Doorstep
Eye Care: When Vision Comes Home to India’s Underserved
At 82, Ramaswamy had learnt to ration his eyesight. Each visit to the eye hospital
meant arranging an escort, enduring crowded transport, waiting for hours for an
eye pressure check, retinal evaluation, cataract assessment or even a simple
change of glasses. By the time he returned home, he was exhausted—and often
unsure whether the effort was worth repeating. Like many elders, he postponed
care, not because it was unnecessary, but because it was overwhelming.
When a comprehensive eye
examination by an optometrist finally reached his doorstep, the difference was
immediate. Eye pressure was measured, the retina examined, cataract status
reviewed and his spectacles updated—all in the familiarity of his living room.
The following morning, he read his newspaper again, fulfilling a long-held wish
he had quietly set aside.
Such moments point to a deeper
truth about eye care in an ageing India.
In 2020, after nearly 26 years in
institutional optometric practice, an optometrist stepped away from routine
professional life to care for his ageing parents. What began as a personal
decision soon evolved into a quiet but powerful rethinking of how eye care
reaches those who need it most.
Elderly relatives first requested
eye check-ups at home. Neighbours and friends followed. Before long, the very
people receiving care became its strongest advocates—vision ambassadors—encouraging
others to seek eye examinations without the ordeal of travelling to hospitals.
The experience exposed a
persistent reality. While India is home to world-class eye hospitals,
access—not availability—remains the real challenge. For elders and vulnerable
populations, hospital visits often involve dependence on caregivers, difficult
travel, long waiting hours, inaccessible restrooms, managing meals outside home
and recurring expenses. These barriers frequently delay or prevent timely eye
care, even when vision loss affects daily functioning.
An Ageing India, a Growing Vision Burden
India is ageing rapidly. People
aged 60 years and above currently account for about 12% of the population, a
figure projected to rise to nearly 22% in the coming decades. With age comes a
sharp increase in vision impairment due to common conditions such as cataract,
uncorrected refractive errors, glaucoma, diabetic eye disease and age-related
macular degeneration.
For many older adults, the
solution does not lie in complex procedures but in regular eye examinations,
early detection and timely optical correction. Yet these essential services
remain out of reach for many precisely because those who need them most are
least able to travel.
Technology Takes Eye Care to the Home
Advances in portable,
technology-enabled eye care equipment have transformed what can be delivered
outside hospital walls. Eye power assessment, eye pressure measurement and
detailed examination of both the front and back of the eye can now be performed
reliably in a patient’s home.
The benefits go beyond
convenience. Care delivered in familiar surroundings is less stressful, more
empathetic and better accepted, especially by elders, persons with
disabilities, the intellectually challenged and individuals with multiple
health conditions. By removing the journey to the hospital, doorstep eye care eliminates
the single greatest barrier to access.
The Optometrist at the Centre of Doorstep Care
Central to this model is the
optometrist—the primary eye care provider and first point of contact in the eye
health system. Trained to assess vision, detect early eye disease, follow-up care, manage refractive, binocular vision
disorders, and common basic eye
conditions, provide low vision care and identify conditions requiring
referral,optometrists are uniquely equipped to deliver comprehensive eye care
at the community level.
Optometric care is inherently
preventive, mobile and people-centred. With portable diagnostic tools, an
optometrist can safely and effectively manage a large proportion of eye care
needs at home, while maintaining strong referral linkages for surgical or
specialised treatment when required. Experience from doorstep programmes shows
that nearly 60–70% of individuals examined can be managed entirely at the
primary care level, significantly reducing unnecessary hospital visits.
This makes doorstep eye care
particularly well suited to independent optometry practice. Individual
practitioners, embedded within communities, often bring continuity of care,
trust and a deeper understanding of patients’ functional visual
needs—especially among elders, persons with disabilities and workers in the
unorganised sector. Far from fragmenting care, this model strengthens the
continuum: the optometrist as the first examiner, hospitals as referral
centres, and the community as an active partner in eye health.
A Community Model Rooted in Dignity
Recognising this need, TwinTech
Healthcare Academy initiated a structured doorstep eye care programme focused
on the truly underserved. Under this initiative, eye care services are provided
free of cost to elders and other vulnerable groups.
The model thrives on
collaboration. The eye care provider contributes professional services
voluntarily. The academy coordinates logistics and connects providers with
beneficiaries. The beneficiaries themselves become partners—spreading
awareness, identifying others in need and supporting future initiatives by
sponsoring spectacles, assisting with transport costs or linking old-age homes
and care shelters with the programme.
The impact has been tangible. In
2025 alone, the initiative reached 1,286 individuals over 109 service days.
About 33% were elders, 12% were Veda Patashala students, 12% were
psychologically challenged adults in asylum centres, with the remainder
comprising workers from the unorganised sector and students. Notably, 421
individuals received spectacles free of cost, restoring functional vision and
independence.
Beyond routine care, select
beneficiaries also received doorstep low vision services, including appropriate
low vision devices. For individuals with irreversible visual loss, this meant
improved ability to read, move independently and manage daily
activities—leading to a meaningful improvement in quality of life.
From Innovation to National Practice
Doorstep eye care is no longer an
isolated experiment. Institutions such as Sankara Nethralaya (Chennai) and L V
Prasad Eye Institute (Hyderabad), along with optical chains like Lenskart and
Lawrence & Mayo, have integrated home-based eye testing into their service
models.
Eye hospitals largely focus on
elders and persons with disabilities, often incorporating teleconsultation and
referral pathways for advanced care. Importantly, experience shows that a
majority of individuals examined at home do not require referral, reinforcing
the value of strong primary eye care delivered closer to communities.
A Public Health Imperative
As India’s elderly population
grows, so will the burden of age-related eye disease. Meeting this challenge
requires strengthening primary eye care, with optometrists playing a central
role beyond clinic walls.
Doorstep eye care is no longer a
charitable add-on or pilot project. It is a public health necessity,
particularly suited to independent optometry practice within an integrated
referral framework. By taking vision care to the homes of those who need it
most, India moves closer to the goal of reaching the unreached.
In the quiet smile of an elder who can see clearly again
lies a powerful truth: accessible eye care begins not in hospitals, but in
homes and communities—one doorstep at a time.
Authors:
Dr R.Krishnakumar,Freelance Optometrist,
Chennai
Dr. A.Mahalingam, TwinTech Healthcare Services,
Chennai
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