Background Improvements in technology could facilitate task-shifting and ocular disease screening in rural areas. Methods Visual acuity (VA) was tested using a Ministry of Health 3-m VA card. Anterior segment photographs were taken using a three-dimensional printed cellphone attachment and remotely graded. Results Of 326 photographed eyes, 1 was ungradable. Of 123 eyes with non-refractive visual impairment, cataract was identified in 35.8%, pterygium in 41.5%, corneal opacity in 5.7% and phthisis in 2.4%. Conclusions While the cause of visual impairment cannot be determined without a posterior segment examination, the smartphone attachment proved to be easy to use by non-specialist workers and identified anterior segment pathology in most cases.

Objective To determine the relationship between socioeconomic status (SES) and visual impairment (VI) or blindness in the rural Peruvian Amazon, hypothesizing that higher SES would have a protective effect on the odds of VI or blindness. Methods In this cross-sectional study of 16 rural communities in the Peruvian Amazon, consenting adults aged ≥ 50 years were recruited from ~30 randomly selected households per village. Each household was administered a questionnaire and had a SES score constructed using principal components analysis. Blindness and VI were determined using a ministry of health 3-meter visual acuity card. Results Overall, 207 adults aged ≥ 50 were eligible; 146 (70.5%) completed visual acuity screening and answered the questionnaire. Of those 146 participants who completed presenting visual acuity screening, 57 (39.0%, 95% CI 30.2–47.1) were classified as visually impaired and 6 (4.1%, 95% CI 0.9–7.3) as blind. Belonging to the highest SES tercile had a protective effect on VI or blindness (OR 0.29, 95% CI 0.09 to 0.91, p = 0.034), with a linear trend across decreasing levels of SES (p = 0.019). This observed effect remained significant regardless of how SES groups were assigned. Conclusion Belonging to a higher SES group resulted in a lower odds of VI or blindness compared to those in the lowest SES group. The observation of a dose response provides confidence in the observed association, but causality remains unclear. Blindness prevention programs could maximize impact by designing activities that specifically target people with lower SES.