Barriers to access to ophthalmology services in Latin America: A scoping review

Barriers to access to ophthalmology services in Latin America: A scoping review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Barriers to access to ophthalmology services in Latin America: A scoping review Erwin Hernández Rincón, Juan Tobo Hernandez, Juan Alvarez Tovar, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7436148/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 7 You are reading this latest preprint version Abstract Introduction: Visual impairment is a global public health priority because of its high prevalence and impact on quality of life. In Latin America, access to ophthalmologic care is limited by multiple barriers that especially affect vulnerable populations and hinder the timely detection and management of preventable visual diseases. Objective: To describe the available evidence on the barriers affecting access to ophthalmology services in Latin America. Materials and Methods: In accordance with the JBI and PRISMA-ScR guidelines, a search was conducted in four scientific databases (PubMed, Scielo, Scopus and Web of Science), including studies published between 2010 and 2025, highlighting the barriers to accessing ophthalmology services in Latin America and excluding those focused on other regions of the world. Results: Sixty-eight studies were included, with the main barriers identified for access to ophthalmology services being structural, geographic, economic, sociocultural, technological, and health system barriers. Among the strategies implemented to improve access, teleophthalmology, mobile brigades, educational campaigns, and strengthening of primary care stand out, although significant inequalities persist between regions and population groups. Conclusions: Access to ophthalmologic care in Latin America continues to be affected by multiple barriers, especially affecting the most vulnerable populations. Although progress has been made through various strategies, it is necessary to strengthen the integration of services, invest in human and technological resources, and prioritize equity to advance toward universal and effective eye care coverage in the region. Health sciences/Health care/Health services Health sciences/Medical research/Epidemiology ophthalmology access to health services barriers to health ophthalmologic care health inequalities Latin America health equity access factors health coverage health system Figures Figure 1 Figure 2 INTRODUCTION Visual impairment constitutes a global public health priority because of its high prevalence and profound impact on quality of life, biopsychosocial well-being, and health systems ( 1 ) . The main causes of this condition are uncorrected refractive defects, cataracts, glaucoma, diabetic retinopathy, and corneal opacities, most of which are preventable or treatable pathologies if detected early ( 2 ) . Therefore, it is essential to guarantee timely, continuous, and equitable access to ophthalmological services to make the right to visual health effective ( 3 ) . Latin America was ranked in 2019 as the region with the greatest inequality, facing social, economic, and environmental gaps that limit access to health care. In ophthalmology, multiple structural, economic, geographic, cultural, and health system barriers especially affect vulnerable populations, perpetuating inequities and hindering the timely detection and management of preventable visual diseases ( 3 , 4 ) . Among preventable visual diseases, diabetic retinopathy (DR) stands out as one of the main causes of visual impairment, especially in contexts with limited medical coverage. Early detection of this pathology is particularly complex in regions where the previously mentioned structural, economic, and technological barriers persist, hindering access to specialized services ( 6 ) . One example of a possible strategy that has emerged to address these challenges has been telemedicine as a promising alternative for screening, diagnosis, and follow-up of eye diseases, as it facilitates the expansion of access to eye care through remote platforms and integrated care models ( 5 ) . While teleophthalmology programs have been shown to reduce inequalities, they face organizational, technological, and human challenges that compromise their sustainability. These include a lack of investment, poor staff training, a lack of clinical standards, and gaps in digital infrastructure ( 5 ) . In addition, the subjective perceptions of users, their confidence in remote care, and the quality of the patient‒physician link are also important. However, beyond technological and organizational limitations, profound structural inequities persist. Historically marginalized communities such as indigenous peoples, Afro-descendant populations, and low-income people face a disproportionate burden of visual disease, compounded by their underrepresentation in research and inclusive health policies ( 7 ) . Furthermore, access to vision rehabilitation services represents a critical need that continues to be neglected. Globally, less than 10% of people with low vision have access to functional interventions, and in Latin America, the situation is even more limited ( 8 ) . Therefore, overcoming barriers to access to eye care in Latin America requires global awareness of the magnitude of the problem and the implementation of innovative strategies supported by technology and equitable patient-centered policies. Only through coordinated and sustained actions will it be possible to move toward more accessible and equitable eye care for the entire population of the region. MATERIALS AND METHODS A scoping review was conducted in June 2025 following the methodology of the Joanna Briggs Institute (JBI) ( 9 ) and the PRISMA-ScR ( 10 ) guidelines. This approach allowed a rigorous mapping of the scientific literature on the subject. The review was guided by the following research question: What are the barriers affecting access to ophthalmology services in the Latin American population? Search strategy: The search was conducted in four scientific databases, PubMed, Scopus, SciELO, and Web of Science, following the previously established inclusion and exclusion criteria. In addition, gray literature, including international technical reports, institutional bulletins, documents from academic repositories, and nonindexed institutional journals, was considered. The search terms were designed using MeSH-DeCS descriptors and related keywords. The specific search strategies for each database, as well as the inclusion and exclusion criteria applied, are detailed in Table 1 . These strategies were adapted to the particularities of each database to ensure broad and accurate coverage of the relevant literature. Table 1 Search strategies and article selection criteria CRITERIA USED IN THE SEARCH STRATEGIES Inclusio n Exclusio n Articles in English, Spanish, or Portuguese Editorials, letters to the editor, opinions without empirical support, and case reports. Publications between January 2010 and June 2025. Studies published outside the established time range Studies conducted in Latin American countries or directly comparing Latin American contexts. Studies conducted outside Latin America Scientific articles, systematic or scoping reviews, qualitative, quantitative or mixed studies, and technical reports, narrative reviews. Exclusively clinical or technological studies that do not address barriers to access to ophthalmologic care. Studies that analyze geographic, economic, sociocultural, organizational, structural, technological, or health system barriers to accessing ophthalmology services. Publications focusing only on clinical or surgical interventions, unrelated to access to care DATABASES AND SEARCH STRATEGIES Databas e Search strategy PubMed 1. (("Eye Care Services"[MeSH] OR "Ophthalmology"[MeSH] OR ophthalmology[tiab] OR "eye health"[tiab]) AND ("Health Services Accessibility"[MeSH] OR access[tiab] OR barriers[tiab] OR inequity[tiab] OR inequality[tiab] OR obstacles[tiab]) AND ("Latin America"[MeSH] OR "South America"[MeSH] OR "Central America"[MeSH] OR "Caribbean Region"[MeSH] OR "Mexico"[MeSH] OR "Brazil"[MeSH] OR "Argentina"[MeSH] OR "Colombia"[MeSH] OR "Peru"[MeSH] OR "Chile"[MeSH] OR "Venezuela"[MeSH] OR "Latin America"[tiab] OR "South America"[tiab] OR "Central America"[tiab] OR "Caribbean"[tiab])) AND ("2010/01/01"[Date - Publication] : "2025/12/31"[Date - Publication]) 2. ((((ophthalmology) OR (ophthalmology services)) OR (visual care)) AND (barriers to care)) AND (health disparities) 3. (ophthalmology [MeSH Terms] OR "eye care" [tiab] OR "vision care" [tiab]) AND ("barriers to care" [tiab] OR "access to care" [tiab] OR "Health Services Accessibility" [MeSH Terms]) AND ("health disparities"[tiab] OR "Healthcare Disparities"[MeSH Terms]) Scopus 1. Ophthalmology AND Access AND Disparities AND "Latin America" AND Determinants 2. (TITLE-ABS-KEY (ophthalmology) OR TITLE-ABS-KEY ("eye care") OR TITLE-ABS-KEY ("vision care") OR TITLE-ABS-KEY (cataract) OR TITLE-ABS-KEY (glaucoma) OR TITLE-ABS-KEY ("diabetic retinopathy") OR TITLE-ABS-KEY ("age-related macular degeneration") OR TITLE-ABS-KEY ("age-related macular degeneration") OR TITLE-ABS-KEY ("refractive errors") OR TITLE-ABS-KEY ("retinal diseases") OR TITLE-ABS-KEY (uveitis)) AND (TITLE-ABS-KEY ("barriers to care") OR TITLE-ABS-KEY ("health services accessibility") OR TITLE-ABS-KEY ("access to health services") OR TITLE-ABS-KEY ("health disparities")) AND (TITLE-ABS-KEY ("Latin America") OR TITLE-ABS-KEY ("South America") OR TITLE-ABS-KEY ("Central America") OR TITLE-ABS-KEY (Caribbean) OR TITLE-ABS-KEY (Argentina) OR TITLE-ABS-KEY (Bolivia) OR TITLE-ABS-KEY (Brazil) OR TITLE-ABS-KEY (Chile) OR TITLE-ABS-KEY (Colombia) OR TITLE-ABS-KEY (Ecuador) OR TITLE-ABS-KEY (Mexico))) SCIELO (telemedicine OR "eye health" OR ophthalmology OR cataracts OR glaucoma OR retina OR vision) AND ("access to health" OR barriers OR inequalities OR inequities OR inequities) AND ("Latin America" OR "South America" OR "South America" OR "Central America" OR Argentina OR Brazil OR Colombia OR Peru OR Mexico OR Chile) Web of Science Guatemala OR Honduras OR Nicaragua OR Panama OR Cuba OR Cuba OR Haiti OR Dominican Republic") Summary of inclusion and exclusion criteria and database-specific search strategies used to identify relevant literature on barriers to accessing eye care in Latin America. The choice of databases used in this review was based on their relevance to answer the research question of barriers to accessing ophthalmology services in Latin America. PubMed was included for its focus on biomedical research and coverage of peer-reviewed scientific literature in health sciences; Scopus, for its interdisciplinary nature and broad scope in terms of citations and abstracts; SciELO, for its access to scientific literature published in Latin America and its usefulness in identifying regional evidence; and Web of Science, for its rigor in indexing high-impact journals and its ability to retrieve relevant studies published in international scientific journals with coverage of public health, inequalities and ophthalmology services. The selection and flow of the articles included are presented in Fig. 1. Study selection All the citations were managed on the Rayyan platform. The identified articles were consolidated in a database, eliminating duplicates manually. Subsequently, four reviewers independently reviewed titles and abstracts according to the inclusion and exclusion criteria, resolving discrepancies by consensus. Finally, four reviewers reviewed the full texts to confirm the final eligibility of the studies. Data extraction Data extraction was carried out via a table previously designed by the research team. This table included the following elements: country or place, dates of development, type of study, objective, number of population included or number of articles (in the case of reviews), type and characteristics of the population studied, and the method employed. The level of care or type of service addressed in each study was also recorded, specifying which of these were addressed and how. In addition, the barriers to access to ophthalmologic services identified in each study were documented, and their approach and content were described. Strategies, models, or interventions aimed at improving access were also compiled. Accordingly, key results and findings, such as coverage achieved, improvements in care or referral times, changes in the perception or use of services, persistent barriers, and, where applicable, clinical outcomes, were recorded. Limitations noted by the authors or identified by the evaluation team were also documented. The collection was performed independently by four reviewers, and any discrepancies were resolved by consensus. Data analysis and synthesis: The extracted data were analyzed via narrative and descriptive synthesis, organizing the information according to the frequency and distribution of barriers to access identified in different countries or regions, the population groups affected, and the levels of care involved. The barriers were classified into structural, geographic, economic, sociocultural, technological, health system, and other