{"id":40078,"date":"2025-09-04T06:07:48","date_gmt":"2025-09-04T06:07:48","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjgh\/?p=40078"},"modified":"2025-09-04T06:07:48","modified_gmt":"2025-09-04T06:07:48","slug":"eliminating-uncorrected-refractive-error-by-2030-lmics-need-policies-and-a-roadmap-not-just-intentions","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjgh\/2025\/09\/04\/eliminating-uncorrected-refractive-error-by-2030-lmics-need-policies-and-a-roadmap-not-just-intentions\/","title":{"rendered":"Eliminating Uncorrected Refractive Error by 2030: LMICs Need Policies and a Roadmap, Not Just Intentions"},"content":{"rendered":"
<\/h6>\n

Eye health<\/a> intersects with several key UN Sustainable Development Goals (SDGs), making it a critical issue globally. An estimated 2.2 billion people suffer from impaired vision, and uncorrected refractive error (URE)<\/a> is among the primary, preventable causes of vision loss. In low- and middle-income countries (LMICs), approximately two-thirds of those who need spectacles lack access to them.<\/a><\/p>\n

In 2021, the World Health Assembly endorsed an ambitious global target: increase effective refractive error coverage (eREC) by 40% by 2030<\/a>. Countries have made this commitment, but with less than five years remaining, most are off-track.<\/a> The barrier is not a lack of solutions\u2014spectacles and basic refractive services are affordable and effective. What is missing is a systematic, scalable, and sustainable delivery model to deliver these solutions equitably to populations who need them most.<\/p>\n

The scale of the URE<\/strong><\/h6>\n

The global burden of URE is staggering. Myopia alone affected an estimated 2.6 billion people in 2020 and is projected to reach 3.4 billion by 2030. In addition, the global lost productivity per annum attributable to myopia is estimated at $244 billion annually.<\/a> Presbyopia affects an additional 1.8 billion people worldwide, nearly half of whom remain uncorrected. These are not just statistics; they reflect real barriers and significant socio-economic impact\u2014children unable to learn, adults unable to earn a livelihood, and elderly losing functional independence due to a treatable condition.<\/p>\n

Even countries like Bhutan, where eye care\u2014including refractive services\u2014has been integrated into the public health system<\/a> for decades, and where coverage is strong by regional standards, eREC remains below 50%. Despite political commitment and a public health approach, significant gaps persist in access, workforce distribution, and service quality, especially in remote and rural areas.<\/p>\n

Fragmented efforts, missing strategy<\/strong><\/h6>\n

In many LMICs, the primary challenge is not a lack of effort but rather what can be described as \u201cfragmented ambition.\u201d Goodwill, innovation, and technical guidance are plentiful\u2014governments, NGOs, social enterprises, and development partners are all active in refractive care. However, initiatives often remain siloed, small-scale, and unsustainable.<\/a> The result is slow, uneven, and non-replicable progress. To eliminate URE by 2030, LMICs need more than good intentions or one-off technology solutions. What\u2019s missing is clear: an actionable roadmap to systematically translate evidence into practice at scale.<\/p>\n

A framework for action<\/strong><\/h6>\n

Given the persistent resource constraints, LMICs need a roadmap\u2014a scalable, evidence-based plan that aligns needs with action and policy with people. No single approach fits all\u2014a Himalayan country will require a different model than a peri-urban setting in sub-Saharan Africa. Nonetheless, universal needs include data-driven planning, cross-sectoral coordination, context-sensitive interventions, scalable strategies, and demand generation. We propose a five-phase sequential framework designed to provide a systematic, adaptable, and policy-relevant pathway for implementation:<\/p>\n

    \n
  1. Estimate the Need:<\/strong> Estimate population-level burden using rapid assessment surveys and synthesize data to close research gaps and identify priority populations.<\/li>\n
  2. Assess the Resources: <\/strong>Assess and map available infrastructure, workforce, and capacity for service delivery using WHO\u2019s\u00a0 Refractive Error Situation Analysis Tool (RESAT)<\/a>.<\/li>\n
  3. Design the Model: <\/strong>Formulate a context-specific service delivery model reflecting local realities through public systems, NGOs, private providers, or a hybrid approach.<\/li>\n
  4. Implement and scale up: <\/strong>Evaluate and implement the model, leveraging adaptive learning and real-time feedback to refine delivery, and monitor outcomes. Ultimately, there is a need to scale up<\/a> what works.<\/li>\n
  5. Generate Demand : <\/strong>The entire refractive error strategy must be supported by an effective health promotion strategy. Culturally sensitive awareness campaigns are critical to drive continued uptake of services.<\/li>\n<\/ol>\n
    Why does this matter now?<\/strong><\/h6>\n

    Urgency is critical. If current patterns persist, URE will continue to disproportionately affect the poorest and most marginalized, including rural populations, women, and the elderly. Recent global milestones have elevated URE at the forefront of the public health agenda. The WHO has launched the SPESC 2030 initiative<\/a> and supporting tools. Funding partners and the private sector are engaged and LMICs increasingly recognize the socio-economic consequences of URE. To build on this momentum, refractive services must be fully integrated into Universal Health Coverage (UHC) and national health planning\u2014not treated as mere add-ons. Importantly, URE should be reframed not solely as a health agenda but as a critical development and economic priority, central to achieving SDGs.<\/p>\n

    The opportunity<\/strong><\/h6>\n

    Bhutan\u2019s experience demonstrates that even free and integrated public eye care systems need more than access alone to achieve high eREC. By embracing an evidence-based strategy, sustained investment, and a people-centered roadmap, LMICs can meet the 2030 eREC targets. We believe our proposed framework offers a practical path forward and serves as a catalyst for policymakers, implementers, and funders. Vision loss from URE is one of the most readily solvable global health challenges. Governments, development partners, and the private sector must urgently prioritize investment in scalable refractive error solutions. Tinkering with small projects is not an option. Let\u2019s not miss the opportunity to eliminate URE\u2014systematically, equitably, and by 2030.<\/p>\n

    Authors: <\/strong>Indra Prasad Sharma is an optometry researcher and the Chief of Clinical Services at the Ministry of Health, Bhutan.<\/p>\n

    Prof. Kovin S. Naidoo is an optometrist, public health advocate, professor at UKZN, South Africa, and UNSW, Australia, renowned for his leadership in global eye health and vision equity. Prof. Naidoo is also the Global Head of Partnerships & Advocacy at OneSight EssilorLuxottica Foundation and visiting Professor at Wenzhou Medical University, China.<\/p>\n

    Prof. Khathutshelo Percy Mashige is a Professor of Optometry and Dean and Head of the School of Health Sciences at UKZN. Prof. Mashige is also the CEO of the African Vision Research Institute and a visiting Professor at Wenzhou University, China.<\/p>\n

    Prof. Nor Tshering Lepcha is an ophthalmologist and professor at the Khesar Gyalpo University of Medical Sciences of Bhutan, and former Technical Advisor for Eye Health to Bhutan\u2019s Ministry of Health.<\/p>\n

    Competing interests:<\/strong> None<\/p>\n

    Handling Editor:<\/strong> Neha Faruqui<\/p>\n","protected":false},"excerpt":{"rendered":"

    Eye health intersects with several key UN Sustainable Development Goals (SDGs), making it a critical issue globally. An estimated 2.2 billion people suffer from impaired vision, and uncorrected refractive error (URE) is among the primary, preventable causes of vision loss. In low- and middle-income countries (LMICs), approximately two-thirds of those who need spectacles lack access […]<\/p>\n

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