Community-Based Eye Screening With Structured Referral Tracking for Preventing Avoidable Blindness in Adults in Rawalpindi, Pakistan (SIGHT)

Community-Based Eye Screening With a Structured Referral Tracking Intervention for the Prevention of Avoidable Blindness Among Adults in Rawalpindi District, Pakistan

This cluster randomized controlled trial aims to evaluate the effectiveness of a Structured Referral Tracking (SRT) intervention in improving referral completion among adults identified with avoidable blindness during community-based eye screening camps in Rawalpindi District, Pakistan. Ten community clusters will be randomized into intervention and control groups. Participants in the intervention group will receive structured referral counseling, weekly reminder calls or messages, and customized referral guidance for eight weeks, while the control group will receive standard referral procedures. The primary outcome is referral completion at a tertiary eye hospital within eight weeks after screening. Secondary outcomes include knowledge regarding avoidable blindness, treatment satisfaction, feasibility, acceptability, and barriers influencing referral completion.

Study Overview

• Status: Not yet recruiting
• Conditions: Diabetic Retinopathy; Refractive Error; Cataract
• Intervention / Treatment: Behavioral: Structured Referral Tracking (SRT)

Detailed Description

Avoidable blindness remains a major public health challenge in low- and middle-income countries, including Pakistan. Community-based eye screening camps are commonly used to identify individuals with visual impairment and eye diseases requiring treatment; however, referral completion to tertiary eye care facilities remains poor. Many patients fail to attend referral hospitals because of limited awareness, lack of follow-up, transportation barriers, and uncertainty regarding treatment procedures.

This study aims to evaluate the effectiveness and implementation of a Structured Referral Tracking (SRT) intervention in improving referral completion among adults identified with avoidable blindness during community-based eye screening camps in Rawalpindi District, Pakistan.

The study will use a cluster randomized controlled trial design. Ten community clusters (union councils) from five tehsils of Rawalpindi District will be selected using multistage random sampling. Clusters will be randomized into intervention and control arms. Participants attending eye screening camps who are diagnosed with eye conditions requiring referral to a tertiary eye hospital will be enrolled after informed consent.

Participants in the intervention arm will receive a multi-component Structured Referral Tracking intervention consisting of referral counseling, weekly reminder calls or mobile messages, visual educational material, and customized referral guidance regarding hospital location, estimated costs, and required documents. Participants in the control arm will receive standard referral procedures consisting of routine counseling and referral slips without structured follow-up.

The primary outcome will be referral completion at the tertiary eye hospital within eight weeks after screening, verified through hospital attendance records. Secondary outcomes will include knowledge regarding avoidable blindness, treatment satisfaction, feasibility and acceptability of the intervention, and barriers influencing referral completion.

The findings of this study are expected to provide evidence regarding the effectiveness and feasibility of structured referral tracking systems for improving eye care service utilization and reducing avoidable blindness in Pakistan.

• Study Type: Interventional
• Enrollment (Estimated): 500
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Khizar Nabeel, PHD (In progress); Phone Number: +923455096776; Email: khizar@hsa.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Rawalpindi, Punjab Province, Pakistan, 46600
      • ACCO Department, Al-Shifa Trust Eye Hospital, Rawalpindi

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 18 years or above
• Individuals diagnosed with visual impairment or eye conditions requiring referral to a tertiary eye care facility
• Permanent residents of Rawalpindi District, Pakistan
• Willing and able to provide informed consent

Exclusion Criteria:

• Individuals already undergoing treatment for the identified eye condition
• Individuals requiring emergency ophthalmic care
• Severe systemic or physical illness limiting follow-up
• Individuals unable to provide informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Structured Referral Tracking (SRT); Participants will receive structured referral counseling, weekly reminder calls or messages, visual educational material, and customized referral guidance for eight weeks following community-based eye screening.	Behavioral: Structured Referral Tracking (SRT); A multi-component referral tracking intervention including referral counseling, weekly reminder calls or mobile messages, visual educational material, and customized referral guidance to improve referral completion after community eye screening.
No Intervention: Standard Referral Procedure; Participants will receive routine referral slips and standard counseling without structured follow-up or reminder communication.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Referral Completion Rate Verified Through Hospital Records	Proportion of referred participants who complete referral visits at the tertiary eye hospital, verified through hospital attendance records.	Within 8 weeks after community eye screening

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knowledge Score on Avoidable Blindness Questionnaire	Participant knowledge regarding avoidable blindness and eye health assessed using a structured questionnaire developed for the study.	Baseline and 8 weeks after screening
Participant Acceptability of Structured Referral Tracking Assessed Using Structured Feedback Questionnaire	Participant acceptability of the Structured Referral Tracking intervention assessed using a structured feedback questionnaire regarding usefulness and satisfaction with reminder communication.	Within 8 weeks after screening
Barriers Influencing Referral Completion Assessed Using Structured Barrier Assessment Questionnaire	Barriers and facilitators influencing referral completion assessed using a structured questionnaire among referred participants.	Within 8 weeks after screening

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participant Treatment Satisfaction Score Using Structured Satisfaction Questionnaire	Participant-reported satisfaction regarding referral services and treatment received at the tertiary eye hospital assessed using a structured satisfaction questionnaire.	Within 8 weeks after screening
Feasibility of Structured Referral Tracking Assessed by Reminder Delivery and Follow-up Completion Rates	Feasibility of the intervention assessed through successful delivery of reminder messages/calls and completion of scheduled follow-up procedures.	Within 8 weeks after screening

Collaborators and Investigators

• Sponsor: Health Services Academy, Islamabad, Pakistan
• Collaborators: Al-Shifa Trust Eye Hospital
• Investigators: Study Director: Dr. Ahmad Abdullah, PHD, Shifa International Hospital, Islamabad

Publications and helpful links

General Publications

• Harwood M, Cunningham W. Lessons from 2020 for equity in global eye health. Lancet Glob Health. 2021 Apr;9(4):e387-e388. doi: 10.1016/S2214-109X(21)00036-X. Epub 2021 Feb 16. No abstract available.
• World Health Organization. Blindness and visual impairment. Geneva: World Health Organization; 2023
• Khan AA, Talpur KI, Awan Z, Arteaga SL, Bolster NM, Katibeh M, Watts E, Bastawrous A. Improving equity, efficiency and adherence to referral in Pakistan's eye health programmes: Pre- and post-pandemic onset. Front Public Health. 2022 Jul 22;10:873192. doi: 10.3389/fpubh.2022.873192. eCollection 2022.

Helpful Links

• WHO Blindness and Visual Impairment

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): November 30, 2026

Study Registration Dates

• First Submitted: May 13, 2026
• First Submitted That Met QC Criteria: May 20, 2026
• First Posted (Actual): May 28, 2026

Study Record Updates

• Last Update Posted (Actual): June 4, 2026
• Last Update Submitted That Met QC Criteria: June 2, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Cataract; Diabetic Retinopathy; Refractive Error; Community Eye Screening; Avoidable Blindness; Referral System; Structured Referral Tracking
• Additional Relevant MeSH Terms: Endocrine System Diseases; Vascular Diseases; Cardiovascular Diseases; Diabetes Mellitus; Eye Diseases; Diabetic Angiopathies; Diabetes Complications; Lens Diseases; Retinal Diseases; Diabetic Retinopathy; Cataract; Refractive Errors
• Other Study ID Numbers: hsa2026135

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: De-identified individual participant data underlying the published results may be shared upon reasonable request after publication of the primary study findings.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No