Pioneering Comprehensive Eye Care in Northern Pakistan: Development and Implementation of a Hub-and-Spoke Model

The hub-and-spoke model in ophthalmology was implemented in Northern Pakistan in 2021 under the Aga Khan Health Service, Pakistan (AKHS-P), in collaboration with the Aga Khan University, Karachi, to expand access to comprehensive and specialized eye care across the geographically challenging and historically underserved regions of Gilgit-Baltistan and Chitral. A central ophthalmology hub was established in Gilgit, equipped with advanced diagnostic, laser, and surgical ophthalmic facilities to provide comprehensive eye care locally. The hub was staffed by a fellowship-trained ophthalmologist and supported by the Aga Khan University Hospital in Karachi as a super-hub, providing subspecialty expertise and teleophthalmology support. Two sub-hubs were subsequently established in Upper and Lower Chitral and staffed by optometrists, while peripheral spokes were developed across remote communities of Gilgit-Baltistan and Chitral and operated by frontline healthcare workers, with periodic visits by optometrists and ophthalmic technicians. Through this tiered network, patients receive care at the level closest to their communities, while those requiring advanced diagnostic assessment, specialist consultation, or surgical intervention are referred to the appropriate level within the network. The sub-hubs address primary and routine ophthalmic needs and facilitate referral, whereas the central hub provides advanced diagnostic, laser, and surgical services. The super-hub at Aga Khan University Hospital, Karachi, further strengthens the network through subspecialty expertise, teleophthalmology, training, and clinical support. Future development may incorporate artificial intelligence (AI)-assisted tele-ophthalmology, continued human-resource development, and strengthened subspecialty networks to support sustainable delivery of comprehensive eye care across geographically isolated and resource-constrained settings.