As demand for specialist eye care continues to grow, healthcare systems are looking for better ways to manage patients safely, efficiently, and closer to where they live. A new study published in Scientific Reports offers a closer look at Singapore’s Primary Eye Care model and the lessons it may hold for wider community eye care programs.
The model was designed to “right-site” patients with non-complex eye conditions by upskilling optometrists and integrating them into a broader care pathway. Rather than sending every patient through hospital-based ophthalmology services, the approach allows suitable cases to be managed in a community setting while maintaining links to specialist care.
What makes this study especially useful is that it does not only evaluate the structure of the program. It looks at the people who make the model work: ophthalmologists, optometrists, primary care physicians, patients, and caregivers.
Trust became the foundation of the model
The strongest finding from the study was the importance of trust between ophthalmologists and optometrists. When ophthalmologists experienced consistent, high-quality care from the Primary Eye Care team, they became more confident referring patients into the model. That confidence helped support responsibility transfer and role expansion for optometrists.
Community eye care models often depend on more than clinical capability alone. They require referral confidence, shared expectations, communication, and clear understanding of where each professional role begins and ends.
“PEC’s high-quality care experienced by the ophthalmologists influenced their motivation to refer patients to PEC paving the way for responsibility transfer and role expansion.”
— Wanfen Yip and co-authors, Scientific Reports
This is an important point for any healthcare system considering similar models. Expanding care into the community is not just a logistical change. It is a relationship-based change that depends on professionals trusting the quality, consistency, and safety of the pathway.
Referral awareness remained a barrier
The study also found that limited interaction between primary care physicians and optometrists affected awareness of the Primary Eye Care service. When physicians were less familiar with what the model offered, how it worked, or how care quality was maintained, they were less motivated to refer patients.
This highlights a common challenge in integrated healthcare. A service can be well designed, but if surrounding professionals do not fully understand it, referral pathways may remain underused.
For community eye care programs to succeed, active engagement with primary care teams becomes essential. That means building awareness, creating clear referral guidance, and maintaining regular communication between community providers and specialist services.
Patients also needed confidence in the pathway
Patient acceptance was another important part of the study. Some patients needed reassurance that community-based care was still connected to hospital services and that optometrists had the capability to manage their condition appropriately.
This is understandable. Patients often associate hospital-based care with higher levels of expertise, even when their condition may be suitable for management in a community setting. Without clear education, a referral away from the hospital may feel like a downgrade rather than a more appropriate care pathway.
The study suggests that interactive patient education could help address these concerns by explaining how the Primary Eye Care model is integrated with hospital services and when escalation back to specialist care is available.
A wider lesson for eye care systems
Although the study focuses on Singapore, the findings are relevant to a much broader conversation about how eye care systems can manage rising demand. Aging populations, chronic disease, and growing patient volumes continue placing pressure on ophthalmology services worldwide.
Community-based eye care models may help reduce unnecessary strain on hospitals while improving patient access to appropriate care. However, the Singapore study shows that successful implementation depends on more than simply creating a new service.
Strong community eye care requires professional trust, referral awareness, patient education, and visible integration between community and hospital-based services. Without those elements, even well-intentioned models may struggle to gain traction.
The study’s broader message is clear: shifting eye care closer to the community can work, but only when the system around it is built to support collaboration, confidence, and continuity of care.
Source: Scientific Reports