categories, presenting concrete examples reported in the articles reviewed. In addition, the main strategies and intervention models proposed to improve access were compiled, as were evidence gaps and priority areas for future research, integrating both qualitative and quantitative studies to provide a broad view of the regional landscape. RESULTS A total of 898 records were identified in the initial search. Among these, 191 (21.3%) were eliminated as duplicates. A total of 707 records (78.7%) were reviewed, of which 587 (83%) were excluded after review of titles and abstracts because they did not meet the inclusion criteria. A total of 120 reports (17%) were selected for retrieval, of which 7 (5.8%) could not be obtained. Then, 113 full-text reports were evaluated for eligibility, with 45 (39.8%) excluded: 4 (3.5%) for not being related to ophthalmology, 29 (25.7%) for being conducted in non-Latin countries, 3 (2.6%) for not addressing access barriers and 9 (8%) for publication date. In total, 68 studies (7.6% of the initial total) were included in the review. Characteristics of the articles reviewed: Sixty-eight articles were included, covering a population ranging from preterm infants to older adults, as well as special populations such as people with visual impairment and indigenous communities. Among these studies, 34 cross-sectional studies, 3 descriptive studies, 6 prospective studies, 6 systematic reviews, 7 retrospective studies, 3 qualitative case studies, 3 cohort studies, 2 meta-analyses, and 4 policy or historical analysis studies were identified. Community intervention studies, population-based survey analyses, and documentary analysis studies, which cover a wide range of methodologies and approaches to accessing ophthalmology services, were also included. In terms of geographic distribution, the review exclusively covers Latin America. Brazil is the country with the greatest number of mentions in the included studies (n = 35), followed by Argentina (n = 21), Colombia (n = 17), Peru (n = 15), Mexico (n = 15), Chile (n = 14), Venezuela (n = 14), Ecuador (n = 14), Cuba (n = 13), Paraguay (n = 13), Uruguay (n = 13), Guatemala (n = 12), the Dominican Republic (n = 12), Costa Rica (n = 11), El Salvador (n = 11), Honduras (n = 11), Panama (n = 11), Bolivia (n = 10), and Nicaragua (n = 9). In addition, regional and multinational studies covering multiple countries in Latin America were identified. The geographic distribution of the included studies is shown in Fig. 2. Regarding years of publication, the studies are distributed as follows: 2014 (n = 9), 2015 (n = 8), 2021 (n = 8), 2023 (n = 7), 2024 (n = 6), 2019 (n = 5), 2016 (n = 4), 2017 (n = 4), 2018 (n = 4), 2022 (n = 4), 2010 (n = 3), 2013 (n = 3), 2020 (n = 2), and 2011 (n = 1). This diversity of studies highlights the variety of methodological approaches and the representation of different contexts and periods in Latin America concerning barriers to accessing ophthalmology services. Barriers to access to ophthalmology services From the analysis of the articles included, it was possible to group the barriers identified into seven major categories: structural, geographic, economic, sociocultural, technological, health system, and other barriers. This classification makes it possible to understand the complexity and multidimensionality of access, as well as the particularities that affect different population groups and regional contexts. The main barriers identified in different Latin American countries are summarized in Table 2 . Table 2 Main barriers to and strategies for improving access to eye care in Latin America. Barrier category Countries involved Strategies used Structural Argentina, Bolivia, Brazil, Colombia, Costa Rica, Chile, Dominican Republic, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, Uruguay, and Venezuela. Training and redeployment of specialists, investment in infrastructure, integration of services, implementation of telemedicine, provision of modern equipment, and strengthening of primary care centers ( 6 , 27 , 38 , 44 , 67 ) . Geographic Brazil, Colombia, Peru, Paraguay, Honduras, Ecuador, Mexico, and Venezuela. Mobile ophthalmology units, tele-ophthalmology for remote diagnosis and follow-up, periodic rural campaigns, subsidized transport for patients, decentralization of services, and training of community agents ( 14 , 27 , 32 , 33 , 44 , 67 ) . Economic Brazil, Bolivia, Chile, Peru, Colombia, Cuba, Costa Rica, Ecuador, Paraguay, El Salvador, Mexico, Guatemala, Nicaragua, Dominican Republic, Argentina, Honduras, Panama, Uruguay, and Venezuela. Mobile brigades and free or subsidized cataract surgery campaigns, free eyeglasses, expansion of public insurance coverage, reduction of direct payments, alliances with NGOs to cover costs of supplies and transportation, subsidies for eyeglasses and surgeries ( 14 , 31 , 37 , 41 , 46 , 50 , 51 , 56 ) . Sociocultural Brazil, Colombia, Chile, Cuba, Dominican Republic, Ecuador, Guatemala, Peru, Argentina, Mexico, Paraguay, and Venezuela. Eye health education through mass campaigns and workshops in indigenous languages, involvement of community leaders and teachers, school awareness programs, training of health promoters, campaigns to reduce fear of surgery and myths about eye diseases ( 15 , 18 , 22 , 31 , 54 ) . Technological Brazil, Paraguay, Mexico, Colombia, Venezuela, Ecuador, Peru, and Ecuador. Implementation of telemedicine and mobile applications for screening and follow-up, provision of portable diagnostic equipment in rural centers, public‒private partnerships for technology acquisition, training in the use of digital tools, development of information systems for monitoring results ( 32 , 36 , 68 , 71 ) . Health system Brazil, Mexico, Chile, and Peru Intermunicipal consortia to share resources, improve referral and counter referral systems, simplify administrative procedures, integrate levels of care, standardize protocols for referral and follow-up, strengthen local management, and use performance indicators ( 23 , 35 , 31 , 38 , 63 ) . Other barriers Several countries Improving data collection, inclusive policies, equity training, addressing discrimination and administrative barriers, developing specific campaigns for vulnerable groups, and strengthening local research ( 2 , 27 , 32 , 38 ) . Summary of the main barriers identified and the strategies implemented or proposed to enhance eye care access across Latin American countries. Structural barriers include the insufficiency and fragmentation of vision rehabilitation services, the shortage of trained professionals, the concentration of services in large cities, the lack of adequate infrastructure, the absence of eye health promotion and prevention initiatives and low integration with primary care ( 1 , 2 , 6 , 16 , 27 , 32 , 40 , 44 , 61 , 62 ) . Geographic barriers are manifested mainly in the distance to specialized centers, lack of adequate transportation, and territorial inequality in the distribution of human resources and ophthalmologic services, especially affecting rural and remote populations, where the concentration of ophthalmologists and equipment in urban areas limits access in underdeveloped regions ( 6 , 17 , 18 , 20 , 21 , 22 , 27 , 29 , 32 , 33 , 34 , 36 , 37 , 41 , 42 , 44 , 50 , 63 , 65 , 66 , 67 , 69 , 73 , 74 , 75 ) . With respect to economic barriers, the cost of consultations, surgeries, medications, optical aids and transportation is one of the main limitations for the population, especially for those who lack insurance or state coverage, in addition to indirect economic barriers such as loss of wages due to absenteeism from work and the costs associated with the continuity of treatment ( 1 , 2 , 12 , 14 , 15 , 16 , 18 , 21 , 24 , 25 , 26 , 29 , 31 , 33 , 35 , 37 , 39 , 41 , 42 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 56 , 57 , 63 , 67 , 68 , 69 , 73 , 74 ) . Sociocultural barriers include a lack of perceived need, a lack of knowledge of diseases or treatments, a fear of surgery or poor outcomes, social stigma, cultural and religious beliefs, and low eye health literacy, making it difficult to demand and adhere to treatments. In addition, women, face additional obstacles related to gender roles, language and autonomy in decision making ( 11 , 12 , 14 , 15 , 16 , 18 , 19 , 22 , 23 , 24 , 25 , 27 , 28 , 32 , 34 , 38 , 42 ,, 52 , 54 , 60 , 66 , 67 , 69 , 73 ) . Technological barriers are related to the limited availability of advanced diagnostic and therapeutic equipment, unequal access to telemedicine technologies, incomplete digitization of records, and the need for technical training in their use, especially in rural areas and public hospitals ( 1 , 2 , 16 , 27 , 32 , 33 , 34 , 38 , 39 , 42 , 57 , 60 , 61 , 65 , 66 , 68 , 71 , 72 , 75 ) . Health system barriers include fragmentation and segmentation of systems, poor coordination between levels of care, administrative delays, a lack of effective universal coverage, long waiting lists, and low integration of ophthalmologic services in primary care, as well as the absence of public policies and systematic detection and prevention programs ( 1 , 2 , 18 , 22 , 25 , 26 , 27 , 28 , 29 , 30 , 32 , 35 , 38 , 39 , 40 , 41 , 42 , 49 , 50 , 51 , 57 , 58 , 60 , 61 , 66 , 72 ) . Other barriers were found to be related to advanced age, comorbidities, lack of companions, mobility problems, denial of treatment by the provider and the perception of visual loss as an inevitable part of aging, in addition to the negative impact of the COVID-19 pandemic, which aggravated many of these difficulties by generating postponements of surgeries and reducing consultations and prevention campaigns ( 11 , 12 , 14 , 18 , 19 , 21 , 23 , 24 , 25 , 28 , 29 , 31 , 32 , 42 , 47 , 53 , 54 , 56 , 69 , 73 , 74 ) . These barriers, identified throughout the included studies, demonstrate the complexity and multidimensionality of access to ophthalmology services in Latin America, differentially affecting the most vulnerable groups in the region. Levels of ophthalmologic care involved in access barriers Access to ophthalmology services in Latin America involves a wide variety of levels of care, from primary and community care to specialized and highly complex services. Numerous articles emphasize the fundamental role of primary care as the gateway to the eye health system, including screening services, initial diagnosis, basic optical correction, and referral to higher levels when necessary ( 11 , 12 , 18 , 27 , 32 , 33 , 34 , 38 , 55 , 58 , 59 , 63 , 67 , 71 , 73 , 74 ) . Models such as the Ophthalmology Primary Care Units (UAPO) in Chile and other countries have demonstrated significant resolution capacity, allowing the majority of general consultations to be resolved and referring only complex cases to secondary or tertiary care ( 13 , 14 , 38 ) . Secondary and specialized care is addressed in studies that analyze outpatient consultations; the management of specific pathologies such as cataracts, diabetic retinopathy and retinopathy of prematurity; and the provision of optical and surgical aids ( 15 , 16 , 23 , 24 , 29 , 30 , 31 , 35 , 36 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 60 , 61 , 62 , 64 , 65 , 66 , 68 , 69 , 72 , 75 ) . At this level, integration with primary care and timely referral are key to continuity of care and improved visual outcomes. Tertiary care and high-complexity hospital services focus on the diagnosis and treatment of complex diseases, specialized surgeries, the management of complications, and visual rehabilitation ( 6 , 20 , 21 , 22 , 24 , 25 , 16 , 28 , 35 , 36 , 43 , 45 , 47 , 60 , 61 , 69 , 72 , 75 ) . These services tend to be concentrated in urban areas and large hospitals, which may limit access for rural or marginalized populations. In addition, community and mobile interventions, such as eye health campaigns, rural brigades, school programs, and mobile care units, which bring services closer to vulnerable and hard-to-reach populations, have been identified ( 13 , 15 , 19 , 25 , 27 , 32 , 33 , 34 , 48 , 49 , 52 , 54 , 55 , 63 , 64 , 67 , 73 , 74 ) . On the other hand, some studies address the integration of telemedicine and artificial intelligence in primary and secondary care, facilitating screening, diagnosis, and referral in contexts with a shortage of specialists ( 27 , 36 , 68 , 75 ) . Overall, the evidence shows that an articulated network between the different levels of care, together with mobile and community initiatives, is essential to reduce access gaps and improve eye health in the region. Strategies and interventions to improve access to ophthalmic care Among the main strategies identified are the implementation of specific public policies on visual health, the strengthening of visual rehabilitation services, the timely provision of optical and nonoptical aids, the continuous training of health personnel, and the application of validated instruments to measure vision-related quality of life ( 1 , 2 , 11 , 12 , 27 , 29 , 39 , 46 , 57 , 67 ) . The promotion and prevention of visual health, the improvement of infrastructure and resources in rehabilitation services, the registration and certification of visual impairment to facilitate access to social and health benefits, and the integration of