Peer-reviewed veterinary case report

Barriers to eye care for underserved patients in mobile clinics

By Villabona-Martinez V et al.·2025·Department of Ophthalmology, United States·View original on Europe PMC →

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Original publication title: Complexity and Barriers to Vision Care: A Narrative Review Informed by a Mobile Eye Program.

Plain-English summary

This study looks at the challenges that people, especially those from underserved communities, face when trying to get eye care. Many of these patients struggle with language barriers, immigration issues, lack of insurance, financial difficulties, and navigating the healthcare system in urban areas. The researchers reviewed existing literature and used real-life examples from a mobile eye care program that offers free eye exams to highlight how these problems show up in everyday situations. They found that eye care is often wrongly labeled as "non-urgent," which leads to patients disengaging from care due to the many obstacles they encounter. The study concludes that to improve eye care for these communities, the healthcare system needs to be more flexible and responsive to patients' needs, which could be achieved through mobile clinics and better support systems.

Abstract

Purpose: To describe structural and systemic barriers to ophthalmic care experienced by underserved patients, particularly those facing language obstacles, immigration-related constraints, limited insurance coverage, financial hardship, and navigation challenges in an urban setting, and to examine these barriers through a complexity-informed lens. Methods: We conducted a narrative literature review focused on healthcare disparities, patient navigation, complexity in care delivery, and time-sensitive prioritization frameworks in ophthalmology. Findings were integrated with case vignettes drawn from Eyes on Wheels (EOW), a mobile eye care initiative that provides no-cost examinations at Federally Qualified Health Centers (FQHCs) and free clinics. Cases were identified through routine clinical documentation and used to illustrate how structural barriers described in the literature manifest in real-world care pathways. Results: Three recurring system-level issues were identified across EOW encounters: (A) misclassification of medically necessary, time-sensitive ophthalmic care as "non-urgent"; (B) patient disengagement driven by cumulative structural and logistical barriers; and (C) failures that arise when the healthcare system, functioning as a complex adaptive system (CAS), is unable to adapt to patients' and systems' changing circumstances. A review of the literature confirmed that these patterns reflect widely documented challenges faced by underserved urban populations. Three EOW case vignettes, selected from seven patients identified in 2024, are presented as illustrative examples of these systemic patterns. Conclusions: Addressing inequities in eye care requires an approach that recognizes how many parts of the healthcare system interact and affect a patient's ability to receive timely treatment. Vision loss is often the preventable result of systems that are rigid, fragmented, or unable to adapt to a patient's circumstances. Improving outcomes will require flexible care models, such as mobile clinics, paired with strong institutional support, patient-centered navigation, and consistent assessment of social needs and barriers to care. Sustained progress will depend on collaboration across organizations, adaptable leadership, and policies that respond to the real-world situations in which patients live.

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Original publication on Europe PMC: https://europepmc.org/article/MED/41464513