Integrating Optometrists into Primary Health Care Facilities: Experience and Evidence from Sindh, Pakistan

Objective

Visual impairment and preventable blindness continue to disproportionately affect rural communities in Pakistan, where the lack of trained eye care professionals at the Primary Health Care (PHC) level remains a critical gap in health service delivery. This study aimed to assess the contribution and practical implications of integrating Sindh Institute of Ophthalmology and Visual Sciences (SIOVS) trained optometrists at 95 Primary Health Care service delivery centres, known as Rural Health Centres (RHCs), across Sindh’s rural areas in 2025.

Design

Retrospective quantitative secondary analysis study.

Setting

Ninety-five Primary Health Care facilities commonly known as Rural Health Centres (RHCs) across rural districts of Sindh province, Pakistan.

Sample

We conducted a descriptive statistical analysis of 1,000 randomly selected patient records from participating RHCs.

Results

The analysis shows that optometrists independently managed 760 patients (76%), while 240 (24%) were referred to ophthalmologists at tertiary health care facilities for advanced care. Of the 118 cataract cases identified, all patients were successfully pre-registered for surgery and completed post-operative follow-up at their local RHC. Demographically, 55% of patients were aged 50 years or older, and women accounted for 52% of those examined, indicating that PHC facility-based optometry services improved access for groups traditionally marginalised in rural healthcare settings.

Conclusions

Our study demonstrates that an optometrist-embedded primary eye care model significantly reduces pressure on tertiary facilities, improves geographic access to essential vision services, and enables timely detection and referral of sight-threatening conditions. The analysis underscores the urgent need to scale up the deployment of qualified optometrists across all RHCs in Pakistan and calls for investment in diagnostic equipment and tele-ophthalmology infrastructure, as well as the integration of optometry into national PHC policy frameworks, to advance universal eye health coverage.

STRENGTHS AND LIMITATIONS OF THIS STUDY

• The strengths of our study include our ability to analyse and report on patient records from first-ever interactions between optometrists and patients at the primary health care (PHC) level, assessing newly appointed optometrists’ contributions to eye care in PHC facilities across the 95 participating Rural Health Centres (RHCs) in Sindh province, Pakistan.

• This study is among the first in Pakistan to assess the integration of optometrists into RHCs using routine service delivery data.

• The use of a systematic random sample of 1,000 patient records, together with high inter-rater reliability (Cohen’s κ = 0.87), strengthened the consistency of data extraction and the validity of the findings.

• The study provides policy-relevant evidence to support strengthening primary eye care services by integrating optometrists at PHC level to improve access to eye care at PHC level in Pakistan.

• Limitations of this study include analysis of only patients’ records available at the facilities and maintained by the optometrists themselves, which may have introduced reporting bias. Including a qualitative component to interview patients and other RHC staff could have added value to this study and minimised potential bias.