Eliminating Uncorrected Refractive Error by 2030: A Sequential Framework for Evidence-Based Action in LMICs

Uncorrected refractive error (URE) is a leading global cause of vision impairment (VI) and remains a critical, yet under-addressed challenge, disproportionately affecting low- and middle-income countries (LMICs). In response to the substantial unmet need for refractive care, the 74th World Health Assembly (WHA) established the first global target of increasing effective refractive error coverage (eREC) by 40% by 2030. However, recent estimates show global adult eREC at 65.8% in 2023, with South Asia lagging at lower rates, indicating that no LMIC is on track. To achieve this ambitious target within the next 5 years, it is imperative to develop and implement evidence-based, contextually adaptable, and sustainable strategies responsive to the needs of individual countries and communities. Persistent barriers, including limited resources, fragmented service delivery, and insufficient policy guidance, impede progress, particularly in LMICs. Drawing from contexts such as Bhutan, where refractive errors account for 96.1% of school-aged VI, but effective spectacle coverage is only 11.5%, this article introduces a five-phase, evidence-informed framework: (1) need estimation via surveys, (2) situational analysis using tools such as WHO Refractive Error Situational Analysis Tool (RESAT), (3) model formulation, (4) evaluation and scaling, and (5) demand generation. This supports systemic planning, implementation, and scaling of sustainable refractive error services.