BARRIERS TO EYE CARE SERVICE UTILIZATION AMONG ADULTS AGED ≥50 YEARS IN INDIA: A SCOPING REVIEW PROTOCOL

Background and Rationale Ageism refers to stereotypes, prejudice, and discrimination directed towards individuals based on their age, operating at individual, interpersonal, and institutional levels. It is increasingly recognized as a significant social determinant of health that can influence health-seeking behaviour and access to healthcare services among older adults (1,2). Age-related biases may lead to delayed care-seeking, underutilization of services, and lower prioritization of health needs.Visual impairment is a major public health concern globally and disproportionately affects older adults. It is estimated that over 250 million people live with visual impairment worldwide, with a substantial proportion aged 50 years and above (5,6). A large share of vision loss is preventable or treatable, particularly conditions such as cataract and uncorrected refractive errors (6). Despite the availability of effective interventions, many individuals do not access eye care services in a timely manner.Access to eye care services is influenced by a range of barriers, including financial constraints, limited awareness, geographical inaccessibility, health system limitations, and social and cultural factors. Among older adults, these challenges may be compounded by age-related dependency, reduced mobility, and perceptions that vision loss is a normal part of ageing. Such perceptions may discourage individuals from seeking timely care and contribute to avoidable visual impairment. India is experiencing rapid demographic ageing, with the proportion of older adults expected to increase substantially in the coming decades (7). The burden of visual impairment among older adults in India remains high, with cataract and uncorrected refractive errors being the leading causes (8,9). Although national initiatives such as the National Programme for Control of Blindness and Visual Impairment have improved service availability, disparities in access persist across regions, socioeconomic groups, and rural urban settings (10). Evidence from qualitative studies in India suggests that factors such as financial dependency, stigma, fatalistic beliefs, and family-controlled decision-making influence the uptake of eye care services, particularly among older adults (11). Even when services are available and affordable, social and contextual factors continue to shape healthcare-seeking behaviour.While individual studies have reported various barriers to accessing eye care services, there is a lack of comprehensive synthesis of evidence focusing specifically on older adults in the Indian context. In particular, age-related factors influencing access to eye care services have not been systematically mapped. Therefore, this scoping review aims to map and synthesize the available evidence on barriers and enablers to accessing eye care services among adults aged ≥50 years in India, with a focus on age-related factors influencing access. Review Objective To map the existing evidence on barriers to eye care service utilization among adults aged ≥50 years in India and to identify age-related factors influencing access.