Vision Guardians: Beacons of Sight

A new article by Dr Srinivas Marmamula and others from L V Prasad Eye Institute discusses the role of Vision Guardians at the foundation of the LVPEI pyramid model. It discusses their training and recruitment, performance monitoring, and the impact vision guardians have on their communities. 

More than a billion people worldwide are impacted by vision loss, but do not have access to eye care. Nearly 90% of this vision loss can be addressed by the provision of glasses or cataract surgery, both relatively inexpensive and simple health interventions. The global healthcare community has acknowledged the social and economic impact of vision loss on health and wellbeing.  The World Health Organization (WHO) global action plan for ‘universal eye health’ has called upon nations to improve access to care. This action plan supports the sustainable development goals (SDGs), where vision loss can influence the success of 11 of the 17 SDGs. Enabling access to eye care is integral to making these policy goals a reality. 

Taking eye care close to where the need is the most is key to addressing issues of access. By providing care closer to such under-served communities, we have a better chance of improving uptake of eye care services. Such shoe-leather eye care work is the first step towards mitigating the various barriers to engagement. Such a grassroots focus can do so much more: restore dignity, address gender imbalance, and foster trust in health services. An eye care service that enjoys the advantages of proximity and trust can lead to better engagement with eye care services and help achieve universal eye health.

A new paper by Dr Srinivas Marmamula and others in the Community Eye Health Journal discusses the role of ‘vision guardians’ in LVPEI’s pyramidal model of eyecare delivery. Vision guardians (VG) form the base of the LVPEI pyramid; they are at the coalface of eye care service uptake. VGs are recruited from the local community and are either part-time volunteers or employed full time to support eye care delivery.  They are trained to examine an eye with a torchlight, inspecting it for abnormalities. They also maintain records of care provided to ensure referrals are realized, and provide basic counselling services. Vision guardians are mostly young women with an interest in the health of their communities.  

The paper also shares the results of a three-year community linked initiative project (CLIP) in a sub district in Telangana. 38,829 people from 52 villages were screened by vision guardians (all women) over 3 years. They identified 9.3% (3616 people) with eye problems and referred them for care. The paper notes that vision guardians who received a salary were more consistent compared to the volunteers. The authors are keen to study such differences.   

'The Vision Guardian is indispensable for extending the reach of primary eye care. I consider this approach as a foundation for providing holistic eye care in our communities,' says Dr Srinivas Marmamula, Associate Director - Public Health Research and Training (GPR ICARE), L V Prasad Eye Institute.   


Marmamula S, Varada R, Williams JD, Khanna RC. Vision guardians for community eye health: the LV Prasad Eye Institute model in India. Community Eye Health. 2022;35(115):24-26. Epub 2022 Sep 20. PMID: 36425853; PMCID: PMC9680605.

Photo credit: Srinivas Marmamula 

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