Toward Universal Eye Health Coverage—Key Outcomes of the World Health Organization Package of Eye Care Interventions
Stuart Keel, Gareth Lingham, Neha Misra, Sandra S. Block, Rupert Bourne, Margarita Calonge, Ching‐Yu Cheng, David S. Friedman, João M. Furtado, Rohit Khanna, Silvio Paolo Mariotti, Wanjiku Mathenge, Elenoa Matoto, Andreas Müeller, Mansur Rabiu, Tuwani A. Rasengane, Serge Resnikoff, Richard Wormald, Sumrana Yasmin, Jialiang Zhao, Jennifer Evans, Alarcos Cieza, Package of Eye Care Interventions Development Group, Augusto Azuara‐Blanco, Ving Fai Chan, Yanxian Chen, Holly R. Chinnery, Sarity Dodson, Laura E. Downie, Iris Gordon, Nima Ghadiri, Pirindhavellie Govender Poonsamy, Xiaotong Han, Flora Hui, Mary Lou Jackson, John G Lawrenson, Chan Ning Lee, Myra B. McGuinness, Craig Murray, David Newsham, Ruth van Nispen, Megan Prictor, Lila Raj Puri, Jacqueline Ramke, Ian Reekie, Sare Safi, Jane Scheetz, Sunny Shen, Sue Silveira, Sahil Thakur, Gianni Virgili, Ai Chee Yong, Justine Zhang, Mohammed Ziaei, Mustafa Abdu Ali, Ibrahim AlObaida, Fatemah T Al Shamlan, Sulaiman M. Alsulaiman, Kwesi Nyan Amissah-Arthur, Marcus Ang, Rajvardhan Azad, Kristin Bell, Shrikant R. Bharadwaj, Dirk Booysen, Sergey Branchevski, Vanessa Bosch, Natalie Brossard-Barbosa, Yi Chen, Jennifer P. Craig, Tanuj Dada, Carmen A Dichoso, Rainald Duerksen, Anne Effiom Ebri, Irmela Erdmann, Thomas F. Freddo, John G. Flanagan, Yazan Gammoh, Neeru Gupta, Peter Hendicott, Mohd Aziz Husni, Andrew Jackson, Muhammad Zahid Jadoon, Ingrida Janulevičienė, Irfan Jeeva, Maria Sheila S Jimenez, Ivo Kocur, Andreas Kreis, Samuel Kyei, Weizhong Lan, Marie Joan V Loy, Srinivas Marmamula, Late Hasan Minto, Mohammad Muhit, Naomi H Nsubuga, Ayobade Ogundipe, Ogugua Ndubuisi Okonkwo, Olusola Olawoye, A Ouertani, Godwin Ovenseri-Ogbomo, Seyhan B. Özkan
Abstract
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.