Taking Action in India

What are the biggest barriers to eye care in these underserved communities?

I think there is still a distinct lack of public awareness. If we screen children, they do not realize that they just need a pair of glasses; they feel that’s just how the world looks. They come from low-income backgrounds and their parents feel the same way. Conversely, older patients – above 40 – feel that deteriorating vision is simply a natural part of aging, and as a result they won’t seek any kind of intervention.

This lack of awareness is exacerbated by the lack of healthcare information available to the general public. For example, people do not always tend to know what an eye screening involves. Some of them believe it’s on par with surgery and an invasive procedure. This kind of misinformation exists within many of the communities we visit.

There are also social stigmas and taboos associated with wearing glasses. This applies to commercial drivers – truckers – as well. If you’re a truck driver who wears glasses in India, you’re actually considered unfit to drive a vehicle. It’s quite paradoxical, given that someone’s found a solution for correcting blurry vision. But the idea is that, if you’re wearing glasses then your eyesight is poor and you’ll be unable to drive. That’s the overriding interpretation.

The third barrier is affordability and access. Especially in rural areas, often there is no access to eye care, and if there is access, it is to really poor quality glasses. So, a patient has a bad experience – they’ve got overpriced glasses that don’t last even a month. This keeps them from seeking a second pair and creates negative word-of-mouth that glasses don’t actually help.

How do you see telemedicine and AI improving access to eye care?

We’ve tested some eye screening devices and got mixed results. It’s not yet able to replace a subjective refraction. More than 70 percent of the patients we encounter are first-time wearers, so we’re very particular about the prescriptions we give out and we want to make sure patients are getting the right kind of glasses. But the technology is evolving.

India has an acute shortage of trained optometrists, and despite corrective steps being taken by the government, there is still a huge gap that needs to be filled. AI is set to play a huge role in the future to solve this problem. Then we can have an optometrist sitting anywhere in the country, with community health workers or ophthalmic assistants going out into rural areas, conducting eye exams and giving eyeglasses on-the-spot or sending the prescriptions to the lens lab for delivery later. India has an advantage in terms of using this technology as it has huge penetration of mobile phones, even in rural regions, and the cheapest internet anywhere in the world.

What is your vision for the next decade of VisionSpring’s growth and impact?

One of the things we are very conscious of is that one organization alone will not be able to solve the problem. In India there are around 550 million people who currently need glasses. Around 200 million have access to some level of eye care, but around 350 million do not. So, no matter how big we become or how well we scale up, our impact will not touch everyone. As a result, we partner with close to 1,000 organizations in India – government, CSRs, hospitals, corporate initiatives, other NGOs, etc., and these collaborations are key.

We are looking at how we can work closely with the government to create more long-term policies for eye care. The WHO’s SPECS 2030 initiative was launched in May 2024, and India has become one of the first countries to adopt that strategy. Already eight states have expressed their willingness to partner with WHO to increase their effective refractive error coverage by 40 percent by 2030, which is the main goal of the strategy.

Everything we do in India, we call it the “India Clear Vision Mission.” We’ve seen that when India does things in a “mission mode,” whether it’s eliminating polio or rolling out the COVID-19 vaccination, these are big successes. It’s a country that can actually create a lot of awareness and achieve a lot in a timely manner when the correct initiatives and incentives are in place.