Factors associated with eye care utilization in Iran: a systematic review based on the Andersen Behavioral Model

Blindness and visual impairment are major public health challenges in Iran; however, no systematic review has synthesized the factors influencing eye care service utilization in the country. This study aimed to identify the factors associated with eye care utilization in Iran based on the Andersen Behavioral Model. A systematic search was conducted in PubMed, Scopus, Web of Science and Magiran from January 2000 to May 2026. Quantitative studies examining factors associated with eye care service utilization in the Iranian population were included. Findings were synthesized using a narrative approach without meta-analysis, organized according to the Andersen Model’s three domains: predisposing, enabling and need factors. Twenty-four studies were included. Among predisposing factors, increasing age was associated with higher service use, yet older adults had the highest unmet need. Women were more proactive in preventive services but lagged in treatment follow-up. Higher education was generally associated with increased utilization. Regarding enabling factors, economic status and insurance coverage were among the most consistently reported factors, with marked pro-rich inequality. Geographic access, referral systems and macro-level policies such as the Health Transformation Plan played positive roles, whereas high out-of-pocket costs remained a major barrier. Concerning need factors, refractive errors and underlying conditions such as diabetes were among the most frequently reported drivers of service need. Low awareness of the necessity of regular eye examinations, particularly among diabetic patients, was identified as a significant barrier. Socioeconomic inequality in access to eye care remains a persistent challenge in Iran. Clinical need does not always translate into effective service use, indicating the importance of enabling and predisposing factors. The findings identify financial barriers, geographic access, referral pathways, and awareness as relevant considerations for eye-health planning. Given the predominantly cross-sectional evidence base, the effectiveness of specific policy interventions requires further evaluation. Not applicable.