Progress, but not enough: Why blindness remains a public health challenge in India

How many people in India are blind?

It’s a simple question but the answer varies, depending on the data source and adoption of “old” (vision of <6/60 in the better eye)  and “new” (vision of <3/60 in the better eye) definitions of blindness for studies. Most news reports estimate India has around 12 million blind people, but this data is from a national survey conducted in 1986-89. Over 30 years later, a study estimated that the prevalence of blindness over the age of 45 is as high as 2.30 percent of the age group population in the country. 

Blindness and vision impairment are significant public health challenges in India. According to the World Health Organisation, India accounts for one-fifth of the global burden of blindness in 2010. The prevalence of blindness and vision impairment in India is disproportionately high compared to developed countries – and it’s a significant obstacle to economic development and social progress.

Although healthcare institutions have made some progress in addressing blindness and vision impairment over the past few decades, much more needs to be done to reduce the burden of eye disease and improve access to ophthalmic services.

Prevalence

Prevalence of blindness and vision impairment in India varies significantly across regions and demographics. According to the National Blindness and Visual Impairment Survey, which was conducted between 2015 and 2019 by the union ministry of health and family welfare, the prevalence of blindness in India is 0.36 percent, which is about 6.2 million people. The prevalence of moderate to severe visual impairment is 1.06 percent, or 55 million.

The survey also noted that blindness in rural areas is 1.37 more prevalent than in urban areas, while the prevalence of moderate to severe visual impairment is 1.22 times higher. Additionally, the prevalence of blindness in people aged 50 and above is 1.43 percent while 4.06 percent suffer moderate to severe visual impairment.

Primary causes

The leading causes of blindness and vision impairment in India include cataracts, uncorrected refractive errors, and glaucoma. According to the National Blindness and Visual Impairment Survey, cataract is the leading cause of blindness, accounting for 66.2 percent of all cases of blindness in India. Uncorrected refractive errors account for 18.6 percent, and glaucoma for 6.7 percent.

Other causes of blindness and vision impairment include corneal opacities (0.9 percent), childhood blindness (1.7 percent), and diabetic retinopathy (3.3 percent). 

Economic burden

Blindness and vision impairment have significant direct healthcare costs for individuals, families and the healthcare system. For example, in India, the cost of cataract surgery (one of the most common causes of blindness) can range from Rs 10,000 to Rs 60,000 (approximately $135-810), depending on the type of surgery and the provider. The cost of other eye conditions and treatments can also be significant, particularly for those living in rural or remote areas, where access to healthcare services may be limited.

Vision impairment significantly impacts individuals and society's productivity, particularly in the working age population. In India, people with vision impairment are more likely to be unemployed or underemployed than those without it. According to the Lancet Global Health Commission on Global Eye Health, visually impaired people in India are 15 percent less likely to be employed than those without visual impairment. Those employed earn 20 percent less than their counterparts without visual impairment. 

Reduced productivity due to vision impairment has an impact on the national economy as well. According to a report, the estimated net loss of gross national income due to blindness in India is estimated to be Rs 84,500 crore ($38.4 billion), with a per capita loss of gross national income per blind person of Rs 1,70,624 ($7,756). The cumulative loss of gross national income due to avoidable blindness in the country was estimated to be  Rs 11.77 lakh crore ($ 535 billion). 

Over the past 20 years, the cumulative loss of gross national income due to blindness has tripled. Additionally, the potential loss of productivity due to vision impairment in the country has been calculated to be Rs 64,600 crore ($29.4 billion).This loss is due to reduced productivity, increased healthcare costs, and lost income due to unemployment or underemployment.

To address the economic impact of blindness and vision impairment, the Indian government needs to focus on creating more job opportunities and vocational training programmes for people with visual impairment. The government can also encourage companies to provide reasonable accommodations for people with visual impairment, such as assistive technology and flexible work arrangements, to enable them to work more effectively.  

Ophthalmic disorders have significant social welfare costs, particularly for those from low-income households. In India, people with visual impairment are more likely to experience poverty and face barriers to accessing education, healthcare, and other essential services. The ​​Andhra Pradesh Eye Disease study, conducted between 1996 and 2000, reported that blindness was more likely in lower (by five times) and extremely lower (by 9.7 times) compared to upper socioeconomic strata. A recent report highlighted the illiteracy rates in blind population were 5.6 times higher compared to the rest of the population.

These social welfare costs can have long-term impacts on individuals and families and the economy as a whole. For example, children with visual impairment are less likely to attend school and receive a quality education, which can limit their future job opportunities and earning potential. This, in turn, can perpetuate the cycle of poverty and reduce overall economic growth.

Progress

In 1976, the National Programme for Control of Blindness and Visual Impairment was launched to reduce the prevalence of blindness in India. Its data indicates blindness and vision impairment in India has decreased from 5.30 percent and 0.68 percent in 2010 to 2.55 and 0.36 percent in 2019, respectively.

The programme has also made significant progress in increasing access to eye care services in India. It established a nationwide network of eye care facilities, including primary eye care centres, vision centres, and tertiary eye care centres, while also training professionals including ophthalmologists, optometrists and paramedical staff. The programme also launched initiatives to address specific causes of blindness and vision impairment including conducting 37.8 lakh cataract surgeries and 71,000 eye donations in 2022-23.

Private organisations – such as LV Prasad Eye Institute, Aravind Eye Hospital and Sankara Nethralaya – have also played a significant role in addressing these issues in India.

Challenges

Despite this progress, several challenges remain, such as the lack of awareness about eye care services among the general population. Many people in India are not aware of the importance of regular eye check-ups and do not seek eye care services until they experience significant vision loss.

Another challenge is the uneven distribution of eye care facilities across the country. Some regions have a relatively high density of these facilities while others, especially rural areas, have a severe shortage. 

The lack of trained eye care professionals is another challenge in addressing blindness and vision impairment in India. While the National Programme for Control of Blindness and Visual Impairment made significant progress in training such professionals, there’s still a shortage of ophthalmologists, optometrists and other eye care professionals, particularly in rural areas.

The high cost of eye care services is a barrier to access for many people in India. The national programme provides free eye care services to specific populations, such as senior citizens and those living below the poverty line, but many others still cannot afford eye care services, particularly for surgical procedures such as cataract removal and intraocular lens placement. 

Finally, the Covid pandemic significantly impacted eye care services in India. Many eye care facilities were closed during that time, and those that remained open faced significant challenges in providing services while adhering to Covid protocols.

So, despite the efforts by governments and private entities, blindness and vision impairment remain significant public health challenges in India. What’s needed is a continued investment in eye care services and greater awareness about the importance of regular eye check-ups.