Clear vision is crucial for performing one’s job effectively, especially in professions requiring sharp eyesight. From artisans and garment factory workers to tailors and tea plantation labourers, clear eyesight enhances productivity, increases income, and prolongs employability.

Research across various sectors has demonstrated that correcting vision significantly boosts worker productivity. A randomised controlled trial by VisionSpring found that tea garden workers in Assam increased their productivity by more than 20 per cent following presbyopia correction. The Indian Journal of Ophthalmology estimates that visual impairments could reduce India’s GDP by 0.47-0.7 per cent, equating to ₹1,158 billion.

Our eye’s natural lens focuses light on the retina, enabling clear vision. In youth, this lens is soft and flexible, adjusting to focus on objects both near and far. By age 40 — sometimes as early as 35 — the lens hardens and loses flexibility, leading to presbyopia. Correcting presbyopia is simple with prescription glasses.

Screening for presbyopia doesn’t require extensive optometric expertise; it can be done by vision technicians with basic training. The World Health Organization (WHO) successfully implemented a model partnering with civil society organisations in Bangladesh, Kenya, Malawi, Uganda, and Zambia to facilitate the screening and distribution of reading glasses through community health workers. Many developed nations now allow over-the-counter purchase of reading glasses, streamlining access.

In India, the Medical Devices Rules, 2017 (MD Rules), set under the Drugs and Cosmetics Act of 1940, govern the sale and distribution of medical devices.

In September 2020, the Drug Controller General of India (DCGI) proposed classifying spectacles and spectacle lenses as medical devices. After public consultation, these items were excluded from the final list, allowing eyeglasses to be sold on e-commerce platforms and in physical stores without a prescription.

Affordable eyeglasses are available online for ₹150 and even cheaper in markets like Chandni Chowk in Delhi for under ₹20.

Govt initiatives

The Central and various State governments have launched initiatives to make eyeglasses more accessible and affordable. The National Programme for Control of Blindness and Visual Impairment offers free screenings and provides reading glasses worth up to ₹350 for individuals aged 45 and older.

In Telangana, the Kanti Velugu scheme aims for universal eye screening, having screened 15 million people and distributed five million eyeglasses in its first phase.

The second phase, with a ₹200-crore budget, targets another 15 million screenings and the distribution of 5.5 million eyeglasses. Andhra Pradesh’s YSR Kanti Velugu programme, launched in 2019, aims to screen 50 million people over three years at a cost of ₹561 crore, distributing about 2,500 pairs of eyeglasses daily. By the end of its third phase, nearly 18 million individuals had been screened.

Despite these efforts, millions of Indians — totalling approximately 300 million people according to the Indian Journal of Ophthalmology — still suffer from uncorrected presbyopia.

India has one optometrist for every 180,000 people, compared to one per 10,000 in developed countries. This shortage is even more severe in rural areas where deploying optometrists is not economically feasible. Distributing affordable eyeglasses to remote areas involves significant logistical challenges and costs. Organising screening camps requiring ophthalmologists and optometrists can increase costs tenfold.

Many are unaware that optometrist screenings are not required for reading glasses, which can be provided through WHO’s model using health workers or community groups.

Government programmes offer free or subsidised eyeglasses but often require a prescription from a government eye specialist, negating the benefit of easier access. Eyeglasses must be procured through State or district bodies, delaying distribution.

For instance, ASHA workers in one government initiative conduct initial screenings and direct those with vision issues to a camp or district hospital for further examination. However, 20 per cent of people do not attend this second screening, and those who do may wait up to six months to receive eyeglasses through the government scheme.

These initiatives can be improved by removing the requirement for prescriptions from government eye specialists, allowing ASHA workers and community cadres to conduct screenings and distribute glasses. This would extend reach and reduce costs.

By providing accessible, affordable, and appropriate vision correction, we can unlock significant productivity gains, increase income, and improve the quality of life for millions.

Gupta is COO, The/Nudge Institute, and Bhushan is Founding-CEO, Ayushman Bharat

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