novel five-phase, evidence-informed framework to address the unmet need for refractive error services.
  • To support systemic planning, implementation, and scaling of sustainable refractive error services in LMICs.
  • To provide a roadmap for countries to achieve global targets for refractive error coverage.

Main Methods:

  • The framework involves five phases: need estimation via surveys, situational analysis (e.g., using WHO RESAT), model formulation, evaluation and scaling, and demand generation.
  • Drawing on case studies like Bhutan, where refractive errors cause significant VI but spectacle coverage is low.
  • Utilizing evidence-based strategies adaptable to diverse country and community needs.

Main Results:

  • Current global adult eREC is 65.8%, with South Asia showing lower rates, indicating most LMICs are not on track to meet the 2030 target.
  • Bhutan's example highlights the disparity: 96.1% of school-aged VI is due to refractive errors, yet effective spectacle coverage is only 11.5%.
  • The proposed framework offers a structured approach to overcome existing barriers and improve refractive care.

Conclusions:

  • Achieving the global target for refractive error coverage requires urgent development and implementation of sustainable, evidence-based strategies.
  • The five-phase framework provides a practical tool for countries to plan and scale refractive error services effectively.
  • Systemic improvements in refractive care are crucial to reduce vision impairment caused by URE, particularly in LMICs.