WHO Publishes Policy Considerations to Improve Access to Refractive Error Care
The World Health Organization, WHO, has published “Policy considerations to improve access to refractive error care.”
The guide focuses on policy actions that can help improve access to spectacles, the most common intervention for refractive error care.
Why Refractive Error Care Matters
WHO states that uncorrected refractive error is the leading cause of vision impairment worldwide.
Refractive errors occur when the shape or length of the eye prevents light from focusing properly on the retina, resulting in blurred vision. Common refractive errors include myopia and presbyopia.
According to the guide, reduced vision from refractive errors can be corrected through a simple and cost-effective solution: spectacles. However, access remains limited due to challenges such as lack of human resources, poor awareness, restrictive regulations, limited access to services and inflated costs.
Global Need and Economic Case
WHO highlights that at least one billion people globally have a vision impairment that could have been prevented or has yet to be addressed.
The guide also notes that fully addressing avoidable vision impairment could generate economic returns of up to US$ 447 billion annually in productivity gains. In low- and middle-income countries, every US$ 1 invested in vision correction is estimated to return US$ 28 through improved workforce participation and education, and reduced health costs.
Link With SPECS 2030
The publication is aligned with WHO’s SPECS 2030 initiative, launched in May 2024 to support countries in achieving the global target of a 40-percentage point increase in refractive error coverage by 2030.
The guide organizes policy actions around five areas aligned with SPECS 2030:
improve access to refractive error services;
build capacity of personnel;
improve population education;
reduce the cost of services;
strengthen surveillance and research.
Government Leadership and Stakeholder Engagement
WHO emphasizes that government leadership is essential to overcome systemic barriers to refractive error management.
The guide notes that most national health systems do not currently include spectacles in health services packages and often treat them as consumer products rather than essential health devices.
WHO recommends that refractive error services be included as part of comprehensive eye care and embedded in national health strategies. The guide also highlights the need to engage stakeholders such as professional associations, optical retailers, informal providers, social enterprises, nongovernmental organizations, ministries, regulatory bodies and consumer groups.
Improving Access to Services
The guide recommends integrating spectacles dispensing into the public health system and authorizing over-the-counter provision of ready-made near-vision spectacles.
WHO also highlights school-based eye care programmes, workplace vision screening and innovative service delivery models to reach underserved populations.
The guide notes that technology-enabled solutions may support access, including mobile eye screening applications, portable autorefractors, telehealth platforms, artificial intelligence for clinical decision support, digital data platforms and digital inventory systems.
Building Workforce Capacity
WHO identifies workforce limitations as a key barrier.
In many countries, people with expertise in refraction, optical dispensing and optical store management may be absent or underused due to unclear legal status or overlapping scopes of practice.
The guide recommends regulatory frameworks based on clearly defined competencies rather than professional titles, legal recognition of refractive error personnel, task reallocation supported by training and referral systems, and structured training programmes with standardized curricula.
Reducing Costs and Regulatory Barriers
WHO explains that spectacles are often treated as consumer or luxury items rather than essential health products, contributing to taxes, tariffs and higher prices.
The guide recommends removing or reducing import duties and customs tariffs on spectacles and components, streamlining importation and market entry procedures, reducing VAT or sales taxes on spectacles, and strengthening local and regional distribution networks.
It also notes that complex regulatory processes can deter providers and increase prices for end users, particularly for low-risk products such as spectacles.
Surveillance, Quality Standards and Research
The guide recommends establishing quality standards for refraction and spectacle dispensing and strengthening refractive error monitoring and surveillance.
WHO highlights the need for quality assessment frameworks across the refractive care process, from refraction to dispensing, and recommends establishing or adhering to international standards for spectacles.
The guide also recommends integrating refractive error indicators into national health information systems, including equity considerations such as geography, socioeconomic status, sex and age.
Impact on Medical Device and Assistive Product Stakeholders
For manufacturers, distributors and regulatory stakeholders involved in spectacles, lenses and related vision products, the publication is relevant because it frames spectacles as essential, cost-effective interventions for public health.
Stakeholders should pay particular attention to:
classification of spectacles as health products or assistive products;
regulatory pathways for ready-made near-vision spectacles;
over-the-counter access models;
quality standards for lenses, frames and dispensing;
import duties, customs tariffs and VAT treatment;
streamlined market entry procedures;
local and regional distribution networks;
public procurement and pooled procurement models;
integration of spectacles into health service packages;
surveillance and post-market quality monitoring.
For companies and organizations working in eye care, the key message is that improving access to spectacles requires coordinated policy action across health, education, labour, trade, finance and regulatory systems.
