Today, poor vision, due to lack of access to eyeglasses, is easily the largest unaddressed disability in the world. In India alone, 550 million individuals are estimated to suffer this fate. Given that eyeglasses cost as little as Rs 200, correction of refractive error through eyeglasses constitutes the health intervention with the largest bang for the buck.
The commonest eye problems result from refractive error due to which eye is unable to focus clearly on an object. The result is hyperopia, presbyopia, myopia or astigmatism.
Loosely speaking, these conditions are about the inability to see objects clearly up close (hyperopia and presbyopia), far away (myopia) or both (astigmatism). The commonest condition is presbyopia, which is age-related and affects a majority aged 35 and above.
Most refractive errors can be corrected with a pair of glasses costing pittance. Presbyopia is particularly easy to correct, since the patient herself can identify corrective lenses by trying out a few of them. In many countries, presbyopia patients get their first pair of reading glasses directly from a pharmacy or even grocery store. Quite apart from the loss of quality of life, measurable economic losses from impaired vision are staggering.
For workers who must be able to see objects up close to perform their tasks, the loss of near vision translates into reduced productivity, excessive effort and frequent headaches. Workers in textiles and apparel, rugmakers, weavers, artisans, tea-pickers, and bicycle and auto mechanics fall in this category. Some recent work with Varanasi weavers has shown that almost 70 per cent need a pair of eyeglasses.
A July 2018 study published in the Lancet (bit.do/e3bYG) tried to measure the impact of near-vision glasses the impact of near-vision glasses on productivity of tea-pickers in terms of gain in daily weight of tea picked. It found that corrective eyeglasses improved productivity of tea pickers on average by 21.7 per cent . For workers aged 50 years and above, the increase was much higher at 32 per cent. This was the highest productivity increase ever recorded through a health intervention in low- and middle-income countries.
In a similar vein, impaired vision among children translates to poorer learning outcomes. Inability to see what is written on the board, or to read books, can result in loss of motivation and poor learning outcomes. Eye tests in schools in India typically show that 8-10 per cent of children, and even higher proportion of teachers, suffer from refractive error and have never worn corrective glasses. Research on primary school children in China has shown that correcting vision is the equivalent of an additional one-third to half a year of schooling.
When it comes to driving, impaired vision also has serious outcomes for road safety. Poor vision is one of the leading causes of road and industrial accidents worldwide. When randomly tested along Indian highways, more than half of truck drivers are found to suffer from vision problems and are without eyeglasses.
Numerous NGOs and social entrepreneurships, including Aravind, LV Prasad, Sankara and VisionSpring, have been working to bring eyeglasses to the underprivileged in India. While their work is admirable, the scale of the problem is too large for them to solve it. Even if they could dispense 10 million glasses a year, which they probably do not do currently, it will take them decades to bring even the first pair of eyeglasses to all those needing them. The real challenge is much bigger since eyeglasses require replacing every two to three years.
This is why India will need the central government to intervene on a vast scale and attack the problem in mission mode. Given the current pressures on the financial resources of GoI, this may not be immediately feasible. But in view of the high ‘bang for the buck’ from corrective eyeglasses, such a mission ought to be high up on its ‘to do’ list.
GoI has many avenues available to it for dispensation of eyeglasses that private NGOs and social entrepreneurships lack. For instance, in rural areas, there are easily 1 million-plus community health workers, most notably, accredited social health activists and anganwadi workers. If these workers dispensed even one pair of eyeglasses a week on average, they would be able to dispense an impressive 50 million-plus pairs each year.
Likewise, GoI could mobilise the instrumentality of India Post, Common Service Centers (CSCs) and Indian Railways. Carrying eyeglasses at post offices, CSCs and railway stations could help reach millions of individuals each day.
In principle, a mission to bring eyeglasses to all could also advance the cause of manufacturing activity and employment creation. At present, India lacks an ecosystem to manufacture eyeglasses at low cost. GoI imposes a customs duty of 25-35 per cent to protect domestic producers, but has only ended up hurting the weaker sections of the society by adding to the cost of eyeglasses they buy. A national mission aimed at providing eyeglasses to all who need them could potentially pave the way for the emergence of their large-scale manufacturing in India while also raising productivity of India’s workforce, improving learning outcomes and reducing deaths due to road accidents.
(The writer is Professor, Economics, Columbia University, US)