This in-depth review, prepared by the Kilimanjaro Centre for Community Ophthalmology (KCCO), explores the concept of task-shifting in eye care — specifically the training and utilization of non-physician cataract surgeons (NPCS) to address the shortage of ophthalmologists in sub-Saharan Africa. The report presents evidence on the effectiveness, quality, productivity, and acceptance of NPCS based on studies and data from countries including Kenya, Tanzania, The Gambia, Malawi, and Ghana. Findings show that NPCS can deliver acceptable surgical outcomes, especially when trained well, supervised, and supported by strong health systems. However, challenges remain with post-training support, rural deployment, regulatory frameworks, and overall system capacity. The report concludes that while NPCS are a practical solution in some contexts, they must be integrated into well-supported eye health programs to be effective and sustainable.