**Background:** Vision impairment and blindness are major public health issues, with approximately 90% of the global burden occurring in low-income and middle-income countries (LMICs). The WHO's World Report on Vision recommends integrated people-centred eye care (IPEC) as a strategic framework to reduce vision loss and improve access. However, the extent to which eye care has been integrated with other health services in LMICs has not been widely reported. This scoping review aimed to describe approaches to integrating eye care service delivery with other systems in low-resource settings and identify factors associated with integration.
**Methods:** The review followed Cochrane Rapid Review and PRISMA guidelines. Databases searched in September 2021 included MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library. Inclusion criteria: peer-reviewed English-language papers published between January 2011 and September 2021, conducted in LMICs, with interventions involving eye care or preventative eye care integrated into other health systems. Two independent reviewers screened, quality appraised, and coded included papers using a deductive-inductive iterative analysis approach focused on service delivery integration. The search identified 3889 potential papers; after screening, 24 papers were included.
**Key Results:** The 24 included papers described studies across 12 countries, with 16 from sub-Saharan Africa, 5 from South Asia, 2 from Southeast/East Asia/Oceania, and 1 from Latin America/Caribbean. Twenty papers incorporated more than one intervention type (promotion, prevention, and/or treatment), but none included rehabilitation. Most articles involved human resources development, yet rarely appeared to be people-centred. The level of integration was associated with building relationships and enhancing service coordination. Integrating human resources was challenged by the need for ongoing support and worker retention. In primary care settings, workers were often already at full capacity, had competing priorities, varying capabilities, and limited motivation. Additional barriers included inadequate referral and information systems, poor supply chain management and procurement practices, and finite financing. For example, in Tanzania, antimicrobial eye drops were expected but rarely received when integrated with the Medical Stores Department due to lack of health systems funding. In Kenya, electronic referrals through Peek Vision and SMS reminders increased referral uptake for children to attend a secondary hospital, but patient, system, and geographical factors continued to hinder compliance. In El Salvador, those with NCDs had a Community Family Health Team that coordinated care closely with a Specialised Community Health Team, including eye care. In Rwanda, efforts were made to generate a continual supply of primary eye care nurses by including eye care into the nursing training curriculum.
**Clinical Implications:** This review highlights that integrating eye care into low-resource health systems is challenging, compounded by resource limitations, competing priorities, and ongoing support needs. The findings call into question what is needed to support 'integration' and 'people-centredness' in line with the WHO's IPEC approach. The dearth of information regarding integration of rehabilitation services emphasises the need for more attention in this area. The review suggests that for each setting, estimating the capacity of primary care to absorb eye care capacities should be cautiously approached, and whether an additional workforce profession is more appropriate and sustainable should be considered. Future interventions should adopt people-centred approaches as a central principle and consider multiple critical health system functions when planning. Additional interventions with evaluation to investigate the integration of low-vision rehabilitation services into other healthcare levels and services are needed.