Effect of Vision Centers on Access to Eye Care and Eye Health Outcomes

NCT ID: NCT07227714

Last Updated: 2025-11-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

40000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-03-01

Study Completion Date

2028-09-01

Brief Summary

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The goal of this clinical trial is to evaluate the effect of vision centers on access to eye care and eye health outcomes in South Asia. The main questions it aims to answer are:

1. Do vision centers increase visits to eyecare centers?
2. Do vision centers increase spectacle ownership and wearing?
3. Do vision centers improve visual acuity of the population?

Researchers will compare outcomes in communities randomized to have a vision center is established with communities randomized to delay establishment of a vision center. Outcomes will be assessed through population-based surveys at baseline and after two years as well as through hospital records collected throughout the study period.

Detailed Description

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The vast majority of visual impairment and blindness is preventable or treatable with existing interventions. Nearly all of this burden is faced by those living in low- and middle-income countries. Access to eye care is a key challenge in these settings, particularly in rural and remote areas.

Vision centers (VCs) have been developed to increase access to primary eye care in such underserved settings. VCs typically involve establishment of a fixed center staffed by a mid-level ophthalmic technician who offers refraction, spectacles, diagnosis and treatment of basic eye conditions, and referrals for more complex care. VCs have become a common approach to increase access to care in many low- and middle-income country settings, yet little rigorous evidence exists on their impact on eye health in the communities they serve. A recent literature review was unable to identify randomized controlled trials on the impact of vision centers on eye health outcomes in real world settings. While the observational research that exists suggests VCs improve eye health in the communities they serve, the existing evidence is prone to bias.

We propose a cluster-randomized trial to evaluate the effect of VCs on access to eye care and eye health outcomes in South Asia. The trial will leverage VCs planned by the Seva Foundation and partners Bangladesh, India, and Nepal and will monitor outcomes via population-based surveys and hospital network records over 2 years. We expect to provide rigorous evidence on VC impact in real-world settings that can be used to influence programmatic decision making and policy.

Conditions

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Cataract Surgery Eye Care Glasses Primary Eye Care Vision Center Eyecare Visits

Keywords

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vision center primary eye care cataract surgery glasses glassess ownership spectacle ownership cluster-randomized trial eyecare visits

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors
Survey data collectors and data analysts conducting the primary analyses will be masked. This will be achieved by not informing survey data collectors of arm assignment and by having an unmasked team member conceal arm assignment before primary analyses.

Study Groups

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Immediate establishment of a vision center

The intervention arm will include the establishment of a fixed vision center equipped with trained vision technicians to provide basic eye care services and referrals to higher care.

Group Type EXPERIMENTAL

Establishment of a vision center

Intervention Type OTHER

The establishment of a vision center includes building a fixed center, and equipping it with a trained vision technician to provide basic eye care services such as refractive error correction, spectacle dispensing, basic diagnosis for common conditions, as well as referrals for advanced care at base hospitals. The establishment of VCs will be actively publicized in the neighboring communities through promotion by local stakeholders, teachers, community workers, village leaders, health workers, and radio announcements prior to establishment. Additional outreach activities include posters and loudspeaker announcements in the communities the day before operations begin.

Delayed establishment of a vision center

The control arm will receive no intervention during the study period. The establishment of a vision center will occur after endline data collection, if hospital interest and resources remain adequate.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Establishment of a vision center

The establishment of a vision center includes building a fixed center, and equipping it with a trained vision technician to provide basic eye care services such as refractive error correction, spectacle dispensing, basic diagnosis for common conditions, as well as referrals for advanced care at base hospitals. The establishment of VCs will be actively publicized in the neighboring communities through promotion by local stakeholders, teachers, community workers, village leaders, health workers, and radio announcements prior to establishment. Additional outreach activities include posters and loudspeaker announcements in the communities the day before operations begin.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* The catchment area of the proposed VC site is predominantly rural.
* The proposed VC site is located within 20-100 km of the base hospital.
* There are no major primary eye care services within 10 km of the proposed site.
* Care at sites randomized to establish VCs immediately is accessible to anyone.

Exclusion Criteria

* Sites located in non-rural or urban catchment areas.
* Sites outside the 20-100 km distance range from the base hospital.
* Sites with existing major primary eye care services within a 10 km radius.
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Seva Foundation

OTHER

Sponsor Role collaborator

Proctor Foundation

UNKNOWN

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kieran O'Brien, PhD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of California, San Francisco

Locations

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University of California, San Francisco

San Francisco, California, United States

Site Status

Countries

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United States

Central Contacts

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Kieran O'Brien, PhD, MPH

Role: CONTACT

Phone: 415-514-2163

Email: [email protected]

References

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Khanna RC, Sabherwal S, Sil A, Gowth M, Dole K, Kuyyadiyil S, Chase H. Primary eye care in India - The vision center model. Indian J Ophthalmol. 2020 Feb;68(2):333-339. doi: 10.4103/ijo.IJO_118_19.

Reference Type BACKGROUND
PMID: 31957722 (View on PubMed)

Rao GN, Khanna RC, Athota SM, Rajshekar V, Rani PK. Integrated model of primary and secondary eye care for underserved rural areas: the L V Prasad Eye Institute experience. Indian J Ophthalmol. 2012 Sep-Oct;60(5):396-400. doi: 10.4103/0301-4738.100533.

Reference Type BACKGROUND
PMID: 22944748 (View on PubMed)

Misra V, Vashist P, Malhotra S, Gupta SK. Models for primary eye care services in India. Indian J Community Med. 2015 Apr-Jun;40(2):79-84. doi: 10.4103/0970-0218.153868.

Reference Type BACKGROUND
PMID: 25861167 (View on PubMed)

Vision Loss Expert Group of the Global Burden of Disease Study; GBD 2019 Blindness and Vision Impairment Collaborators. Global estimates on the number of people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020. Eye (Lond). 2024 Aug;38(11):2156-2172. doi: 10.1038/s41433-024-02961-1.

Reference Type BACKGROUND
PMID: 38461217 (View on PubMed)

Vision Loss Expert Group of the Global Burden of Disease Study; GBD 2019 Blindness and Vision Impairment Collaborators. Global estimates on the number of people blind or visually impaired by Uncorrected Refractive Error: a meta-analysis from 2000 to 2020. Eye (Lond). 2024 Aug;38(11):2083-2101. doi: 10.1038/s41433-024-03106-0. Epub 2024 Jul 4.

Reference Type BACKGROUND
PMID: 38965322 (View on PubMed)

GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021 Feb;9(2):e130-e143. doi: 10.1016/S2214-109X(20)30425-3. Epub 2020 Dec 1.

Reference Type BACKGROUND
PMID: 33275950 (View on PubMed)

GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021 Feb;9(2):e144-e160. doi: 10.1016/S2214-109X(20)30489-7. Epub 2020 Dec 1.

Reference Type BACKGROUND
PMID: 33275949 (View on PubMed)

Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomao SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health. 2021 Apr;9(4):e489-e551. doi: 10.1016/S2214-109X(20)30488-5. Epub 2021 Feb 16. No abstract available.

Reference Type BACKGROUND
PMID: 33607016 (View on PubMed)

Other Identifiers

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25-45086

Identifier Type: -

Identifier Source: org_study_id