From blurry to bold: The case for presbyopia care and education for older women in low- and middle-income countries

Abstract

Presbyopia, the age-related loss of near vision, affects over 1.8 billion people globally and is now the leading cause of vision impairment. Yet, it remains under-addressed in public health strategy. In low- and middle-income countries (LMICs), older women bear a disproportionate burden of uncorrected presbyopia, limiting their ability to work, learn, and participate fully in society. Despite global commitments to gender equality and healthy aging, presbyopia correction is largely absent from vision care frameworks due to low prioritization, cost barriers, and regulatory constraints. This Perspective adopts a person-centred approach, framing presbyopia through the lens of functional vision-how older adults use near vision in everyday tasks such as caregiving, earning income, and self-care. It explores the intersection of gender, aging, and vision loss, drawing on evidence from Bangladesh, Vietnam, South Africa, and Zanzibar to highlight the transformative potential of low-cost near-vision glasses. To address the gaps in needs, we propose six strategies: raising awareness and health literacy, training primary and community health workers, expanding access points, ensuring affordable and reliable spectacle supply, adapting procurement regulations, and translating evidence into policy. We argue that presbyopia correction must be recognised as an essential element of equitable eye health systems and inclusive development policy. Addressing this overlooked need can support gender-responsive universal health coverage and serve as a foundation for integrated, comprehensive approaches to vision care in later life.