services to reduce fragmentation are highlighted ( 1 , 2 , 27 , 32 , 38 , 40 , 46 , 57 , 63 ) . Multidisciplinary and multicomponent rehabilitation, including the use of electronic and manual optical aids, occupational therapy and psychology interventions, and group device training programs, is an effective intervention, especially when it is locally adapted and validated ( 2 , 13 , 27 , 32 , 38 , 45 ) . The integration of services and the reduction of fragmentation are recommended, as are the adaptation of international models and the promotion of public policies and social awareness ( 2 , 11 , 27 , 32 , 38 , 40 , 46 , 57 , 63 ) . Other strategies include expanding the supply of and access to health services, investing in continuity of care, training professionals in communication skills, providing access to medication care, and implementing eye and foot exams as routine care for populations with diabetes ( 12 , 35 , 32 , 39 , 47 , 69 ) . For the child and school population, visual screening campaigns, school health programs, free eyeglasses, and follow-up by teachers, as well as teacher training for early detection of visual problems, have been implemented ( 13 , 14 , 15 , 32 , 48 , 49 , 54 , 55 , 64 , 73 ) . In these programs, school screening coverage has exceeded 90% in some contexts, and adherence to follow-up has reached values above 80% (13,14,15,32,48,49,54,55,64,73) . Teleophthalmology and the use of digital technologies have been recurrent strategies to expand coverage in rural and remote areas, allowing training of local technicians, transmission of images, remote analysis by specialists, and reduction of unnecessary referrals ( 27 , 33 , 36 , 38 , 43 , 59 , 60 , 63 , 68 , 71 , 75 ) . In successful telemedicine models, the first contact case resolution rate has reached 85%, and the reduction in unnecessary referrals has reached 50% (27,33,36,38,43,59,60,63,68,71,75) . The average turnaround time between detection and surgical treatment in screening and rapid referral programs has been reduced to less than 21 days, and the postoperative follow-up rate exceeds 75% in organized campaigns ( 24 , 25 , 37 , 42 , 51 , 57 , 63 , 67 , 69 ) . In the surgical field, campaigns have been developed for cataract surgery, subsidies or free of charge in countries with universal coverage, improvements in surgical quality and monitoring of results, as well as training in low-cost techniques such as MSICS ( 16 , 24 , 25 , 29 , 37 , 42 , 44 , 47 , 49 , 52 , 53 , 56 , 61 , 62 , 65 , 66 ) . The cataract surgery rate has reached values of up to 77% in Uruguay and 76.8% per eye in Brazilian studies, whereas in El Salvador, it has barely reached 15%, reflecting regional disparities ( 13 , 25 , 37 , 52 ) . The proportion of optimal visual outcomes after cataract surgery varies: in Uruguay, 70% of patients achieve a visual acuity of at least 20/60, whereas in El Salvador, only 56% reach this threshold, and up to 23% show poor results ( 13 , 25 , 37 , 52 ) . Eye health education and public awareness, especially among vulnerable groups, have been cross-cutting components in many programs, achieving increases in consultation and surgery attendance of up to 40% after educational interventions ( 18 , 19 , 21 , 22 , 23 , 25 , 30 , 31 , 34 , 35 , 41 , 45 , 46 , 49 , 51 , 52 , 53 , 60 , 63 , 66 , 70 , 73 ) . Models of decentralized care, the creation of intermunicipal consortia, the integration of eye care into primary care, and the development of performance indicators for local monitoring and management have also been identified ( 27 , 38 , 40 , 42 , 46 , 50 , 57 , 63 , 67 ) . In summary, the performance indicators reported in these studies include case resolution rates between 75% and 85% in primary care and mobile campaigns; postoperative follow-up rates above 75%; and average response times of 14–21 days for surgical interventions and school and community screening coverage exceeding 80% in the most consolidated programs ( 13 , 14 , 15 , 24 , 25 , 32 , 37 , 42 , 48 , 49 , 51 , 54 , 48 , 55 , 63 , 67 , 69 , 73 ) . These strategies, adapted to local contexts and with multisectoral participation, have proven to be fundamental in reducing access gaps and improving visual health in the region. The main strategies implemented to overcome the barriers raised in different Latin American countries are summarized in Table 2 . DISCUSSION Health system inequities and limitations in access to ophthalmologic care Inequities in access to eye care in Latin America are related mainly to the fragmentation of health systems, the concentration of resources in urban areas, and the lack of integration and sustained public policies, aggravated by insufficient financing and segmentation between subsystems, which increases inequality for vulnerable populations ( 1 , 12 , 15 , 24 , 26 , 29 , 32 ,, 37 , 40 , 41 , 44 , 46 , 47 , 48 , 50 , 51 , 53 , 61 , 67 , 73 , 76 ) . A comparison of these findings with the international literature reveals that structural inequities in Latin America replicate patterns identified in other contexts, such as the United States, where the social determinants of health (SDOH) and structural racism have a significant impact on eye health and access to eye care, affecting mainly ethnic minorities, low-income people and rural residents (() ( 77 ) ()) . In both settings, the unequal distribution of ophthalmologists and resources, gaps in insurance coverage, and lack of integration of eye health services into primary care perpetuate inequities in eye health outcomes ( 76 , 77 ) . In Latin America, the segmentation and fragmentation of health systems result in difficulties in referral and counterreferral, administrative delays, long waiting lists, and low continuity of care, which limits the effectiveness of interventions and exacerbates the burden of preventable visual impairment ( 1 , 2 , 18 , 22 , 25 , 26 , 27 , 28 , 29 , 30 , 32 , 35 , 38 , 39 , 40 , 41 , 42 , 49 , 50 , 51 , 57 , 58 , 60 , 61 , 66 , 72 , 76 ) . Unequal access to diagnostic technologies, advanced treatments, and rehabilitation programs reinforces the gap between urban and rural populations, as well as between those with and without sufficient financial coverage ( 1 , 2 , 16 , 27 , 32 , 33 , 34 , 31 , 38 , 42 , 57 , 60 , 61 , 65 , 66 , 68 , 71 , 72 , 75 ) . At the regional level, countries such as Brazil and Mexico show better indicators of coverage and case resolution in urban contexts and the presence of specific national programs, whereas in countries with less public investment and greater fragmentation, such as Honduras, Paraguay or El Salvador, access rates and optimal visual outcomes are considerably lower ( 13 , 25 , 37 , 52 , 53 , 56 , 57 , 63 , 67 , 69 , 73 , 74 ) . ()) . The diversity of strategies documented in Table 2 reflects the heterogeneity of barriers and responses in Latin America, which underscores the need for integrated, flexible, and evidence-based public policies. In summary, structural inequities and limitations of the health system in Latin America constitute a fundamental obstacle to equitable access to eye care, and addressing them requires profound reforms in governance, financing, integration of services, and prioritization of eye health in the public agenda, in line with international recommendations and comparative evidence ( 76 , 77 ) . Benefits and limitations of strategies to improve access to eye care The strategies implemented in Latin America to improve access to ophthalmologic care have shown significant progress, especially in the expansion of surgery campaigns, the strengthening of primary care, and the adoption of models such as teleophthalmology and mobile units ( 14 , 20 , 27 , 33 , 38 , 48 , 60 ) . These actions have made it possible to bring services closer to rural populations, improve coverage, and promote eye health education, in line with the recommendations of the WHO World Vision Report, which emphasizes the need to integrate eye care into health systems and strengthen primary care to achieve effective universal coverage ( 3 ) . However, structural limitations persist that hinder the sustainability and long-term impact of these strategies. The fragmentation of health systems, lack of data integration, unequal distribution of human and technological resources, and scarce systematic evaluation of results continue to be common challenges in the region ( 2 , 6 , 16 , 32 , 40 , 61 , 62 ) . In addition, the international literature indicates that although intervention models in Latin America have made progress, the lack of stable funding, dependence on ad hoc campaigns and the absence of robust monitoring and evaluation mechanisms limit their ability to sustainably transform eye care systems, a problem that is also observed in other regions and that requires structural solutions and long-term policies ( 3 ) . Clinical and social consequences of unequal access to eye care Unequal access to ophthalmologic care in Latin America has a direct and differentiated impact on the prognosis and clinical consequences of various ocular pathologies, modulating both the prevalence of avoidable blindness and the quality of life of those affected. In the case of refractive errors, economic and cultural barriers, together with a lack of access to affordable optical services and school screening campaigns, perpetuate high levels of avoidable visual impairment, affecting academic performance and work productivity ( 3 , 14 , 15 , 32 , 48 , 49 , 54 , 55 , 64 , 73 ) . For cataracts, the main cause of reversible blindness, economic limitations, low surgical coverage in rural areas, and lack of integration of surgery in primary care results in late diagnosis and progression to blindness, despite the existence of cost-effective interventions ( 3 , 16 , 24 , 15 , 29 , 37 , 42 , 44 , 47 , 51 , 52 , 53 , 56 , 61 , 62 , 65 , 66 ) . In pathologies such as glaucoma and diabetic retinopathy, the lack of follow-up, low adherence to treatment, and scarcity of specialists in rural and peripheral areas lead to diagnoses in advanced stages, when therapeutic options are limited and visual damage is irreversible ( 2 , 3 , 13 , 27 , 32 , 38 , 45 , 60 , 63 , 68 , 71 , 72 , 75 ) . These conditions, considered causes of "irreversible blindness" if not detected and treated promptly, show how inequity in access defines the difference between preventable disability and permanent visual loss. Strategies implemented, such as teleophthalmology, mobile campaigns, and the integration of eye care into primary care, have been shown to improve early detection and access to interventions, but their impact remains uneven and depends on overcoming structural barriers and strengthening referral and follow-up systems ( 3 , 20 , 27 , 33 , 36 , 38 , 43 , 59 , 60 , 63 , 68 , 71 , 75 ) . The specific relationships among the main clinical conditions, the predominant barriers, and the consequences of limited access are summarized in Table 3 . Table 3 Relationships between ocular clinical conditions, predominant barriers, and consequences of limited access in the region Clinical condition Predominant barriers Consequences of limited access Refractive errors Economic, cultural, and a lack of access to opticians and school campaigns. Avoidable visual impairment affects school and work performance, reduces quality of life, causes social isolation, increases risk of accidents, and perpetuation the cycle of poverty due to the impossibility of accessing adequate optical correction ( 3 , 14 , 15 , 32 , 48 , 49 , 54 , 55 , 64 , 73 ) . Cataracts Economic, geographic, lack of surgical coverage, integration Untreated reversible blindness leading to loss of autonomy, dependence on third parties, increased risk of falls and fractures, deterioration of mental health, social exclusion, and significant reduction in life expectancy and quality of life. In addition, it increases the burden on the family and the health system due to prolonged care ( 3 , 16 , 24 , 25 , 29 , 37 , 42 , 44 , 47 , 51 , 52 , 53 , 56 , 61 , 62 , 65 , 66 ) . Glaucoma Lack of follow-up, shortage of specialists, poor adherence Late diagnosis resulting in irreversible optic nerve damage, progressive visual field loss, permanent blindness, and functional disability. This limits personal independence and can generate severe emotional impact, in addition to increasing social and healthcare costs due to disability ( 2 , 3 , 13 , 27 , 32 , 38 , 45 , 60 , 63 , 68 , 71 , 72 , 75 ) . Diabetic retinopathy Lack of follow-up, access to screening, and technological resources Avoidable visual loss due to lack of detection and timely treatment, progression to blindness, difficulties in diabetes self-care, increased risk of systemic complications, reduced productivity, and economic burden for the patient and family ( 2 , 3 , 13 , 27 , 32 , 38 , 45 , 60 , 63 , 68 , 71 , 72 , 75 ) . Infectious pathologies and trachoma Social, environmental, lack of sanitation, and education Avoidable blindness with chronic sequelae, stigmatization, reduced productive capacity, intergenerational transmission of the disease, and perpetuation of conditions of poverty and marginalization in rural and indigenous communities ( 3 ) . Table 3. Overview of major eye conditions, their main access barriers, and health outcomes in Latin America. Gaps in the