Community-based paediatric eye care in low- and middle-income countries: bridging the gap between policy and practice

Childhood visual impairment and blindness remain major public health concerns in low- and middle-income countries (LMICs), despite a substantial proportion being preventable or treatable. Delayed diagnosis, inadequate access to eye care services, fragmented referral systems, limited awareness and insufficient community-level interventions continue to contribute to the burden. In recent years, the epidemiological profile of paediatric ocular morbidity has shifted from infectious and nutritional causes towards refractive errors, myopia and developmental eye disorders, necessitating stronger community-oriented eye care models. This review examines the burden, determinants, policy frameworks, implementation gaps and future strategies related to community-based paediatric eye care in LMICs, with particular emphasis on bridging the gap between policy and practice. Evidence from global literature, WHO frameworks and national programmes such as India's Rashtriya Bal Swasthya Karyakram and National Programme for Control of Blindness and Visual Impairment highlights the importance of integrated life-course approaches involving neonatal, preschool and school-age screening. However, implementation remains constrained by workforce shortages, inadequate infrastructure, poor referral linkage, limited financing and disparities in access to specialised equipment. Community-based strategies including school vision screening, tele-ophthalmology, mobile eye clinics, digital surveillance systems and artificial intelligence-assisted diagnostics demonstrate considerable potential in improving access and continuity of care. Strengthening paediatric eye care in LMICs requires integration with primary healthcare systems, training of non-ophthalmic personnel, sustainable financing mechanisms, effective referral pathways and technology-supported service delivery to reduce avoidable childhood blindness and visual impairment.