Encouraging Workers Who Need Glasses to Buy & Wear Them


Building Holistic Health




10 factories, 2000 workers


Shahi Exports, VisionSpring, Queens University Belfast, United States Agency for International Development, Clearly







Every year, the Indian economy faces productivity losses to the tune of $37 billion, due to eye related problems. Uncorrected refractive errors and presbyopia affect 10.2% (55 million) and 33% (177 million) of the adult population in India respectively. These conditions can be treated with an inexpensive pair of eye- glasses. Yet, only 25% of those who need glasses actually use them. What stops people from buying and wearing eye-glasses?


What kind of easy to implement pricing of glasses or monitoring system can ensure that workers in garment factories purchase glasses and use them regularly in the workplace? Would providing free glasses to workers (thereby overcoming price barriers) positively impact productivity of workers, attrition from their jobs, job satisfaction and quality of life?


The Eye Health (EH) study is composed of three randomized controlled trials. In all 3 trials, we narrow down on sewing machine operators (SMOs) in garment factories suffering from the progressive decline of eyesight with age, called presbyopia. Uncorrected presbyopia costs up to $11 billion in lost productivity globally, assuming people are productive up to the age of 50 years. Addressing this widespread and easily remedied problem has the potential to improve quality of life, job satisfaction, and job performance. However, in order to motivate industry and other key stakeholders to invest in solving the problem of uncorrected presbyopia in adults, higher-quality data on the postive impact of vision correction are needed. These trials have been co-designed and implemented with a team of researchers who in their RCT conducted among presbyopic tea plantation workers in Assam, India, found massive increases in productivity in the treatment group which was provided free glasses (Congdon et al. (2018). In the first trial, our interventions vary prices- workers get glasses for a subsidized rate or for free. We study the impact of these interventions on adherence to glasses wear, visual quality of life, and attitudes towards glasses among other outcomes. In the second trial, we evaluate the impact of offering free glasses to SMOs suffering from presbyopia and monitoring by supervisors on attrition from the factories over a period of 18 months. This would be accompanied by a qualitative study investigating workers' reasons for attriting, the impact of glasses on their duties at work, and the difficulties they faced in developing a habit of wearing glasses. In the third trial, we will measure the effect of providing free glasses to presbyopic SMOs on their productivity at work. The results of the three trials would provide rigorous evidence on which pricing policies and monitoring mechanisms improve the use of glasses among sewing machine operators. It would also be instructive in making (or not making) a case for employer-provisioned free or subsidized glasses for presbyopic workers in the garment industry, depending on the consequent causal increase in productivity and decrease in attrition.


Our qualitative research brought forth many key insights, some of which are below:

  1. Apart from a strong monetary constraint, negative social perceptions of glasses form a complex barrier to their purchase and usage. Even when workers display symptoms of poor eyesight such as strong headaches, or are prescribed glasses by doctors, they either do not buy glasses or ration their use because of concerns about physical appearance or teasing.
  2. The age and gender of the worker impacts their attitude towards spectacles; men and older women were less affected by the opinion of their co-workers or family about their appearance than younger women.
  3. Moreover, there are informational constraints; workers are not well informed about the right price to pay for glasses, how to judge quality and which doctors to go to. So they wait until they visit their hometown to avail such services.
  4. Additionally, poor glasses design often causes prolonged physical discomfort which discourages habit formation.

Scale up

The objective of this study is to find the pricing and encouragement mechanisms for eyeglasses uptake and usage that can unlock labor productivity gains in the Indian garment manufacturing sector. Our qualitative study has shown that uncorrected refractive errors are common among the workforce, and hamper performance at work and in personal life through a negative impact on physical and emotional health. Using human-centred design thinking, we are processing our qualitative data to create relevant nudges that will help build a positive attitude towards good eye health. Currently, we are developing ideas around educational videos, motivational posters, inclusive public signs like toilet signs, multilingual eye care charts and factory announcement systems.

Write to us to find out more about the process we are using to design the nudges, the interventions we plan to test and good eye care practices in general. We would love to hear your nudge and intervention ideas and any research relevant to this project.

Image credits: Nayantara Parikh / Shalin Gor