Understanding eye care needs beyond vision loss across six countries: addressing distance and near visual impairment and other eye conditions

Objective. Population growth and ageing are placing increasing pressure on eye care services. We present a model estimating comprehensive eye care needs using data across six countries. Methods and analysis. We used cross-sectional data from community screening programmes (n = 2,338,193; all ages) conducted in 2022 - 2023 in India, Pakistan and Nepal (South Asia) and Kenya, Tanzania and Uganda (sub-Saharan Africa). Total eye care need was defined as the presence of distance visual impairment (VI), near VI, or any other eye condition requiring care in at least one eye, reported with 95% confidence intervals (CI). Distance and near VI were assessed on presenting visual acuity, measured with existing correction where available; estimates therefore reflect unmet need rather than total impairment. Logistic regression identified factors associated with increased need, reported as adjusted odds ratios (AORs). Results. Among those aged ≥ 50 years, the prevalence of distance VI was 36.3% (95% CI: 36.1 - 36.5), and 74.8% (95% CI: 74.6 - 74.9) had at least one eye care need. In those aged < 50 years, the prevalence of distance VI was 6.3% (95% CI: 6.2 - 6.3), and 19.9% (95% CI: 19.8 -19.9) had at least one eye care need. Higher need was observed among older individuals (AOR: 1.06 per year), females (AOR: 1.13), and in programmes conducted in sub-Saharan Africa compared to South Asia (AOR: 2.75); all p-values < 0.001. Conclusion. This study expands knowledge by including all age groups, all types of eye care needs, and each affected eye, not only bilateral problems, offering a more complete picture of eye care needs in mass screening programmes.