Toward Universal Eye Health Coverage—Key Outcomes of the World Health Organization Package of Eye Care Interventions
Authors: Keel Stuart , Lingham Gareth , Misra Neha , Block Sandra , Bourne Rupert , Calonge Margarita , Cheng Ching-Yu , Friedman David S. , Furtado João M. , Khanna Rohit , Mariotti Silvio , Mathenge Wanjiku , Matoto Elenoa , Müeller Andreas , Rabiu Mansur , Rasengane Tuwani , Resnikoff Serge , Wormald Richard , Yasmin Sumrana , Zhao Jialiang , Evans Jennifer R. , Cieza Alarcos ,   Package of Eye Care Interventions Development Group, Azuara-Blanco Augusto , Chan Ving Fai , Chen Yanxian , Chinnery Holly , Dodson Sarity , Downie Laura , Gordon  Iris  , Ghadiri Nima , Govender Poonsamy Pirindhavellie , Han Xiaotong , Hui Flora , Jackson Mary Lou , Lawrenson John , Ning Lee Chan , McGuinness Myra , Murray Craig , Newsham David , van Nispen Ruth , Prictor Megan , Puri Lila , Ramke Jacqueline , Reekie Ian , Safi Sare , Scheetz Jane , Shen Sunny , Silveira Sue , Thakur Sahil , Virgili Gianni , Yong Ai Chee , Zhang Justine , Ziaei Mohammed , Ali Mustafa Abdu , AlObaida Ibrahim Abdulkarim , AlShamlan Fatemah T , Alsulaiman Sulaiman M , Amissah-Arthur Kwesi N , Ang Marcus , Azad Rajvardhan  , Bell Kristin , Bharadwaj Shrikant R , Booysen Dirk J , Branchevski Sergey  , Bosch Vanessa , Brossard-Barbosa Natalie , Chen Yi , Craig Jennifer P , Dada Tanuj , Dichoso Carmen A , Duerksen Rainald , Ebri Anne  , Erdmann Irmela , Freddo Thomas , Flanagan John  , Gammoh Yazan , Gupta Neeru , Hendicott Peter , Husni Mohd Aziz , Jonathan Jackson Andrew , Jadoon Muhammad Zahid , Januleviciene Ingrida , Jeeva Irfan , Jimenez Maria Sheila S , Kocur Ivo , Kreis Andreas , Kyei Samuel , Lan Weizhong  , Loy Marie Joan V , Marmamula Srinivas , Minto Late Hasan  , Muhit Mohammad , Nsubuga Naomi H , Ogundipe Ayobade , Okonkwo Ogugua N , Olawoye Olusola O , Ouertani Amel Meddeb , Ovenseri-Ogbomo Godwin , Özkan Seyhan B , Patel Bina , Paula Jayter S , Rahi Jugnoo S , Ravilla Ravindran D , Senanayake Nandana Saman , Sil Asim Kumar , Solebo Ameenat L , Sousa Raúl ARC , Tennant Matthew TS , van Staden Diane B , Wazir Junaid Faisal , Webber Ann L , Yorston David , Zin Andrea , Faal Hannah B , Keeffe Jill , McGrath Colleen E 
Published: November 2022

Importance

Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed.

Objective

To describe the key outcomes of the PECI development.

Evidence Review

A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review.

Findings

Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI.

Conclusions and Relevance

This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.