Eye care systems in developing nations are undergoing significant transformation through innovative digital tools, community health worker training, and local partnerships, yet critical gaps in workforce, funding, and geographic access continue to limit treatment for millions. Countries like Rwanda have successfully deployed screening programs that reach remote villages, but closing the gap between diagnosis and actual treatment remains a major challenge, particularly for conditions requiring ongoing monitoring.

How Is Rwanda Redesigning Eye Care Access?

Rwanda has implemented a comprehensive strategy to bring eye health services to its population of over 13 million people. The country trained general nurses in primary eye care across all 514 local health centers, equipped 48 district hospitals to handle eye care, and deployed digital tracking systems to ensure patients don't get lost in the referral process.

• Community Health Workers: Over 100,000 community health workers can be deployed to screen people in their villages and identify those who need clinical care, with more than 1,250 nurses handling basic eye issues at local health centers.
• Digital Tracking System: Rwanda's Eye Tracker tool, embedded within the national health management information system, monitors patients from initial village screening through hospital referral and post-surgery follow-up.
• AI-Powered Screening: The Rwanda International Institute of Ophthalmology deployed artificial intelligence software to automatically detect eye damage caused by diabetes during routine diabetes clinic checkups.
• Affordable Eyeglasses: A partnership between the University of Rwanda and OneSight allows the country to assemble prescription glasses locally, making them more affordable for populations where standard glasses are unaffordable and not covered by community health insurance.

"We can only make progress step by step. At first, you are struggling to even identify the people with disease, and when you find a model to identify them, that's a step forward. But that step forward opens up many problems: Who is going to deliver the care? Where will the care be delivered? What equipment do we have to deliver the care?" said Cik Mathenge, founding director of RIIO iHospital and RIIO School of Ophthalmology in Rwanda.

Cik Mathenge, MD, MSc, PhD, Founding Director of RIIO iHospital and RIIO School of Ophthalmology, Rwanda

What Eye Health Problems Still Plague Developing Nations?

Despite Rwanda's progress, significant vision problems persist across the country and the broader developing world. Cataract-related blindness affects approximately 1.1% of Rwanda's population, while visual impairment at the 6/18 level (a measure of sight where someone needs to stand 6 meters away to see what a person with normal vision can see at 18 meters) affects 4.4% of the population. Refractive errors, such as nearsightedness and farsightedness, and cataracts remain the major causes of vision loss.

Screening rates for serious eye conditions remain dismally low. Less than 1% of adults are routinely screened for glaucoma, a condition that damages the optic nerve and can lead to blindness if untreated. Additionally, less than 4% of preterm infants are screened for retinopathy of prematurity, a potentially blinding eye disease that affects premature babies.

Resource constraints compound these challenges. More than one-third of health facilities frequently run out of essential eye medicines. Geographic barriers persist, with 70% of public cataract surgeries concentrated in only one province, forcing patients in other regions to travel long distances for treatment. Gender gaps also affect care access: approximately 40% of women diagnosed with cataracts never present for surgery despite community health insurance covering the procedure.

In Tanzania, the largest country in East Africa, retinal disease services are severely limited. The country has only three centers equipped to treat retinal conditions, two located in Dar es Salaam and one in Moshi. Patients from rural areas and distant cities must travel up to 1,600 kilometers to reach these facilities. Meanwhile, lifestyle changes are driving a surge in diabetic retinopathy and ocular hypertension, creating growing demand for specialized care that the healthcare system cannot meet.

Why Are Workforce Shortages Blocking Progress?

The most critical bottleneck in developing nations' eye care systems is a severe shortage of trained eye specialists. Rwanda, a country of over 13 million people, has only 30 to 36 fully trained ophthalmologists, most concentrated in major cities. The heavy lifting of managing eye care at local district hospitals falls to approximately 130 eye clinical officers, many of whom are stretched thin across multiple responsibilities.

Even when new technologies like artificial intelligence-enabled cameras are introduced, workforce limitations prevent their effective use. At facilities equipped with AI-enabled fundus cameras provided by Orbis International, screening happens sporadically because the trained nurses are often assigned to other tasks like immunization campaigns or take leave, leaving the expensive equipment underutilized.

"Eye health gets less than 0.2% of Rwanda's total health budget. Because of this, the sector still relies heavily on external partners such as the Fred Hollows Foundation and Fondazione Leonardo Del Vecchio to pay for crucial surgical supplies," explained Cik Mathenge.

Cik Mathenge, MD, MSc, PhD, Founding Director of RIIO iHospital and RIIO School of Ophthalmology, Rwanda

Funding constraints further limit progress. Eye health receives less than 0.2% of Rwanda's total health budget, forcing the sector to depend on external partners and nongovernmental organizations to purchase critical surgical supplies and equipment. This dependency creates instability and limits the country's ability to plan long-term improvements.

What Does the Path Forward Look Like?

Despite these obstacles, developing nations are gradually shifting toward self-reliance and building local capacity. Rwanda and other countries are investing in training local health professionals who can innovate within resource-constrained environments. As Mathenge noted, educated professionals with specialized skills can develop creative solutions even when resources are limited, and innovations emerge from necessity.

The integration of eye care services into existing health systems, combined with digital tools and community-based screening, represents a sustainable model for expanding access. However, experts emphasize that solving one problem often reveals the next layer of challenges. Closing the gap between diagnosis and treatment, ensuring consistent staffing and equipment maintenance, and securing adequate funding remain ongoing struggles that require sustained commitment from governments, international organizations, and local institutions working together.