E-Paper
Addressing India's growing burden of vision impairment
This article is authored by Rishi Raj Borah, country director, Orbis India.
India stands at a crucial moment in its health care development. While we celebrate big advances in medical technology and infrastructure, there is a silent crisis that threatens the future of our country: approximately 47 million people in India are affected by severe vision impairment. The problem is not only in the numbers, but also in the fact that almost 80% of cases of visual impairment could be prevented or treated. If a child cannot see the blackboard and if the elderly can no longer walk without help, the repercussions extend far beyond that individual and affect the economic stability of the family and even stretch the public healthcare system’s capacity. What we need is to close the distance between the tertiary eye care hospitals and the distant rural areas that need them the most.
Historically, eye care in India has been a reactive process, which means that people first seek help when they start facing severe impairment in functional vision. Illnesses such as uncorrected refractive error in children and slow progressive diseases, for example, glaucoma or diabetic retinopathy in adult patients, can develop unnoticed until an irreparable impairment occurs. For school children, visual impairment becomes a direct impediment to education and socialisation since around 80% of childhood learning is visually based. Waiting for a patient to travel hundreds of kilometres to an urban hospital is a systemic failure.
This journey inflicts a severe economic toll on vulnerable families. Travelling such long distances forces daily-wage labourers to sacrifice their daily income, a loss often doubled because a family member must also forfeit their earnings to travel as a guide. When combined with the steep, immediate out-of-pocket expenses for transport, food, and lodging, the financial burden of simply reaching a clinic becomes too high. For a household living hand-to-mouth, these compounding costs make seeking care a financial impossibility, forcing them to delay treatment until temporary vision issues worsen into permanent disability.
To dismantle the twin barriers of distance and affordability, we have to decentralise diagnostic capabilities. Training grassroots community members, including teachers and local health care workers, creates a robust, permanent frontline defence against avoidable blindness. Scalable initiatives like the Refractive Error Among Children (REACH) model have demonstrated the immense value of this approach, successfully executing millions of screenings by utilising structured guidelines and digital data management tools right inside school premises. By equipping local networks to identify common vision issues early, we can instantly resolve thousands of cases through simple interventions like prescription eyeglasses, reserving tertiary medical resources for complex surgical cases.
The true advancement in eye care in the country can be traced back to the establishment of sustainable infrastructure. Initiatives such as community-based eye care centres play an important role in serving as a resource for primary care in remote areas, bringing important screenings and referrals directly to people's homes. Moreover, there is a need to think about future developments, where recent research has shown that new decentralised primary eye care practices increase the number of patients receiving services while minimising carbon emissions caused by travelling. The most important task now is to increase the number of services provided, thereby bringing the quality of eye care in the cities to rural areas. By prioritising early detection and reinforcing our community frameworks, we can secure a brighter, clearer future for millions of citizens across the nation.
(The views expressed are personal)
This article is authored by Rishi Raj Borah, country director, Orbis India.
