Globally, uncorrected refractive error (URE) is one of the leading causes of visual impairment and the second leading cause of blindness after cataracts. 1 Out of 2. 2 billion people with visual impairment, there exists a significant portion (one billion) that can be prevented if timely addressed and treated. 2 Since sensory input is very crucial for learning, living with URE can worsen academic performance and cognitive domain, especially in children. The economic burden due to URE alone is estimated to be 200 billion globally, due to loss of productivity. 3 The implementation of simple, cost-effective, refractive services, such as the provision of spectacles, can restore functional vision, improve educational performance, enhance work productivity, and significantly improve overall quality of life. Despite being cost-effective, mounting evidence suggests that the coverage of spectacle usage is not uniform, being lower in rural areas than in urban areas. This regional disparity could be due to a lack of accessibility, affordability, inadequate human resources, intruding cultural myths associated with the use of spectacles, and poorly integrated eye care services with the health system. This situation underscores the need for inclusion of people-centered targeted eye care services in the health system, with the coordination of stakeholders (Govt, nongovernmental organization (NGO), and private organizations) and aiming toward not only the detection of refractive error but also timely correction and quality-related outcomes across all age groups. A Global Eye Health Indicator—Effective Refractive Error Coverage (eREC) To address the quality gap in services, WHO included “eREC” as a phenomenal global eye health indicator at the World Health Assembly in 2021, which aims to increase the coverage of refractive error services by 40 percentage points by 2030. 4 The “eREC” is defined as the proportion of individuals with refractive error who have received appropriate correction and achieved a good visual outcome, relative to the total number of people in need of refractive services. 3 It clearly differentiates met need from undermet and unmet need, thereby focusing not only on the number of spectacles being dispensed but also on the impact it made on the individual’s life after the provision of service. It highlights the potential lacunae in quality, follow-up, and efficient service delivery. 3 India has made commendable progress in reducing avoidable blindness, particularly due to cataract, but the refractive error services have largely been addressed through fragmented initiatives such as school screening programs, outreach awareness camps, strengthening vision centers for dispensing spectacles, and leveraging private, public, and NGO. It is imperative to integrate all the fragmented efforts into national eye health to achieve global targets of strengthening refractive error services and to identify population groups which are in need of intervention. Though multiple studies in the past, within India and outside India, have documented the prevalence of refractive errors among children and adults, there is a significant scarcity of baseline data on e-REC to compare with other regions of India or the World. The initiative started by the All-India Ophthalmological Society to conduct a survey across India for the evaluation of the prevalence of refractive errors and eREC, targeting children. Similar initiatives have been planned to assess the eREC among all age groups, including presbyopia, as part of the National Blindness and Visual impairment Survey. This will help to generate baseline data and will serve as a benchmark against which other data can be compared to measure the impact of refractive services in India. It will also help in strengthening the policy implementation by the ministry and National programme for control of blindness (NPCB) and Visual impairment (VI). Strategic Plan across the Age Children and adolescents Refractive errors in children have far-reaching implications for learning, social development, and future productivity. Though effective eye screening programs in school remain the cornerstone for detection, challenges regarding effective refractive coverage, compliance, and proper spectacle use need to be monitored strictly. 5 Improving eREC among children requires structured elaborative screening protocols linked to accessible refraction services, timely provision of quality spectacles, and monitoring of visual outcomes and adherence. 5, 6 Engagement of teachers and alleviating parents’ appraisal of spectacle usage is imperative to destigmatize and improve compliance. Currently, although school vision screening and free spectacle distribution are national priorities, the current target of 1. 5 million spectacles falls short of the actual need among school-going children. Adults and old people Among adults, URE contributes to reduced productivity, increased risk of falls, fractures, and avoidable economic losses. 7 To strengthen, effective refractive error services among adults require integration of services at primary healthcare, expansion of vision center model staffed by trained optometrists, and workplace-based screening programs in both organized and informal sectors. 8, 9 To improve coverage, ensuring affordability remains critical. Despite high prevalence and cost-effective correction of presbyopia, it often goes unnoticed. Many older adults continue to experience difficulty with near tasks, affecting daily functioning and independence. 9, 10 Improving eREC for presbyopia requires routine near-vision assessment, availability of cost-effective ready-made reading glasses, and inclusion of near-vision correction in outreach and insurance-based programs. 7 The NPCB and VI is also considering the implementation of a Mass Presbyopia Program, involving Accredited social health activist (ASHA) workers and community volunteers, to expand access to near-vision correction. WHO Supporting provision of eye care coverage and spectacles (SPECS) 2030 The WHO SPECS 2030 was endorsed in May 2024 to offer a comprehensive, structured framework globally to guide countries, policy makers, and stakeholders, to work in coordination to strengthen refractive services across all age groups. It aims to achieve the global target of 40% by universal access to affordable and quality-assured people-centered eye care. It works on five strategic pillars—Services, Personnel, Education, Cost, and Surveillance. At the heart of this structured framework is the evaluation of eREC, which indicates not only the accessibility of services but also how effective those services are in restoring the vision. By integrating refractive services into national health systems and leveraging the Global SPECS Network, the program aims to destigmatize and reduce economic barriers for over 800 million people who currently lack glasses. Conclusion Universal eye health for refractive error services in India is not merely a clinical imperative but a public health and developmental priority. The national representative data on e-REC is very crucial to build robust refractive service-related monitoring, expand refractive services, and integrate refractive error care into broader health frameworks. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest. About the authorProf. Dr. Praveen Vashist Prof. Dr. Praveen Vashist, MD, MSc (London) and is currently Officer in-charge, Community Ophthalmology, at Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi. He is providing technical support to the National Programme for Control of Blindness in India and has been involved in planning, implementation, and monitoring in all major surveys under NPCB over the last 20 years (National Blindness & Visual impairment survey, National diabetic retinopathy surveys, National Trachoma Prevalence Surveys, National TT only surveys, National Corneal Opacity Survey, National Human resource and Infrastructure surveys). He is a Member of many National Task Force & Committees under NPCB&VI, India. He is known for working for Trachoma Elimination in India and is currently implementing AIOS_ Project SEE- National survey on eREC among Children and National survey on Rapid Assessment of eREC and Presbyopia in India.
Praveen Vashist (Thu,) studied this question.