Integrating eye care into Community Health Centers: a framework for advancing vision equity in underserved communities

Vision health is a critical yet often overlooked component of comprehensive primary care, particularly for underserved populations. Patient access to eye care services enhances workplace productivity, household income, and employment opportunities, ultimately supporting economic growth, poverty reduction, and food security<b>.</b> Community Health Centers (CHC) collectively serve over 32 million patients annually and are uniquely positioned to address disparities in eye care access. Yet only 26% of CHCs offer vision care services, and only 2.9% of people who access CHC services receive eye care. Addressing this gap requires a strategic, systems-level approach to implementation. This perspective proposes an integrated framework to guide the sustainable and equitable integration of eye care providers, including optometrists and ophthalmologists, into Community Health Centers (CHCs). Drawing on and uniting the Consolidated Framework for Implementation Research (CFIR), the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework, and the National Association of Community Health Centers' (NACHC) Value Transformation Framework (VTF), we outline a multi-level strategy that addresses implementation readiness, equity, and sustainability. This integrated framework is intended to inform implementation research and policy development aimed at making on-site eye care via an optometrist or ophthalmologist a mandated service in CHCs nationwide. In doing so, we offer an actionable game plan for CHC leaders, healthcare administrators, and public health advocates to expand access to comprehensive eye care in underserved communities.