evidence on access to ophthalmologic services in Latin America Despite the growing interest in investigating barriers to access to ophthalmology services in Latin America, important gaps in the evidence persist that limit the generalizability and applicability of the findings. Many studies present methodological limitations, such as the predominance of cross-sectional designs that prevent establishing causality and the lack of long-term follow-up to evaluate the real impact of interventions ( 11 , 12 , 24 , 25 , 26 , 27 , 64 , 70 ) . In addition, there is a notorious scarcity of high-quality research in certain areas, especially in visual rehabilitation and telerehabilitation, as well as considerable variability in the instruments and outcomes used, which makes comparisons between contexts and countries difficult ( 1 , 2 , 16 , 32 , 38 , 39 , 57 , 68 , 75 ) . The lack of systematic data and updated national databases, together with the underreporting of procedures and the limited representation of rural, indigenous, and low-income areas, restricts a comprehensive understanding of inequities in access ( 27 , 28 , 29 , 33 , 38 , 40 , 61 , 62 ) . Similarly, the absence of robust monitoring and quality indicators, the limited evaluation of long-term impact, and the lack of qualitative studies on user experience demonstrate the need to strengthen local and regional research ( 2 , 27 , 32 , 38 , 40 , 50 , 54 , 55 , 57 , 63 , 68 ) . In this context, it is essential to invest in longitudinal studies, impact evaluations, and mixed approaches to better understand the dynamics of access and design more effective and equitable interventions for the region ( 11 , 12 , 16 , 27 , 32 , 38 , 57 , 68 , 75 ) . Public health implications Access barriers identified in the region, such as the fragmentation of health systems, the concentration of services in urban areas, economic limitations, and the lack of integration of ophthalmologic care in primary care, represent priority challenges for the public health agenda in Latin America ( 1 , 2 , 6 , 16 , 27 , 32 , 40 , 44 , 61 , 62 ) . These barriers especially affect rural and indigenous populations and people in vulnerable situations, perpetuating inequity and making it difficult to achieve effective and universal coverage (14,24,33,48,57,78) . The strategies and intervention models implemented, such as teleophthalmology, mobile brigades, school programs, subsidies, and municipal consortia, have shown progress in expanding coverage and reducing immediate barriers ( 14 , 20 , 27 , 33 , 38 , 48 , 60 ) . However, their long-term sustainability, integration, and responsiveness remain limited, especially in contexts of low public investment and fragmented systems ( 2 , 6 , 16 , 32 , 40 , 61 , 62 ) . The results and key findings of these studies show that although improvements have been achieved in the detection and timely treatment of pathologies such as cataracts and refractive errors, the lack of follow-up, the variability in the quality of services, and the scarce impact evaluations limit the scope of these interventions ( 24 , 25 , 37 , 42 , 51 , 57 , 63 , 67 , 69 ) . At the public health level, these limitations translate into the persistence of a high burden of avoidable blindness and visual impairment, which affects the social and economic development of the region. The global goals for 2030, which propose increasing the effective coverage of refractive error correction by 40% and cataract surgery by 30%, underscore the need for integrated, sustainable, and equity-focused public policies (78,79) . To achieve these objectives, strengthening the integration of eye health into national health systems, investing in human and technological resources, and adopting monitoring and evaluation mechanisms that allow strategies to be adjusted according to the real needs of the population are essential (2,6,14,20,24,15,27,32,33,37,38,40,42,48,50,51,54,55,57,60,61,62,63,67,68,69,78,79) . This is why the limitations reported by the authors, such as the lack of systematic data, the scarce representation of vulnerable populations and the absence of longitudinal studies, highlight the need for greater investment in research and in the generation of local evidence to guide decision making and ensure the sustainability of eye health policies in the region ( 2 , 27 , 31 , 38 , 40 , 50 , 54 , 55 , 57 , 63 , 68 ) . CONCLUSION Access to ophthalmology services in Latin America continues to be affected by a multiplicity of structural, geographic, economic, sociocultural, technological, and health system barriers that differentially affect the most vulnerable populations in the region. Although various strategies and intervention models have been implemented, such as teleophthalmology, mobile brigades, educational campaigns, and subsidies, significant challenges persist in terms of sustainability, integration, and equity. The heterogeneity of national and local responses highlights the need for flexible, integrated, and evidence-based public policies aligned with global goals for 2030. Overcoming inequities in visual health requires strengthening primary care, investing in human and technological resources, improving monitoring and evaluation systems, and prioritizing the inclusion of historically marginalized groups. Only in this way will it be possible to advance toward universal and effective coverage in ophthalmologic care in Latin America. Declarations AUTHORS' CONTRIBUTIONS: AMR, JCT, JNA, AOM: Conceptualization, methodology, formal analysis, research, data curation, writing the original draft, reviewing and editing, visualization. EHHR: Methodology, visualization, oversight, project management, and securing funding. Ethical Approval: This study was approved by the Ethics and Research Committee of the Faculty of Medicine, Universidad de La Sabana. Availability of data and materials: Not applicable. Conflicts of interest: The authors declare that they have no conflicts of interest. Funding: This study was funded by the Universidad de La Sabana (Project MED-341-2023). Acknowledgments: Not applicable. References Carlos Jimenez, et al. Assessment of vision-related quality of life in people diagnosed with low vision: a review of the literature. 2019; 14(2):21–38. https://repository.ces.edu.co/server/api/core/bitstreams/e6639db3-dda9-4791-bc57-57dc91de7b03/content Oviedo-Cáceres M. et al. Evidence-based recommendations for the diagnosis, treatment, rehabilitation, and follow-up of people older than 7 years with low vision. Rev. mex. oftalmol. 2022 Oct; 96(5): 191-204. Available at: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2604-12272022000500191&lng=es. World Health Organization. (2020). World Vision Report. World Health Organization. https://iris.who.int/handle/10665/331423 Tetelboin, C et al. 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Rincón","email":"data:image/png;base64,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","orcid":"","institution":"Universidad de la Sabana","correspondingAuthor":true,"prefix":"","firstName":"Erwin","middleName":"Hernández","lastName":"Rincón","suffix":""},{"id":514747927,"identity":"b28a0a4b-1f0d-4257-923e-149413dc8989","order_by":1,"name":"Juan Tobo Hernandez","email":"","orcid":"https://orcid.org/0000-0002-2767-6954","institution":"Universidad de la 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1","display":"","copyAsset":false,"role":"figure","size":389560,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrism flow chart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.png","url":"https://assets-eu.researchsquare.com/files/rs-7436148/v1/ad1a17d8526107a1dbcef205.png"},{"id":91728080,"identity":"7a388af3-9097-4779-b13e-5e1d89a0db65","added_by":"auto","created_at":"2025-09-19 15:25:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":100854,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGeographical distribution of the studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBrazil is the country with the greatest number of included studies (n= 35), followed by Argentina (n= 21), Colombia (n= 17), Peru (n= 15), Mexico (n= 15), Chile (n= 14), Venezuela (n= 14), Ecuador (n= 14), Cuba (n= 13), Paraguay (n= 13), Uruguay (n= 13), Guatemala (n= 12), the Dominican Republic (n= 12), Costa Rica (n= 11), El Salvador (= 11), Honduras (= 11), Panama (n= 11), Bolivia (n= 10), and Nicaragua (n= 9).\u003c/p\u003e","description":"","filename":"Picture2.png","url":"https://assets-eu.researchsquare.com/files/rs-7436148/v1/548666ca51d72d3ab9e4e5f0.png"},{"id":91730659,"identity":"619f1546-9f9f-479c-9555-93fd5033f08c","added_by":"auto","created_at":"2025-09-19 15:57:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2148884,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7436148/v1/be2f5647-4ee0-4d1c-b46a-bb56ab63294f.pdf"}],"financialInterests":"There is no conflict of interest","formattedTitle":"Barriers to access to ophthalmology services in Latin America: A scoping review","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eVisual impairment constitutes a global public health priority because of its high prevalence and profound impact on quality of life, biopsychosocial well-being, and health systems \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. The main causes of this condition are uncorrected refractive defects, cataracts, glaucoma, diabetic retinopathy, and corneal opacities, most of which are preventable or treatable pathologies if detected early \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e. Therefore, it is essential to guarantee timely, continuous, and equitable access to ophthalmological services to make the right to visual health effective \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eLatin America was ranked in 2019 as the region with the greatest inequality, facing social, economic, and environmental gaps that limit access to health care. In ophthalmology, multiple structural, economic, geographic, cultural, and health system barriers especially affect vulnerable populations, perpetuating inequities and hindering the timely detection and management of preventable visual diseases \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAmong preventable visual diseases, diabetic retinopathy (DR) stands out as one of the main causes of visual impairment, especially in contexts with limited medical coverage. Early detection of this pathology is particularly complex in regions where the previously mentioned structural, economic, and technological barriers persist, hindering access to specialized services \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e. One example of a possible strategy that has emerged to address these challenges has been telemedicine as a promising alternative for screening, diagnosis, and follow-up of eye diseases, as it facilitates the expansion of access to eye care through remote platforms and integrated care models \u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWhile teleophthalmology programs have been shown to reduce inequalities, they face organizational, technological, and human challenges that compromise their sustainability. These include a lack of investment, poor staff training, a lack of clinical standards, and gaps in digital infrastructure \u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e. In addition, the subjective perceptions of users, their confidence in remote care, and the quality of the patient‒physician link are also important.\u003c/p\u003e\u003cp\u003eHowever, beyond technological and organizational limitations, profound structural inequities persist. Historically marginalized communities such as indigenous peoples, Afro-descendant populations, and low-income people face a disproportionate burden of visual disease, compounded by their underrepresentation in research and inclusive health policies \u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFurthermore, access to vision rehabilitation services represents a critical need that continues to be neglected. Globally, less than 10% of people with low vision have access to functional interventions, and in Latin America, the situation is even more limited \u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eTherefore, overcoming barriers to access to eye care in Latin America requires global awareness of the magnitude of the problem and the implementation of innovative strategies supported by technology and equitable patient-centered policies. Only through coordinated and sustained actions will it be possible to move toward more accessible and equitable eye care for the entire population of the region.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eA scoping review was conducted in June 2025 following the methodology of the Joanna Briggs Institute (JBI) \u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e and the PRISMA-ScR \u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e guidelines. This approach allowed a rigorous mapping of the scientific literature on the subject. The review was guided by the following research question: What are the barriers affecting access to ophthalmology services in the Latin American population?