One of the most distinctive features about His Holiness the Dalai Lama are his beloved spectacles. It is difficult to imagine him without those familiar circular lenses that have accompanied him all his life. While his glasses could be said to enhance his relatively scholarly activity, from reciting the Kanjur to performing exquisitely elaborate consecrations, empowerments, and other rituals, eyewear is far from the preserve of the bookish. Recently, His Holiness gave his blessing to non-profit VisionSpring’s new presence in Dharamsala, the Indian base of his Gelug school and Tibetan community. VisionSpring focuses on screening eye health and providing optical care to low-income nations in the global south.
“I know from personal experience how a pair of eyeglasses can change someone’s life for the better. I am pleased to know about the good work being done by VisionSpring to correct the vision of underprivileged people, young and old, in Dharamsala recently and in other places as well,” the Dalai Lama said (VisionSpring, India). He met with the executive board of VisionSpring India on 21 June. The organization began screening people in Dharamsala in late April, and in early June, began screening a pool of 812 monastics. And it was a good thing the monks got checked up: 60 per cent needed a pair of glasses and VisionSpring played a critical role in helping 70 per cent get their first pair.
Anshu Taneja, vice president and managing director of VisionSpring India, was effusive about his encounter with His Holiness, reflecting: “He gave us his blessings and was kind enough to spend some one-on-one time with us. We had the leadership of VisionSpring India getting emotional about seeing His Holiness face-to-face. We were so struck by his compassion, gentleness, and encouraging words. It was so special that it will stay with us for the rest of our lives.”
Sub-Saharan Africa, South Asia, Southeast Asia, and Latin America are all within the sphere of concern for VisionSpring’s team. India takes up the largest share of VisionSpring’s work. A staggering 550 million Indians need eyewear, with more than a million requiring eye care annually. Globally, the World Health Organization (WHO) estimates that 1.1 billion people do not have the eyeglasses they need. Conversely, global productivity could be boosted dramatically with proper eye care for this billion-strong population. A 2018 randomized control trial in Assam by the University of Belfast—the results were published in The Lancet—showed that productivity increased as high as 22–32 per cent among a sample group with eye care. Better productivity in much of the global south remains a pathway to a higher quality of life.
“We have a program called Livelihoods in Focus, and its aim is to screen the eyesight of tea, coffee, and cocoa workers around the world. Dharamsala is full of tea plantations but there are also schoolchildren, artisans or craftspeople, and other groups that depend on their eyesight for their livelihoods or education,” Taneja explained. “Glasses are extremely important for people that do delicate or technical work. Consider Namgyal Institute, a learning center for Tibetan crafts. The typical artisans need healthy, sharp vision for what they do when it comes to intricate carvings and sculpting or cutting techniques. And reading sutras, rituals, and ceremonies all require good vision.”
Dharamsala was therefore a natural choice for the VisionSpring board to bring Livelihoods in Focus to. So far, more than 14,000 people in the city and wider area have been screened. The Refractive Error Rate was 63 per cent for adults and 36 per cent for children, the latter being the highest the organization has found in India so far. “We are very proud of how we localize our eyecare initiatives. Being embedded locally helps us overcome cultural biases against eyewear and promote optometrical health through local authority figures and education,” said Taneja.
The misinformation that people can harbor about eyecare is significant and often difficult to dislodge.
“We face a good deal of inertia, denial, and ignorance about eye care in India,” Taneja continued. “A lot of it centers on social stigmas and taboos, for example, among women. In rural India there is almost not a single woman that wears sunglasses, and that is purely based on social and cultural perceptions of sunglasses as projecting a certain image or reflecting on the woman’s character as somehow ‘too cool’ or threatening to men.”
In certain communities, misperceptions about eyewear gets the causality backwards: a driver wearing glasses is seen as having bad eyesight, when it is the glasses that has corrected his already bad eyesight.
“Of course, the poor are more affected by poor eye health,” Taneja continued. “But the plight of the urban poor is usually worse than that of the rural poor, despite the difference being marginal. The rural poor lack access to eyecare, but the urban poor cannot afford the high and prohibitive cost of glasses, whilst financial distress and pollution is worse in cities than in the countryside.”
Being embedded locally is critical to correcting these misconceptions: “In certain areas where the position of women is frankly not good at all, it takes a lot of work from village councils or influential women to educate people about the need for women to get eye care. In certain cases we have made eyeglass screenings into an event by presenting eyeglasses to children like it is a prize, something desirable. We have done campaigns with the government but we need sustained campaigns through social media and with authority figures, like religious leaders and indeed His Holiness. Wearing glasses should be normalized. Taboos can be so ingrained and strong that even those that wear glasses in the home might not wear them in public.”
The good news is that mobile phone culture and social media has penetrated into even rural India, allowing for the stigmas to be challenged more frequently. Building on this trend, VisionSpring India has launched its Clear Vision India initiative. “Anyone who wants eyeglasses will get access to them,” said Taneja. “We have a five-year plan to make eyecare affordable, change perceptions, and create awareness. One question we ask is how we can work more closely with government and stakeholders in places like Dharamsala.”
The leadership plans to return to Dharamsala later this year, to screen more people in tea gardens, schools, and monasteries. They will also make a trip to Ladakh.
Much more work remains to be done, even with a well-honed supply chain. VisionSpring India’s glasses come from different sources, from in-house manufacturing to local manufacturers. Teams then take the glasses to communities. Seventy per cent of glasses are delivered, which was the model followed in Dharamsala. This is only possible, however, with the consent and participation of the local communities.
“Many of the monasteries in Ladakh, especially, are very remote. Almost no one there can get proper eye care. Based on our findings with the monks in Dharamsala, it is fair to predict that many Ladakhi monastics have poor or deteriorating eyesight. We truly hope to make a difference to people there: our work has only just begun.
“We will always seek support from His Holiness, and indeed local support is critical whenever we go to a new area or community. Taking the local people along helps us to get more access and build trust. In the case of Dharamsala, Dawa Phunkyi of Delek Hospital helped us to understand the needs of the community. When he introduced us to the local people, everything became simpler. We are outsiders pushing for a new way of looking at something as intimate and personal as eyesight. But when someone who is part of the community introduces us, we become trustworthy.”
Effect of providing near glasses on productivity among rural Indian tea workers with presbyopia (PROSPER): a randomised trial (The Lancet)
Vision for the Future: Investing in eye health to safeguard sight (Deloitte)