Community-Based Eye Screening With Structured Referral Tracking for Preventing Avoidable Blindness in Adults in Rawalpindi, Pakistan

Avoidable blindness remains a major public health challenge in low- and middle-income countries, including Pakistan. Community-based eye screening camps are commonly used to identify individuals with visual impairment and eye diseases requiring treatment; however, referral completion to tertiary eye care facilities remains poor. Many patients fail to attend referral hospitals because of limited awareness, lack of follow-up, transportation barriers, and uncertainty regarding treatment procedures.

This study aims to evaluate the effectiveness and implementation of a Structured Referral Tracking (SRT) intervention in improving referral completion among adults identified with avoidable blindness during community-based eye screening camps in Rawalpindi District, Pakistan.

The study will use a cluster randomized controlled trial design. Ten community clusters (union councils) from five tehsils of Rawalpindi District will be selected using multistage random sampling. Clusters will be randomized into intervention and control arms. Participants attending eye screening camps who are diagnosed with eye conditions requiring referral to a tertiary eye hospital will be enrolled after informed consent.

Participants in the intervention arm will receive a multi-component Structured Referral Tracking intervention consisting of referral counseling, weekly reminder calls or mobile messages, visual educational material, and customized referral guidance regarding hospital location, estimated costs, and required documents. Participants in the control arm will receive standard referral procedures consisting of routine counseling and referral slips without structured follow-up.

The primary outcome will be referral completion at the tertiary eye hospital within eight weeks after screening, verified through hospital attendance records. Secondary outcomes will include knowledge regarding avoidable blindness, treatment satisfaction, feasibility and acceptability of the intervention, and barriers influencing referral completion.

The findings of this study are expected to provide evidence regarding the effectiveness and feasibility of structured referral tracking systems for improving eye care service utilization and reducing avoidable blindness in Pakistan.

Inclusion criteria

• Adults aged 18 years or above
• Individuals diagnosed with visual impairment or eye conditions requiring referral to a tertiary eye care facility
• Permanent residents of Rawalpindi District, Pakistan
• Willing and able to provide informed consent

Exclusion criteria

• Individuals already undergoing treatment for the identified eye condition
• Individuals requiring emergency ophthalmic care
• Severe systemic or physical illness limiting follow-up
• Individuals unable to provide informed consent