Prevention of avoidable blindness is a social imperative: Facile economic models do not help. Indian J Ophthalmol. 2023 Jun;71(6):2605. doi: 10.4103/IJO.IJO_3142_22. PMID: 37322695.

Singh M, Bhardwaj D, Singh T, Kaushik T, Puliyel J.

Prevention of avoidable blindness is a social imperative: Facile economic models do not help

Singh, Manoj; Bhardwaj, Deepali; Singh, Tanya; Kaushik, Tanuj; Puliyel, Jacob
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Indian Journal of Ophthalmology 71(6):p 2605, June 2023. | DOI: 10.4103/IJO.IJO_3142_22


Dear Editor,

Economic models built by aggregating assumptions yield only a new set of assumptions, and these cannot be relied upon, except to the extent that they provide verifiable data points. The article on evaluation of the economic burden of blindness in India by Mannava et al.[1] unfairly deprecates the value of people with visual disability and makes an incorrect inference.

The productivity of the blind is calculated at 5% that of the sighted. (It is assumed that 20% of the blind are economically productive at 25% of the actual productive workforce.) Also, it is premised that the care of a blind person consumes 10% of the productivity of a sighted person. These assumptions imply that the visually handicapped are a gross drain on the economy. This kind of speculative modeling can be dangerous. Mostert has documented how the Nazis used similar calculations to label the disabled as “useless eaters” and to call for their extermination.[2]

The authors point out that with their calculations, when the prevalence of blindness had reduced to a third (due to reduction of preventable blindness), the loss due to blindness doubled. When avoidable blindness is reduced, the proportion of unavoidable blindness in the population of the blind will increase. The increased loss due to blindness, despite the reduction in its prevalence, is mostly due to an increase in per capita gross national income (GNI). The authors are mistaken when they assert that a “general increase in the proportion of avoidable blindness” contributes to this.

The authors advocate for increased spending on preventing blindness, which we support wholeheartedly. However, this must be based on the disabled person’s inherent right to exist with dignity and what that adds to us as a society – not on faulty calculations of the individual’s economic worth or costs.[3]
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Conflicts of interest

There are no conflicts of interest.
1. Mannava S, Borah RR, Shamanna BR. Current estimates of the economic burden of blindness and visual impairment in India:A cost of illness study. Indian J Ophthalmol 2022;70:2141–5.

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2. Mostert MP. Useless eaters:Disability as genocidal marker in Nazi Germany. J Spec Educ 2002;36:157–70.

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3. Kuhse H, Singer P. Handicapped babies:A right to life?. Nurs Mirror 1985;160:17–20.

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