**Background:** Monitoring health outcomes by socioeconomic position (SEP) is essential for achieving universal health coverage and ensuring no one is left behind. In eye health, rapid population surveys like the Rapid Assessment of Avoidable Blindness (RAAB) are commonly used, but they currently lack a standard SEP measure that is feasible within streamlined examination protocols. This study aimed to evaluate whether one objective asset-based measure (EquityTool) and three subjective measures of relative SEP (self-reported economic ladder question, household food adequacy, and income sufficiency) could identify inequality in key eye health outcomes in The Gambia.
**Methods:** Data were from the 2019 Gambia National Eye Health Survey, a comprehensive cross-sectional survey with an embedded RAAB. A subset of 4020 adults aged 50 years and older was analyzed. Eye health outcomes included blindness (presenting visual acuity [PVA] <3/60), any vision impairment (VI) (PVA <6/12), cataract surgical coverage (CSC), and effective cataract surgical coverage (eCSC) at two operable cataract thresholds (<6/12 and <6/60). SEP was measured using: (1) EquityTool (objective asset-based wealth quintiles benchmarked to 2013 DHS), (2) a 5-step economic ladder question, (3) household food adequacy (less than adequate, just adequate, more than adequate), and (4) household income sufficiency (not enough, just enough, more than enough). Patterns of inequality (mass deprivation, marginal exclusion, queuing, complete coverage) were assessed. Analyses were adjusted for clustering and post-stratified by age-sex distribution of the 2013 Gambia Census.
**Key Results:** Among the 4020 participants aged 50 years and older, the age-sex weighted prevalence of blindness was 2.4% (95% CI 1.9% to 3.0%) and any VI was 27.2% (95% CI 25.4% to 29.0%). CSC and eCSC at the <6/60 threshold were 63.1% (95% CI 57.6% to 68.3%) and 29.1% (95% CI 24.2% to 34.6%), respectively; at the <6/12 threshold, they were 33.9% (95% CI 30.5% to 37.5%) and 15.3% (95% CI 12.6% to 18.4%).
- **Objective asset wealth (EquityTool):** No pattern of inequality was identified across within-sample wealth quintiles for any outcome. There were no statistically significant differences between quintiles.
- **Economic ladder question:** No clear pattern of inequality was observed. Most participants clustered on steps 2 and 3. Step 3 had a significantly higher prevalence of any VI compared to steps 1, 2, and 5, but no significant differences in blindness.
- **Household food adequacy:** A queuing pattern (socioeconomic gradient) was apparent in point estimates for most outcomes. Any VI, blindness, CSC <6/60, and eCSC <6/60 were significantly worse among those with less than adequate food compared to those with just adequate food. For example, any VI prevalence was higher in the less than adequate group (point estimates not explicitly given in text but figures show significant difference). CSC <6/60 and eCSC <6/60 were significantly lower in the less than adequate group.
- **Household income sufficiency:** A queuing pattern was seen across three levels. Any VI and CSC <6/60 were significantly worse among those with not enough income compared to those with just enough income. For instance, eCSC <6/60 point estimates were lower in the insufficient income group (21%) compared to the just enough group (not explicitly stated but implied).
Correlation between objective and subjective SEP measures was weak (Kendall's tau-b: 0.09 for food adequacy, 0.15 for income sufficiency, 0.18 for economic ladder; all p<0.001).
**Clinical Implications:** Subjective measures of household food adequacy and income sufficiency were able to identify a socioeconomic gradient in vision impairment and cataract surgical coverage, whereas the objective asset-based measure (EquityTool) and the economic ladder question did not. These simple, self-reported questions are feasible to include in rapid surveys like RAAB and may help monitor eye health equity, particularly for effective cataract surgical coverage. The authors recommend pilot-testing these indicators in other settings to assess acceptability, reliability, and repeatability. Tracking eCSC by food adequacy or income sufficiency could align with WHO's goal of increasing coverage in all population subgroups. Limitations include the uneven distribution of the sample across national wealth quintiles, the small number of participants in the highest SEP categories, and the lack of assessment of reliability or acceptability of the subjective measures. Future research should test these indicators in diverse countries and cultural contexts.