\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSearch strategy:\u003c/h2\u003e\u003cp\u003eThe search was conducted in four scientific databases, PubMed, Scopus, SciELO, and Web of Science, following the previously established inclusion and exclusion criteria. In addition, gray literature, including international technical reports, institutional bulletins, documents from academic repositories, and nonindexed institutional journals, was considered. The search terms were designed using MeSH-DeCS descriptors and related keywords.\u003c/p\u003e\u003cp\u003eThe specific search strategies for each database, as well as the inclusion and exclusion criteria applied, are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. These strategies were adapted to the particularities of each database to ensure broad and accurate coverage of the relevant literature.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSearch strategies and article selection criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCRITERIA USED IN THE SEARCH STRATEGIES\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInclusio\u003c/b\u003en\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eExclusio\u003c/b\u003en\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArticles in English, Spanish, or Portuguese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEditorials, letters to the editor, opinions without empirical support, and case reports.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublications between January 2010 and June 2025.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudies published outside the established time range\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudies conducted in Latin American countries or directly comparing Latin American contexts.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudies conducted outside Latin America\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScientific articles, systematic or scoping reviews, qualitative, quantitative or mixed studies, and technical reports, narrative reviews.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExclusively clinical or technological studies that do not address barriers to access to ophthalmologic care.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudies that analyze geographic, economic, sociocultural, organizational, structural, technological, or health system barriers to accessing ophthalmology services.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublications focusing only on clinical or surgical interventions, unrelated to access to care\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDATABASES AND SEARCH STRATEGIES\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDatabas\u003c/b\u003ee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSearch\u003c/b\u003e strategy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePubMed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. ((\"Eye Care Services\"[MeSH] OR \"Ophthalmology\"[MeSH] OR ophthalmology[tiab] OR \"eye health\"[tiab]) AND (\"Health Services Accessibility\"[MeSH] OR access[tiab] OR barriers[tiab] OR inequity[tiab] OR inequality[tiab] OR obstacles[tiab]) AND (\"Latin America\"[MeSH] OR \"South America\"[MeSH] OR \"Central America\"[MeSH] OR \"Caribbean Region\"[MeSH] OR \"Mexico\"[MeSH] OR \"Brazil\"[MeSH] OR \"Argentina\"[MeSH] OR \"Colombia\"[MeSH] OR \"Peru\"[MeSH] OR \"Chile\"[MeSH] OR \"Venezuela\"[MeSH] OR \"Latin America\"[tiab] OR \"South America\"[tiab] OR \"Central America\"[tiab] OR \"Caribbean\"[tiab])) AND (\"2010/01/01\"[Date - Publication] : \"2025/12/31\"[Date - Publication])\u003c/p\u003e\u003cp\u003e2. ((((ophthalmology) OR (ophthalmology services)) OR (visual care)) AND (barriers to care)) AND (health disparities)\u003c/p\u003e\u003cp\u003e3. (ophthalmology [MeSH Terms] OR \"eye care\" [tiab] OR \"vision care\" [tiab]) AND (\"barriers to care\" [tiab] OR \"access to care\" [tiab] OR \"Health Services Accessibility\" [MeSH Terms]) AND (\"health disparities\"[tiab] OR \"Healthcare Disparities\"[MeSH Terms])\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eScopus\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Ophthalmology AND Access AND Disparities AND \"Latin America\" AND Determinants\u003c/p\u003e\u003cp\u003e2. (TITLE-ABS-KEY (ophthalmology) OR TITLE-ABS-KEY (\"eye care\") OR TITLE-ABS-KEY (\"vision care\") OR TITLE-ABS-KEY (cataract) OR TITLE-ABS-KEY (glaucoma) OR TITLE-ABS-KEY (\"diabetic retinopathy\") OR TITLE-ABS-KEY (\"age-related macular degeneration\") OR TITLE-ABS-KEY (\"age-related macular degeneration\") OR TITLE-ABS-KEY (\"refractive errors\") OR TITLE-ABS-KEY (\"retinal diseases\") OR TITLE-ABS-KEY (uveitis)) AND (TITLE-ABS-KEY (\"barriers to care\") OR TITLE-ABS-KEY (\"health services accessibility\") OR TITLE-ABS-KEY (\"access to health services\") OR TITLE-ABS-KEY (\"health disparities\")) AND (TITLE-ABS-KEY (\"Latin America\") OR TITLE-ABS-KEY (\"South America\") OR TITLE-ABS-KEY (\"Central America\") OR TITLE-ABS-KEY (Caribbean) OR TITLE-ABS-KEY (Argentina) OR TITLE-ABS-KEY (Bolivia) OR TITLE-ABS-KEY (Brazil) OR TITLE-ABS-KEY (Chile) OR TITLE-ABS-KEY (Colombia) OR TITLE-ABS-KEY (Ecuador) OR TITLE-ABS-KEY (Mexico)))\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSCIELO\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(telemedicine OR \"eye health\" OR ophthalmology OR cataracts OR glaucoma OR retina OR vision) AND (\"access to health\" OR barriers OR inequalities OR inequities OR inequities) AND (\"Latin America\" OR \"South America\" OR \"South America\" OR \"Central America\" OR Argentina OR Brazil OR Colombia OR Peru OR Mexico OR Chile)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeb of Science\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGuatemala OR Honduras OR Nicaragua OR Panama OR Cuba OR Cuba OR Haiti OR Dominican Republic\")\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eSummary of inclusion and exclusion criteria and database-specific search strategies used to identify relevant literature on barriers to accessing eye care in Latin America.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe choice of databases used in this review was based on their relevance to answer the research question of barriers to accessing ophthalmology services in Latin America. PubMed was included for its focus on biomedical research and coverage of peer-reviewed scientific literature in health sciences; Scopus, for its interdisciplinary nature and broad scope in terms of citations and abstracts; SciELO, for its access to scientific literature published in Latin America and its usefulness in identifying regional evidence; and Web of Science, for its rigor in indexing high-impact journals and its ability to retrieve relevant studies published in international scientific journals with coverage of public health, inequalities and ophthalmology services. The selection and flow of the articles included are presented in \u003cb\u003eFig.\u0026nbsp;1.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy selection\u003c/h3\u003e\n\u003cp\u003eAll the citations were managed on the Rayyan platform. The identified articles were consolidated in a database, eliminating duplicates manually. Subsequently, four reviewers independently reviewed titles and abstracts according to the inclusion and exclusion criteria, resolving discrepancies by consensus. Finally, four reviewers reviewed the full texts to confirm the final eligibility of the studies.\u003c/p\u003e\n\u003ch3\u003eData extraction\u003c/h3\u003e\n\u003cp\u003eData extraction was carried out via a table previously designed by the research team. This table included the following elements: country or place, dates of development, type of study, objective, number of population included or number of articles (in the case of reviews), type and characteristics of the population studied, and the method employed. The level of care or type of service addressed in each study was also recorded, specifying which of these were addressed and how. In addition, the barriers to access to ophthalmologic services identified in each study were documented, and their approach and content were described.\u003c/p\u003e\u003cp\u003eStrategies, models, or interventions aimed at improving access were also compiled. Accordingly, key results and findings, such as coverage achieved, improvements in care or referral times, changes in the perception or use of services, persistent barriers, and, where applicable, clinical outcomes, were recorded. Limitations noted by the authors or identified by the evaluation team were also documented. The collection was performed independently by four reviewers, and any discrepancies were resolved by consensus.\u003c/p\u003e\n\u003ch3\u003eData analysis and synthesis:\u003c/h3\u003e\n\u003cp\u003eThe extracted data were analyzed via narrative and descriptive synthesis, organizing the information according to the frequency and distribution of barriers to access identified in different countries or regions, the population groups affected, and the levels of care involved. The barriers were classified into structural, geographic, economic, sociocultural, technological, health system, and other categories, presenting concrete examples reported in the articles reviewed. In addition, the main strategies and intervention models proposed to improve access were compiled, as were evidence gaps and priority areas for future research, integrating both qualitative and quantitative studies to provide a broad view of the regional landscape.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 898 records were identified in the initial search. Among these, 191 (21.3%) were eliminated as duplicates. A total of 707 records (78.7%) were reviewed, of which 587 (83%) were excluded after review of titles and abstracts because they did not meet the inclusion criteria. A total of 120 reports (17%) were selected for retrieval, of which 7 (5.8%) could not be obtained. Then, 113 full-text reports were evaluated for eligibility, with 45 (39.8%) excluded: 4 (3.5%) for not being related to ophthalmology, 29 (25.7%) for being conducted in non-Latin countries, 3 (2.6%) for not addressing access barriers and 9 (8%) for publication date. In total, 68 studies (7.6% of the initial total) were included in the review.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eCharacteristics of the articles reviewed:\u003c/h2\u003e\u003cp\u003eSixty-eight articles were included, covering a population ranging from preterm infants to older adults, as well as special populations such as people with visual impairment and indigenous communities. Among these studies, 34 cross-sectional studies, 3 descriptive studies, 6 prospective studies, 6 systematic reviews, 7 retrospective studies, 3 qualitative case studies, 3 cohort studies, 2 meta-analyses, and 4 policy or historical analysis studies were identified. Community intervention studies, population-based survey analyses, and documentary analysis studies, which cover a wide range of methodologies and approaches to accessing ophthalmology services, were also included.\u003c/p\u003e\u003cp\u003eIn terms of geographic distribution, the review exclusively covers Latin America. Brazil is the country with the greatest number of mentions in the included studies (n\u0026thinsp;=\u0026thinsp;35), followed by Argentina (n\u0026thinsp;=\u0026thinsp;21), Colombia (n\u0026thinsp;=\u0026thinsp;17), Peru (n\u0026thinsp;=\u0026thinsp;15), Mexico (n\u0026thinsp;=\u0026thinsp;15), Chile (n\u0026thinsp;=\u0026thinsp;14), Venezuela (n\u0026thinsp;=\u0026thinsp;14), Ecuador (n\u0026thinsp;=\u0026thinsp;14), Cuba (n\u0026thinsp;=\u0026thinsp;13), Paraguay (n\u0026thinsp;=\u0026thinsp;13), Uruguay (n\u0026thinsp;=\u0026thinsp;13), Guatemala (n\u0026thinsp;=\u0026thinsp;12), the Dominican Republic (n\u0026thinsp;=\u0026thinsp;12), Costa Rica (n\u0026thinsp;=\u0026thinsp;11), El Salvador (n\u0026thinsp;=\u0026thinsp;11), Honduras (n\u0026thinsp;=\u0026thinsp;11), Panama (n\u0026thinsp;=\u0026thinsp;11), Bolivia (n\u0026thinsp;=\u0026thinsp;10), and Nicaragua (n\u0026thinsp;=\u0026thinsp;9). In addition, regional and multinational studies covering multiple countries in Latin America were identified. The geographic distribution of the included studies is shown in \u003cb\u003eFig.\u0026nbsp;2.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRegarding years of publication, the studies are distributed as follows: 2014 (n\u0026thinsp;=\u0026thinsp;9), 2015 (n\u0026thinsp;=\u0026thinsp;8), 2021 (n\u0026thinsp;=\u0026thinsp;8), 2023 (n\u0026thinsp;=\u0026thinsp;7), 2024 (n\u0026thinsp;=\u0026thinsp;6), 2019 (n\u0026thinsp;=\u0026thinsp;5), 2016 (n\u0026thinsp;=\u0026thinsp;4), 2017 (n\u0026thinsp;=\u0026thinsp;4), 2018 (n\u0026thinsp;=\u0026thinsp;4), 2022 (n\u0026thinsp;=\u0026thinsp;4), 2010 (n\u0026thinsp;=\u0026thinsp;3), 2013 (n\u0026thinsp;=\u0026thinsp;3), 2020 (n\u0026thinsp;=\u0026thinsp;2), and 2011 (n\u0026thinsp;=\u0026thinsp;1). This diversity of studies highlights the variety of methodological approaches and the representation of different contexts and periods in Latin America concerning barriers to accessing ophthalmology services.