Refractive Error

Millions are functionally blind for the lack of access to spectacles

Refractive error

Information and resources provided courtesy of the Brien Holden Vision Institute (BHVI) – photos by Dean Saffron, BHVI

Refractive errors (myopia, hypermetropia, astigmatism, presbyopia) result in an unfocussed image falling on the retina. Uncorrected refractive errors, which affect persons of all ages and ethnic groups, are the main cause of vision impairment. They may result in lost education and employment opportunities, lower productivity and impaired quality of life.

Optical workshop in the Solomon Islands Photo by Dean Saffron, courtesy of Brien Holden Vision InstituteIn 2010, it was estimated that 123 million people had significant vision impairment (< 6/18 in the better eye) due to uncorrected refractive errors affecting distance vision, including at least eight million people with blindness (< 3/60 in the better eye).1 In addition, 517 million people were without adequate correction for functional presbyopia in 2005 estimate.2

The global economic cost in lost productivity due to avoidable distance vision impairment alone was estimated to be I$269 billion (approximately US$202 billion) each year in 2009.3 A relatively small investment (compared to the cost) of US$28 billion would establish the eye care services required to provide good vision to people with uncorrected refractive error and create savings of US$202 billion to the global economy annually.4Refraction trianing in Vietnam Photo by Dean Saffron, courtesy of Brien Holden Vision InstituteThe economic value of an intervention that eliminated uncorrected refractive error is dwarfed by  the humanitarian imperative that is driving efforts to deliver quality eye care to all that need it. We continue to see lives transformed in developing communities through the building of sustainable eye care systems via collaborations between eye care professionals, non government organisations, local governments, health care systems, communities and individuals.

However, the task of meeting the needs of all of those with uncorrected refractive error remains a monumental one. A critical advance in thinking has been the movement towards  the integration of eye care within the broader development paradigm and the Millennium Development Goals. By advocating for eye care programs as a logical fit with reforms geared to improving economic, social and health outcomes, success is more likely.

Additional Resources

IAPB Refractive Error Work Group

In September 2013 the IAPB Board approved the establishment of the Refractive Error Work Group with the objective to provide leadership for IAPB Members and other stakeholders on priority matters relating to Refractive Error. Learn more about the group and ways for members to engage at the link below.

RE Work Group


  1. Pascolini, D. & Mariotti, S.P. 2011. Global Estimates of Visual Impairment: 2010. British Journal of Ophthalmology, doi:10.1136/bjophthalmol-2011-300539. Pp. 1-5.
  2. Holden BA, Fricke TR, May Ho S, Wong R, Schlenther G, Cronje S, Burnett A, Papas E, Naidoo KS, Frick KD, ‘Global vision impairment due to uncorrected presbyopia’, Archives of Ophthalmology, Vol 126 (No. 12), Dec 2008
  3. Smith TST, Frick KD, Holden BA, Fricke TR, Naidoo KS, ‘Potential lost productivity resulting from the global burden of uncorrected refractive error’ in Bulletin of the World Health Organization, 2009; 87
  4. Fricke TR, Holden BA, Wilson DA, Schlenther G, Naidoo KS, Resnikoff S & Frick KD. Global cost of correcting vision impairment from uncorrected refractive error. Bulletin of the World Health Organization, published online ahead of print 12 July 2012.