Expensive Private Sector Dominates India’s Eye Care: AIIMS Survey Reveals Deep Gaps in Public Services

A landmark national survey led by the All India Institute of Medical Sciences (AIIMS), New Delhi, has revealed a striking dominance of private players in India’s eye care system, leaving vast sections of the population, particularly in rural and low-income areas, without access to affordable and comprehensive services. The Human Resources and Infrastructure for Ophthalmic Services in India survey, conducted during 2020–21 and published in the Indian Journal of Ophthalmology in November 2025, is the largest-ever mapping of the country’s ophthalmic infrastructure and workforce. It covered nearly 8,000 institutions and was carried out in collaboration with the Union Health Ministry, the All India Ophthalmological Society (AIOS), and Vision 2020 India, a global initiative to eliminate avoidable blindness.​

Key Findings and Developments

The survey found that over 70% of India’s eye-care institutions are privately run, while government and NGO sectors together account for less than 30%. Government facilities constitute roughly 15%, with NGOs about 13.8%. This imbalance has led to quality eye care being heavily dependent on the ability to pay. Specifically, private centers perform nearly 60% of cataract surgeries and 90% of refractive-error corrections, which are among the most common eye procedures; government hospitals account for only 40% and 10% respectively.​

Moreover, only 40% of eye care institutions provide emergency eye care services, and fewer than 6% possess eye banks vital for corneal transplants. Less than a third offer low-vision rehabilitation services crucial for people with irreversible vision loss. The availability of pediatric eye care services is also severely limited; only about 25% of hospitals provide them, with just 6% of ophthalmologists trained in that subspecialty. At the national level, there is roughly one ophthalmologist for every 65,000 people, lagging behind WHO’s recommended target of 20-25 ophthalmologists per million population. Eye care infrastructure is insufficient, with only 74 eye beds per million population against the benchmark of 100.​

Expert Commentary

Dr Praveen Vashist, Professor and Head of Community Ophthalmology at AIIMS and lead investigator of the survey, emphasized the disparity’s consequences: “Private centres handle the bulk of eye surgeries, especially cataract and refractive-error corrections, but this skews equitable access, particularly in rural and economically disadvantaged regions.” He underscored the necessity to strengthen government eye care infrastructure and expand primary vision centers to ensure universal eye care reaches all segments of the population.​

Dr Ajay Saxena, a noted ophthalmologist not associated with the study, opined, “While India has made commendable progress in cataract surgeries, the primary and secondary eye care levels remain fragile. Early detection and treatment, especially for children and for conditions like myopia, require better-trained specialists and equipment at ground-level centers.” He advocated urgent reforms in public health policy to bridge these gaps.​

Context and Background

India’s eye health challenges reflect its vast population and socioeconomic diversity. Cataract remains a leading cause of avoidable blindness, and refractive errors affect millions. The Vision 2020 initiative by the WHO and partner organizations aims to eliminate avoidable blindness globally by improving access to high-quality eye care. The AIIMS survey constitutes a foundational step in assessing India’s progress toward these goals, identifying critical shortfalls in infrastructure, workforce, and service distribution.​

Implications for Public Health

The heavy reliance on the private sector, which tends to prioritize financially lucrative procedures, means low-income populations frequently face barriers to essential eye care. Emergency eye care, pediatric services, and rehabilitative services are underrepresented, limiting comprehensive vision health coverage. This situation increases the risk of preventable vision loss, affecting quality of life and economic productivity.

Strengthening public eye care infrastructure—especially at primary and secondary levels—and increasing training for ophthalmologists and allied health professionals are vital steps. Integrating tele-ophthalmology could improve specialist access in remote areas. Policy interventions must aim to balance public-private collaborations to expand affordable, quality eye care nationwide.​

Limitations and Counterarguments

The survey, while comprehensive, reflects data collected in 2020-21 and published in 2025; rapid developments may have occurred since. There is also regional variation with some states lacking adequate representation. Additionally, private sector dominance is sometimes justified by faster service delivery and advanced technologies unavailable in public settings. Nonetheless, the data highlight the urgent need to address affordability and access gaps.

Conclusion

The AIIMS-led national survey reveals a critical imbalance in India’s eye care landscape, dominated by expensive private institutions while public services remain inadequate. To achieve universal eye health coverage, India must invest strategically in expanding public sector capacity, enhancing training and infrastructure, and fostering equitable access to essential eye care services for all citizens.

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.

References