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eBarriers to access to ophthalmology services\u003c/h3\u003e\n\u003cp\u003eFrom the analysis of the articles included, it was possible to group the barriers identified into seven major categories: structural, geographic, economic, sociocultural, technological, health system, and other barriers. This classification makes it possible to understand the complexity and multidimensionality of access, as well as the particularities that affect different population groups and regional contexts. The main barriers identified in different Latin American countries are summarized \u003cb\u003ein\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMain barriers to and strategies for improving access to eye care in Latin America.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarrier category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCountries involved\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrategies used\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStructural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArgentina, Bolivia, Brazil, Colombia, Costa Rica, Chile, Dominican Republic, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, Uruguay, and Venezuela.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTraining and redeployment of specialists, investment in infrastructure, integration of services, implementation of telemedicine, provision of modern equipment, and strengthening of primary care centers \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeographic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrazil, Colombia, Peru, Paraguay, Honduras, Ecuador, Mexico, and Venezuela.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMobile ophthalmology units, tele-ophthalmology for remote diagnosis and follow-up, periodic rural campaigns, subsidized transport for patients, decentralization of services, and training of community agents \u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrazil, Bolivia, Chile, Peru, Colombia, Cuba, Costa Rica, Ecuador, Paraguay, El Salvador, Mexico, Guatemala, Nicaragua, Dominican Republic, Argentina, Honduras, Panama, Uruguay, and Venezuela.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMobile brigades and free or subsidized cataract surgery campaigns, free eyeglasses, expansion of public insurance coverage, reduction of direct payments, alliances with NGOs to cover costs of supplies and transportation, subsidies for eyeglasses and surgeries \u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSociocultural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrazil, Colombia, Chile, Cuba, Dominican Republic, Ecuador, Guatemala, Peru, Argentina, Mexico, Paraguay, and Venezuela.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEye health education through mass campaigns and workshops in indigenous languages, involvement of community leaders and teachers, school awareness programs, training of health promoters, campaigns to reduce fear of surgery and myths about eye diseases \u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTechnological\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrazil, Paraguay, Mexico, Colombia, Venezuela, Ecuador, Peru, and Ecuador.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImplementation of telemedicine and mobile applications for screening and follow-up, provision of portable diagnostic equipment in rural centers, public‒private partnerships for technology acquisition, training in the use of digital tools, development of information systems for monitoring results \u003csup\u003e(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth system\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrazil, Mexico, Chile, and Peru\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntermunicipal consortia to share resources, improve referral and counter referral systems, simplify administrative procedures, integrate levels of care, standardize protocols for referral and follow-up, strengthen local management, and use performance indicators \u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSeveral countries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImproving data collection, inclusive policies, equity training, addressing discrimination and administrative barriers, developing specific campaigns for vulnerable groups, and strengthening local research \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eSummary of the main barriers identified and the strategies implemented or proposed to enhance eye care access across Latin American countries.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eStructural barriers include the insufficiency and fragmentation of vision rehabilitation services, the shortage of trained professionals, the concentration of services in large cities, the lack of adequate infrastructure, the absence of eye health promotion and prevention initiatives and low integration with primary care \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/sup\u003e. Geographic barriers are manifested mainly in the distance to specialized centers, lack of adequate transportation, and territorial inequality in the distribution of human resources and ophthalmologic services, especially affecting rural and remote populations, where the concentration of ophthalmologists and equipment in urban areas limits access in underdeveloped regions \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWith respect to economic barriers, the cost of consultations, surgeries, medications, optical aids and transportation is one of the main limitations for the population, especially for those who lack insurance or state coverage, in addition to indirect economic barriers such as loss of wages due to absenteeism from work and the costs associated with the continuity of treatment \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e)\u003c/sup\u003e. Sociocultural barriers include a lack of perceived need, a lack of knowledge of diseases or treatments, a fear of surgery or poor outcomes, social stigma, cultural and religious beliefs, and low eye health literacy, making it difficult to demand and adhere to treatments. In addition, women, face additional obstacles related to gender roles, language and autonomy in decision making \u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eTechnological barriers are related to the limited availability of advanced diagnostic and therapeutic equipment, unequal access to telemedicine technologies, incomplete digitization of records, and the need for technical training in their use, especially in rural areas and public hospitals \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e. Health system barriers include fragmentation and segmentation of systems, poor coordination between levels of care, administrative delays, a lack of effective universal coverage, long waiting lists, and low integration of ophthalmologic services in primary care, as well as the absence of public policies and systematic detection and prevention programs \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOther barriers were found to be related to advanced age, comorbidities, lack of companions, mobility problems, denial of treatment by the provider and the perception of visual loss as an inevitable part of aging, in addition to the negative impact of the COVID-19 pandemic, which aggravated many of these difficulties by generating postponements of surgeries and reducing consultations and prevention campaigns \u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e)\u003c/sup\u003e. These barriers, identified throughout the included studies, demonstrate the complexity and multidimensionality of access to ophthalmology services in Latin America, differentially affecting the most vulnerable groups in the region.\u003c/p\u003e\n\u003ch3\u003eLevels of ophthalmologic care involved in access barriers\u003c/h3\u003e\n\u003cp\u003eAccess to ophthalmology services in Latin America involves a wide variety of levels of care, from primary and community care to specialized and highly complex services. Numerous articles emphasize the fundamental role of primary care as the gateway to the eye health system, including screening services, initial diagnosis, basic optical correction, and referral to higher levels when necessary \u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e)\u003c/sup\u003e. Models such as the Ophthalmology Primary Care Units (UAPO) in Chile and other countries have demonstrated significant resolution capacity, allowing the majority of general consultations to be resolved and referring only complex cases to secondary or tertiary care \u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSecondary and specialized care is addressed in studies that analyze outpatient consultations; the management of specific pathologies such as cataracts, diabetic retinopathy and retinopathy of prematurity; and the provision of optical and surgical aids \u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e. At this level, integration with primary care and timely referral are key to continuity of care and improved visual outcomes.\u003c/p\u003e\u003cp\u003eTertiary care and high-complexity hospital services focus on the diagnosis and treatment of complex diseases, specialized surgeries, the management of complications, and visual rehabilitation \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e. These services tend to be concentrated in urban areas and large hospitals, which may limit access for rural or marginalized populations.\u003c/p\u003e\u003cp\u003eIn addition, community and mobile interventions, such as eye health campaigns, rural brigades, school programs, and mobile care units, which bring services closer to vulnerable and hard-to-reach populations, have been identified \u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOn the other hand, some studies address the integration of telemedicine and artificial intelligence in primary and secondary care, facilitating screening, diagnosis, and referral in contexts with a shortage of specialists \u003csup\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e. Overall, the evidence shows that an articulated network between the different levels of care, together with mobile and community initiatives, is essential to reduce access gaps and improve eye health in the region.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStrategies and interventions to improve access to ophthalmic care\u003c/h2\u003e\u003cp\u003eAmong the main strategies identified are the implementation of specific public policies on visual health, the strengthening of visual rehabilitation services, the timely provision of optical and nonoptical aids, the continuous training of health personnel, and the application of validated instruments to measure vision-related quality of life \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e. The promotion and prevention of visual health, the improvement of infrastructure and resources in rehabilitation services, the registration and certification of visual impairment to facilitate access to social and health benefits, and the integration of services to reduce fragmentation are highlighted \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMultidisciplinary and multicomponent rehabilitation, including the use of electronic and manual optical aids, occupational therapy and psychology interventions, and group device training programs, is an effective intervention, especially when it is locally adapted and validated \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/sup\u003e. The integration of services and the reduction of fragmentation are recommended, as are the adaptation of international models and the promotion of public policies and social awareness \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOther strategies include expanding the supply of and access to health services, investing in continuity of care, training professionals in communication skills, providing access to medication care, and implementing eye and foot exams as routine care for populations with diabetes \u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e)\u003c/sup\u003e. For the child and school population, visual screening campaigns, school health programs, free eyeglasses, and follow-up by teachers, as well as teacher training for early detection of visual problems, have been implemented \u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/sup\u003e. In these programs, school screening coverage has exceeded 90% in some contexts, and adherence to follow-up has reached values above 80% \u003csup\u003e(13,14,15,32,48,49,54,55,64,73)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eTeleophthalmology and the use of digital technologies have been recurrent strategies to expand coverage in rural and remote areas, allowing training of local technicians, transmission of images, remote analysis by specialists, and reduction of unnecessary referrals \u003csup\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e. In successful telemedicine models, the first contact case resolution rate has reached 85%, and the reduction in unnecessary referrals has reached 50% \u003csup\u003e(27,33,36,38,43,59,60,63,68,71,75)\u003c/sup\u003e. The average turnaround time between detection and surgical treatment in screening and rapid referral programs has been reduced to less than 21 days, and the postoperative follow-up rate exceeds 75% in organized campaigns \u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn the surgical field, campaigns have been developed for cataract surgery, subsidies or free of charge in countries with universal coverage, improvements in surgical quality and monitoring of results, as well as training in low-cost techniques such as MSICS \u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/sup\u003e. The cataract surgery rate has reached values of up to 77% in Uruguay and 76.8% per eye in Brazilian studies, whereas in El Salvador, it has barely reached 15%, reflecting regional disparities \u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e)\u003c/sup\u003e. The proportion of optimal visual outcomes after cataract surgery varies: in Uruguay, 70% of patients achieve a visual acuity of at least 20/60, whereas in El Salvador, only 56% reach this threshold, and up to 23% show poor results \u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eEye health education and public awareness, especially among vulnerable groups, have been cross-cutting components in many programs, achieving increases in consultation and surgery attendance of up to 40% after educational interventions \u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eModels of decentralized care, the creation of intermunicipal consortia, the integration of eye care into primary care, and the development of performance indicators for local monitoring and management have also been identified \u003csup\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e. In summary, the performance indicators reported in these studies include case resolution rates between 75% and 85% in primary care and mobile campaigns; postoperative follow-up rates above 75%; and average response times of 14\u0026ndash;21 days for surgical interventions and school and community screening coverage exceeding 80% in the most consolidated programs \u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/sup\u003e. These strategies, adapted to local contexts and with multisectoral participation, have proven to be fundamental in reducing access gaps and improving visual health in the region. The main strategies implemented to overcome the barriers raised in different Latin American countries are summarized \u003cb\u003ein\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eHealth system inequities and limitations in access to ophthalmologic care\u003c/h2\u003e\u003cp\u003eInequities in access to eye care in Latin America are related mainly to the fragmentation of health systems, the concentration of resources in urban areas, and the lack of integration and sustained public policies, aggravated by insufficient financing and segmentation between subsystems, which increases inequality for vulnerable populations \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eA comparison of these findings with the international literature reveals that structural inequities in Latin America replicate patterns identified in other contexts, such as the United States, where the social determinants of health (SDOH) and structural racism have a significant impact on eye health and access to eye care, affecting mainly ethnic minorities, low-income people and rural residents \u003csup\u003e(() (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e) ())\u003c/sup\u003e. In both settings, the unequal distribution of ophthalmologists and resources, gaps in insurance coverage, and lack of integration of eye health services into primary care perpetuate inequities in eye health outcomes \u003csup\u003e(\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn Latin America, the segmentation and fragmentation of health systems result in difficulties in referral and counterreferral, administrative delays, long waiting lists, and low continuity of care, which limits the effectiveness of interventions and exacerbates the burden of preventable visual impairment \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e)\u003c/sup\u003e. Unequal access to diagnostic technologies, advanced treatments, and rehabilitation programs reinforces the gap between urban and rural populations, as well as between those with and without sufficient financial coverage \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAt the regional level, countries such as Brazil and Mexico show better indicators of coverage and case resolution in urban contexts and the presence of specific national programs, whereas in countries with less public investment and greater fragmentation, such as Honduras, Paraguay or El Salvador, access rates and optimal visual outcomes are considerably lower \u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e)\u003c/sup\u003e. \u003csup\u003e())\u003c/sup\u003e. The diversity of strategies documented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e reflects the heterogeneity of barriers and responses in Latin America, which underscores the need for integrated, flexible, and evidence-based public policies.\u003c/p\u003e\u003cp\u003eIn summary, structural inequities and limitations of the health system in Latin America constitute a fundamental obstacle to equitable access to eye care, and addressing them requires profound reforms in governance, financing, integration of services, and prioritization of eye health in the public agenda, in line with international recommendations and comparative evidence \u003csup\u003e(\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eBenefits and limitations of strategies to improve access to eye care\u003c/h2\u003e\u003cp\u003eThe strategies implemented in Latin America to improve access to ophthalmologic care have shown significant progress, especially in the expansion of surgery campaigns, the strengthening of primary care, and the adoption of models such as teleophthalmology and mobile units \u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e)\u003c/sup\u003e. These actions have made it possible to bring services closer to rural populations, improve coverage, and promote eye health education, in line with the recommendations of the WHO World Vision Report, which emphasizes the need to integrate eye care into health systems and strengthen primary care to achieve effective universal coverage \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, structural limitations persist that hinder the sustainability and long-term impact of these strategies. The fragmentation of health systems, lack of data integration, unequal distribution of human and technological resources, and scarce systematic evaluation of results continue to be common challenges in the region \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/sup\u003e. In addition, the international literature indicates that although intervention models in Latin America have made progress, the lack of stable funding, dependence on ad hoc campaigns and the absence of robust monitoring and evaluation mechanisms limit their ability to sustainably transform eye care systems, a problem that is also observed in other regions and that requires structural solutions and long-term policies \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eClinical and social consequences of unequal access to eye care\u003c/h2\u003e\u003cp\u003eUnequal access to ophthalmologic care in Latin America has a direct and differentiated impact on the prognosis and clinical consequences of various ocular pathologies, modulating both the prevalence of avoidable blindness and the quality of life of those affected. In the case of refractive errors, economic and cultural barriers, together with a lack of access to affordable optical services and school screening campaigns, perpetuate high levels of avoidable visual impairment, affecting academic performance and work productivity \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/sup\u003e. For cataracts, the main cause of reversible blindness, economic limitations, low surgical coverage in rural areas, and lack of integration of surgery in primary care results in late diagnosis and progression to blindness, despite the existence of cost-effective interventions \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn pathologies such as glaucoma and diabetic retinopathy, the lack of follow-up, low adherence to treatment, and scarcity of specialists in rural and peripheral areas lead to diagnoses in advanced stages, when therapeutic options are limited and visual damage is irreversible \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e. These conditions, considered causes of \"irreversible blindness\" if not detected and treated promptly, show how inequity in access defines the difference between preventable disability and permanent visual loss. Strategies implemented, such as teleophthalmology, mobile campaigns, and the integration of eye care into primary care, have been shown to improve early detection and access to interventions, but their impact remains uneven and depends on overcoming structural barriers and strengthening referral and follow-up systems \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e. The specific relationships among the main clinical conditions, the predominant barriers, and the consequences of limited access are summarized \u003cb\u003ein\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationships between ocular clinical conditions, predominant barriers, and consequences of limited access in the region\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical condition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePredominant barriers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConsequences of limited access\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRefractive errors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEconomic, cultural, and a lack of access to opticians and school campaigns.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAvoidable visual impairment affects school and work performance, reduces quality of life, causes social isolation, increases risk of accidents, and perpetuation the cycle of poverty due to the impossibility of accessing adequate optical correction \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCataracts\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEconomic, geographic, lack of surgical coverage, integration\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUntreated reversible blindness leading to loss of autonomy, dependence on third parties, increased risk of falls and fractures, deterioration of mental health, social exclusion, and significant reduction in life expectancy and quality of life. In addition, it increases the burden on the family and the health system due to prolonged care \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlaucoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of follow-up, shortage of specialists, poor adherence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLate diagnosis resulting in irreversible optic nerve damage, progressive visual field loss, permanent blindness, and functional disability. This limits personal independence and can generate severe emotional impact, in addition to increasing social and healthcare costs due to disability \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetic retinopathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of follow-up, access to screening, and technological resources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAvoidable visual loss due to lack of detection and timely treatment, progression to blindness, difficulties in diabetes self-care, increased risk of systemic complications, reduced productivity, and economic burden for the patient and family \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfectious pathologies and trachoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial, environmental, lack of sanitation, and education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAvoidable blindness with chronic sequelae, stigmatization, reduced productive capacity, intergenerational transmission of the disease, and perpetuation of conditions of poverty and marginalization in rural and indigenous communities \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e\u0026nbsp; Overview of major eye conditions, their main access barriers, and health outcomes in Latin America.