rki.news
By Dr Amaal Khalid Chauhan
Earlier this year, Pakistan’s Supreme Court had convened, examining reports that a former incarcerated Prime Minister had suffered significant vision loss after delayed treatment. Imran Khan’s trial was widely covered in the news. But most of Pakistan’s prisoners with worsening eyesight do not make the headlines, because their predicament rarely receives the same scrutiny.
Somewhere in a Pakistani jail, perhaps, an ordinary prisoner tries to read a charge sheet, a bail application, a notice of hearing. He holds the page at arm’s length, then closer, squinting at the light. It is not that he cannot read; it is that he cannot see the page.
They may never have had an eye problem before. Jail can make a new one easy to miss; it may only be noticed once a prisoner complains, – if even then. Prisoners may also hesitate to complain repeatedly if they fear being labelled difficult or troublesome. What looks like an ordinary reading difficulty may be the first sign a prisoner’s vision is deteriorating.
This matters, because sight is tied to legal agency. A prisoner needs to read the FIR, understand what he is asked to sign, follow notices and orders, and know what is being filed on his behalf. If he is unable to perceive these matters for himself, he becomes dependant on another to interpret his own context; a barrier to meaningful participation in his own defence. Sight is a prerequisite for reading, following and understanding what is happening to one legally.
This is not a hypothetical grievance. Blindness and eye disease inside prisons are common, and often neglected issues in most incarceration systems. A 2021 study of 367 inmates at Uganda’s Luzira Prison found almost half of them had various eye diseases, most commonly presbyopia (age-related loss of near vision), allergic conjunctivitis, and cataract. Inmates 50 and older were roughly twelve times more likely to have eye disease than those in their twenties. In Nigeria, a survey of 515 inmates at Ilesa Prison found almost 70 percent had some sort of eye disorder, with uncorrected refractive error being the most common source of vision loss. A larger older study of over 1,000 inmates in another Nigerian prison found that approximately 25 percent had some kind of eye disease, with cataract being the most common cause of blindness in one eye and the only cause of blindness in both. For our purposes, this is useful data from other resource-constrained prison settings.
Pakistan has not studied its prisoners’ eye health in recent years, but the 2014 District Jail Lahore study, published in the Pakistan Journal of Ophthalmology, suggests that the situation gives no reason for complacency. This study screened 270 prisoners (79 percent of whom were over 40) who had self-reported and presented with eye complaints, so it was not a prevalence survey of the prison population as a whole. It found that 56 percent had normal unaided vision, while over a third had presbyopia. The rest had various issues ranging from cataract to glaucoma, conjunctivitis, or trauma-induced vision loss. The authors recommended implementing a screening program and a set of appropriate referrals. Pakistan is still waiting on a systemic province-wide policy. What exists today is closer to sporadic charity. Though it exists, nonetheless.
The difficulty is compounded by the conditions in which prison healthcare has to operate. Currently, Pakistan’s prisons run at roughly 152-164 percent of designed capacity, with some jails as high as 200–300 percent (Karachi Central Jail has been cited above 350 percent). Broad infection-control research agrees: overcrowded, poorly ventilated facilities with weak surveillance are structurally prone to outbreaks including epidemic keratoconjunctivitis, one of the most common eye infections to spread through crowded institutional settings- a concern underscored by the recurring waves of conjunctivitis witnessed in eye OPDs across Pakistan.
Prison doesn’t have to cause eye disease; it just has to break the care that holds existing disease back. A diabetic prisoner losing insulin, glucose checks or diet may go months uncontrolled as retinopathy progresses unseen, never once examined. A glaucoma patient who misses drops or pressure checks builds optic-nerve damage that, once spotted, is already irreversible. Stress hormones lift both blood sugar and blood pressure, so incarceration’s psychological toll is physiological too; and retinal fine vessels bear the brunt. Assault-related eye trauma turns vision-threatening when specialist review or surgery is delayed. Similarly, in badly under-resourced prisons, vitamin-A deficiency adds a nutritional route to the same outcome.
Refractive errors should not be regarded as a trivial matter to dismiss, either. When left uncorrected, they constitute the foremost cause of vision loss globally. Although glasses can readily resolve the issue, neglecting basic eye care within prisons transforms a straightforward, treatable condition into a lasting disability. Beyond the eye-strain and headaches they can cause; in older people, they have been linked to a greater likelihood of falling and fracturing bones, developing dementia, and experiencing depression, on top of the risks of other eye diseases. Some forms of uncorrected refractive error carry their own risks: high myopia, for example, is associated with a greatly increased chance of glaucoma, cataract, and retinal detachment, which are all serious illnesses that may require monitoring and treatment. An imprisoned person with high myopia who has not had a full eye exam to detect these dangers is not receiving the care he needs.
A country cannot plan for the things it does not measure. Pakistan has a limited understanding of how many of its imprisoned citizens have refractive errors that need to be corrected, or how many are living with cataract, glaucoma, or other diseases. Pakistan certainly does not know how many of its prisoners might leave blind from curable causes, or how that might affect the system. These gaps in reliable data ensure that eye health will continue to be a forgotten component of incarceration and correctional healthcare; and where there is no system, there is no treatment.
That lack of local evidence leaves Pakistan looking outward for clues that strengthen the case for further investigation. Across studies from Asia and Africa, the findings are consistent enough to warrant action. The legal and judicial infrastructure designed to ensure due process means little to someone who cannot see the documents on which their case depends. It is an ethical obligation to ensure that the people who are charged and convicted have access to treatment for eye disease, just as it is to ensure that procedural fairness occurs.
The solution requires nothing more than a few well-designed programmes. First, Pakistan needs a multicentre survey on refractive error and eye disease in its prison population, with women’s jails represented in appropriate proportion to assess the scale of the issue. Second, eye screening needs to be built into the intake and follow-up processes, not only for prisoners who happen to be vocal about their concerns. Third, spectacles need to be available: refraction is one of the most inexpensive interventions in medicine. Reading-glasses can correct presbyopia while also helping with otherwise manageable vision problems. Lastly, a functioning refferal system must be established to deal with cases of cataract and glaucoma, and basic instructions need to be given to prison doctors about the red flags for these diseases.
The Pakistan Supreme Court may have taken up the case of one man’s failing eyesight, but it is long past time for a population-wide approach to the issue.
Note: Author is a young medical graduate who is passionate about tackling social reasons for health inequalities and can be reached at amaal.chauhan1@gmail.com