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eGaps in the evidence on access to ophthalmologic services in Latin America\u003c/h2\u003e\u003cp\u003eDespite the growing interest in investigating barriers to access to ophthalmology services in Latin America, important gaps in the evidence persist that limit the generalizability and applicability of the findings. Many studies present methodological limitations, such as the predominance of cross-sectional designs that prevent establishing causality and the lack of long-term follow-up to evaluate the real impact of interventions \u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/sup\u003e. In addition, there is a notorious scarcity of high-quality research in certain areas, especially in visual rehabilitation and telerehabilitation, as well as considerable variability in the instruments and outcomes used, which makes comparisons between contexts and countries difficult \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe lack of systematic data and updated national databases, together with the underreporting of procedures and the limited representation of rural, indigenous, and low-income areas, restricts a comprehensive understanding of inequities in access \u003csup\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/sup\u003e. Similarly, the absence of robust monitoring and quality indicators, the limited evaluation of long-term impact, and the lack of qualitative studies on user experience demonstrate the need to strengthen local and regional research \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn this context, it is essential to invest in longitudinal studies, impact evaluations, and mixed approaches to better understand the dynamics of access and design more effective and equitable interventions for the region \u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003ePublic health implications\u003c/h2\u003e\u003cp\u003eAccess barriers identified in the region, such as the fragmentation of health systems, the concentration of services in urban areas, economic limitations, and the lack of integration of ophthalmologic care in primary care, represent priority challenges for the public health agenda in Latin America \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/sup\u003e. These barriers especially affect rural and indigenous populations and people in vulnerable situations, perpetuating inequity and making it difficult to achieve effective and universal coverage \u003csup\u003e(14,24,33,48,57,78)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe strategies and intervention models implemented, such as teleophthalmology, mobile brigades, school programs, subsidies, and municipal consortia, have shown progress in expanding coverage and reducing immediate barriers \u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e)\u003c/sup\u003e. However, their long-term sustainability, integration, and responsiveness remain limited, especially in contexts of low public investment and fragmented systems \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/sup\u003e. The results and key findings of these studies show that although improvements have been achieved in the detection and timely treatment of pathologies such as cataracts and refractive errors, the lack of follow-up, the variability in the quality of services, and the scarce impact evaluations limit the scope of these interventions \u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAt the public health level, these limitations translate into the persistence of a high burden of avoidable blindness and visual impairment, which affects the social and economic development of the region. The global goals for 2030, which propose increasing the effective coverage of refractive error correction by 40% and cataract surgery by 30%, underscore the need for integrated, sustainable, and equity-focused public policies \u003csup\u003e(78,79)\u003c/sup\u003e. To achieve these objectives, strengthening the integration of eye health into national health systems, investing in human and technological resources, and adopting monitoring and evaluation mechanisms that allow strategies to be adjusted according to the real needs of the population are essential \u003csup\u003e(2,6,14,20,24,15,27,32,33,37,38,40,42,48,50,51,54,55,57,60,61,62,63,67,68,69,78,79)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis is why the limitations reported by the authors, such as the lack of systematic data, the scarce representation of vulnerable populations and the absence of longitudinal studies, highlight the need for greater investment in research and in the generation of local evidence to guide decision making and ensure the sustainability of eye health policies in the region \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eAccess to ophthalmology services in Latin America continues to be affected by a multiplicity of structural, geographic, economic, sociocultural, technological, and health system barriers that differentially affect the most vulnerable populations in the region. Although various strategies and intervention models have been implemented, such as teleophthalmology, mobile brigades, educational campaigns, and subsidies, significant challenges persist in terms of sustainability, integration, and equity.\u003c/p\u003e\u003cp\u003eThe heterogeneity of national and local responses highlights the need for flexible, integrated, and evidence-based public policies aligned with global goals for 2030. Overcoming inequities in visual health requires strengthening primary care, investing in human and technological resources, improving monitoring and evaluation systems, and prioritizing the inclusion of historically marginalized groups. Only in this way will it be possible to advance toward universal and effective coverage in ophthalmologic care in Latin America.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHORS\u0026apos; CONTRIBUTIONS:\u003c/strong\u003e\u003cbr\u003eAMR, JCT, JNA, AOM: Conceptualization, methodology, formal analysis, research, data curation, writing the original draft, reviewing and editing, visualization. EHHR: Methodology, visualization, oversight, project management, and securing funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e\u003cbr\u003eThis study was approved by the Ethics and Research Committee of the Faculty of Medicine, Universidad de La Sabana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003cbr\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e\u003cbr\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cbr\u003eThis study was funded by the Universidad de La Sabana (Project MED-341-2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003cbr\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCarlos Jimenez, et al. 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Rev Panam Salud Publica. 2014;36(5):300. https://pubmed.ncbi.nlm.nih.gov/25604099/\u003c/li\u003e\n\u003cli\u003eBarria F, et al. Prevalence of refractive error and spectacle coverage in schoolchildren in two urban areas of Chile. Rev Panam Salud Publica. 2018;42:e61. http://dx.doi.org/10.26633/RPSP.2018.61\u003c/li\u003e\n\u003cli\u003eFernandes LA, et al. An\u0026aacute;lise da a\u0026ccedil;\u0026atilde;o de sa\u0026uacute;de ocular do Programa Sa\u0026uacute;de na Escola no Brasil de 2014 a 2019: um estudo transversal. 2021. http://dx.doi.org/10.1590/s1679-49742021000200008\u003c/li\u003e\n\u003cli\u003eBarrenechea R, et al. National survey of blindness and avoidable visual impairment in Argentina, 2013. Rev Panam Salud Publica. 2015;37(1):7-12.\u003c/li\u003e\n\u003cli\u003eLeasher JL, et al. Prevalence and causes of vision loss in Latin America and the Caribbean in 2015: magnitude, temporal trends and projections. 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BMC Ophthalmol 24, 452 (2024). https://doi.org/10.1186/s12886-024-03710-4\u003c/li\u003e\n\u003cli\u003eLomuto CC, Galina L, Brussa M, Quiroga A, Alda E, Ben\u0026iacute;tez AM, et al. Laser treatment for retinopathy of prematurity in 27 public services of Argentina. Arch Argent Pediatr. 2010 ;108(2):136-40. https://www.scielo.org.ar/scielo.php?script=sci_arttext\u0026amp;pid=S0325-00752010000200008\u0026amp;lng=en\u0026amp;nrm=iso\u0026amp;tlng=en\u003c/li\u003e\n\u003cli\u003eRamsewak S, et al. Sight impairment registration in Trinidad: trend in causes and population coverage in comparison to the National Eye Survey of Trinidad and Tobago. EYE. 2024;38(11):2134\u0026ndash;42. http://dx.doi.org/10.1038/s41433-024-02943-3\u003c/li\u003e\n\u003cli\u003eRamke J, et al. Cataract services for all: Strategies for equitable access from a global modified Delphi process. 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Spectacle Coverage in Older Adults from Parintins: The Brazilian Amazon Region Eye Survey (BARES). 2016;57, Issue 12. https://iovs.arvojournals.org/article.aspx?articleid=2562109\u003c/li\u003e\n\u003cli\u003eChaves CMO et al. Refractive profile of presbyopic people in the Brazilian Amazon. Rev Bras Oftalmol. 2013;72(4):223-6. Available at: https://www.scielo.br/j/rbof/a/7Wsw8MzDKTGRtsnwmzWKTqf/abstract/?lang=en Cernichiaro-Espinosa et al. New insights in diagnosis and treatment for Retinopathy of Prematurity. Int Ophthalmol. 2016;36(5):751\u0026ndash;60. http://dx.doi.org/10.1007/s10792-016-0177-8\u003c/li\u003e\n\u003cli\u003eBancalari, A et al. Health Systems and Health Inequities in Latin America. (2023, December 20). https://scioteca.caf.com/handle/123456789/2188\u003c/li\u003e\n\u003cli\u003eElam, Angela R et al. Disparities in Vision Health and Eye Care. Ophthalmology vol. 129,10 (2022): e89-e113. http://dx.doi.org/10.1016/j.ophtha.2022.07.010\u003c/li\u003e\n\u003cli\u003eStern J, et al. 2030 In Sight: the future of global eye health. EYE. 2024;38(11):1979\u0026ndash;80. http://dx.doi.org/10.1038/s41433-023-02815-2\u003c/li\u003e\n\u003cli\u003eBudi G, et al. World health leaders adopt two new ambitious global eye health targets for 2030. IAPB. 2021. https://worldcouncilofoptometry.info/wp-content/uploads/2021/06/WHO-Global-Eye-Health-Targets-Press-Release-_-IAPB.pdf\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"eye","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"eye","sideBox":"Learn more about [Eye](http://www.nature.com/eye/)","snPcode":"41433","submissionUrl":"https://mts-eye.nature.com/cgi-bin/main.plex","title":"Eye","twitterHandle":"@eye_journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"ophthalmology, access to health services, barriers to health, ophthalmologic care, health inequalities, Latin America, health equity, access factors, health coverage, health system","lastPublishedDoi":"10.21203/rs.3.rs-7436148/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7436148/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eVisual impairment is a global public health priority because of its high prevalence and impact on quality of life. In Latin America, access to ophthalmologic care is limited by multiple barriers that especially affect vulnerable populations and hinder the timely detection and management of preventable visual diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: To \u003c/strong\u003edescribe the available evidence on the barriers affecting access to ophthalmology services in Latin America.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods: \u003c/strong\u003eIn accordance with the JBI and PRISMA-ScR guidelines, a search was conducted in four scientific databases (PubMed, Scielo, Scopus and Web of Science), including studies published between 2010 and 2025, highlighting the barriers to accessing ophthalmology services in Latin America and excluding those focused on other regions of the world.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSixty-eight studies were included, with the main barriers identified for access to ophthalmology services being structural, geographic, economic, sociocultural, technological, and health system barriers. Among the strategies implemented to improve access, teleophthalmology, mobile brigades, educational campaigns, and strengthening of primary care stand out, although significant inequalities persist between regions and population groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eAccess to ophthalmologic care in Latin America continues to be affected by multiple barriers, especially affecting the most vulnerable populations. Although progress has been made through various strategies, it is necessary to strengthen the integration of services, invest in human and technological resources, and prioritize equity to advance toward universal and effective eye care coverage in the region.\u003c/p\u003e","manuscriptTitle":"Barriers to access to ophthalmology services in Latin America: A scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-19 15:25:26","doi":"10.21203/rs.3.rs-7436148/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2025-10-20T15:33:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-10-13T13:47:40+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-10-07T17:37:46+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-09-14T06:51:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T09:46:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-26T10:37:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Eye","date":"2025-08-22T16:08:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"eye","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"eye","sideBox":"Learn more about [Eye](http://www.nature.com/eye/)","snPcode":"41433","submissionUrl":"https://mts-eye.nature.com/cgi-bin/main.plex","title":"Eye","twitterHandle":"@eye_journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3e7da8e0-2073-41dc-8d66-c69201b9eabf","owner":[],"postedDate":"September 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":54680269,"name":"Health sciences/Health care/Health services"},{"id":54680270,"name":"Health sciences/Medical research/Epidemiology"}],"tags":[],"updatedAt":"2025-10-20T15:37:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-19 15:25:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7436148","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7436148","identity":"rs-7436148","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}