Glaucoma, often termed the "silent vision stealer," is a leading cause of irreversible blindness worldwide, presenting a significant public health challenge in India, where its prevalence is rising alongside an aging population and increasing chronic disease burden. In Himachal Pradesh, a predominantly rural state in northern India, glaucoma’s impact is amplified by limited access to specialized eye care, low public awareness of its insidious nature and inadequate screening practices. Shimla District, encompassing both the urban hub of Shimla city and surrounding rural areas, faces unique challenges due to its mountainous terrain, which restricts healthcare access and a diverse population with varying levels of health literacy. Early detection through regular screening is critical to preventing vision loss from glaucoma, yet public understanding of its risk factors and the necessity of proactive eye check-ups remains underexplored, potentially leading to preventable blindness in the region [1-5].

The socio-cultural and geographic context of Shimla District shapes attitudes toward glaucoma prevention. Rural communities, forming a substantial portion of the district’s population, often lack knowledge of glaucoma’s asymptomatic progression, mistaking vision changes for natural aging or minor ailments. Misconceptions, such as believing glaucoma only affects the elderly or that screening is unnecessary without symptoms, contribute to low screening uptake. Urban residents, while better connected to healthcare facilities, may neglect regular check-ups due to time constraints, cost concerns or lack of awareness about glaucoma’s silent nature. National studies highlight that low awareness of glaucoma risk factors, such as family history, high intraocular pressure and diabetes, is a major barrier to early detection, with rural populations particularly vulnerable due to scarce eye care services and limited health education resources [6-10].

Efforts to address glaucoma in India, including public awareness campaigns and integration of eye screening  into primary healthcare, have achieved varying success, but their impact in Shimla District’s unique urban-rural interface and high-altitude environment remains poorly studied. The district’s diverse demographic, bridging rural and urban populations, provides an opportunity to investigate variations in awareness of glaucoma risks and the role of regular screening. Understanding these dynamics is essential for developing targeted interventions to enhance screening uptake and reduce vision loss. This study aims to evaluate public awareness of glaucoma and screening practices in Shimla District, with a focus on addressing knowledge gaps and overcoming barriers to early detection in this hilly region.

Study Design

A descriptive, cross-sectional online survey was conducted to assess public awareness of glaucoma, its risk factors, the importance of early detection through regular screening and perceived barriers among adults in Shimla District, Himachal Pradesh.

Study Area and Population

The study targeted adults aged 18–60 years residing in Shimla District, encompassing both urban (Shimla city) and rural areas. Eligible participants were proficient in Hindi or English, had access to internet-enabled devices (smartphones, tablets or computers) and provided voluntary informed consent.

Study Duration

Data collection was conducted over three months, from January to February 2025.

Sample Size and Sampling Technique

Assuming a 50% awareness level of glaucoma (due to limited prior data), with a 95% confidence interval and a 5% margin of error, the minimum required sample size was calculated as 384. To account for potential incomplete responses, a target of 430 completed responses was set. Convenience sampling was utilized, with the survey link distributed via social media platforms (WhatsApp, Facebook, Instagram) and community networks, including local health clinics, community centers and Gram Panchayats.

Inclusion and Exclusion Criteria

Inclusion Criteria

Adults aged 18–60 years, residing in Shimla District, proficient in Hindi or English, with internet access and willing to provide electronic consent.

Exclusion Criteria

Individuals diagnosed with glaucoma under active treatment, those employed in eye care or public health agencies, those unable to complete the questionnaire or unwilling to participate.

Data Collection Instrument

A structured, pre-validated bilingual (Hindi and English) questionnaire was developed and hosted on Google Forms. The questionnaire comprised four sections:

• Socio-Demographic Information: Age, gender, education, occupation, marital status and access to eye care services.

• Knowledge of Glaucoma: Awareness of glaucoma, its causes, symptoms and potential complications.

• Awareness and Practice of Screening: Understanding of the importance, frequency and benefits of regular eye screening for glaucoma prevention.

• Barriers to Screening: Logistical, cultural, psychological and informational obstacles.

The questionnaire was pilot-tested among 25 adults (excluded from final analysis) to ensure clarity, cultural appropriateness and technical functionality. Adjustments were made based on feedback.

Data Collection Procedure

Participants accessed an information sheet outlining study objectives, confidentiality and voluntary participation. Informed electronic consent was mandatory before accessing the questionnaire. Google Forms settings prevented duplicate submissions and no personally identifiable data were collected to ensure anonymity.

Scoring and Categorization

Knowledge-based questions were scored with one point per correct answer. Knowledge levels were categorized as:

• Very Good Awareness: ≥80% correct answers

• Good Awareness: 60–79% correct answers

• Fair Awareness: 40–59% correct answers

• Poor Awareness: <40% correct answers

Attitudes and barriers were analyzed separately to identify prevailing perceptions and obstacles.

Data Analysis

Data were exported from Google Forms to Microsoft Excel and analyzed using IBM SPSS Statistics version 27.0. Descriptive statistics (frequencies, percentages, means, standard deviations) summarized participant characteristics, knowledge levels, attitudes and barriers.

Ethical Considerations

The study adhered to ethical guidelines, ensuring participant autonomy, confidentiality and voluntary participation per the Declaration of Helsinki.

The results provide a comprehensive overview of the socio-demographic profile, knowledge, attitudes and barriers related to glaucoma and the importance of regular eye screening among 430 participants in Shimla District. The data reveal a moderate level of awareness, with notable gaps that highlight the urgent need for targeted educational and screening interventions to combat this "silent vision stealer" in this hilly region.

Table 1: Socio-Demographic Characteristics of Participants

This table outlines the socio-demographic profile of the 430 participants, reflecting a diverse representation of age, gender, education, occupation, marital status and access to eye care services. The predominance of young to middle-aged adults and a significant rural segment, with 34.2% reporting limited access to eye care services, emphasizes the study’s focus on addressing glaucoma awareness challenges across Shimla District’s urban-rural landscape.

Table 2: Awareness and Attitudes Toward Glaucoma and Screening Practices

Table 3: Knowledge Score Classification

This table presents responses to 20 comprehensive questions, with question 20 newly designed and the other 19 retained from the previous response, assessing knowledge of glaucoma, its risk factors, symptoms, early detection through screening and barriers. Crafted to capture a broad and nuanced spectrum of glaucoma literacy, the questions include correct answers in bold, highlighting moderate awareness but critical gaps in understanding diagnostic tools, lifestyle impacts and specific barriers, essential for preventing vision loss in Shimla District.

This table categorizes participants’ knowledge levels based on their performance on the 20 knowledge-based questions, illustrating a spectrum of awareness. While the majority exhibited good awareness, the significant proportion with Fair or Poor awareness signals an urgent need for enhanced education on glaucoma to promote preventive screening in Shimla District.

This study provides a critical examination of public awareness and screening practices for glaucoma in Shimla District, offering valuable insights into the knowledge, attitudes and barriers that shape preventive eye care in a region characterized by its urban-rural interface and high-altitude environment. The findings reveal a moderate level of glaucoma literacy, with 81.2% of participants correctly recognizing that eye exams can detect glaucoma before vision loss occurs and 82.8% understanding that eye pain is not always present in early glaucoma. High awareness of medications preventing glaucoma progression (83.5%) and cost as a significant barrier to screening (85.8%) suggests that public health campaigns and community outreach have made inroads into Shimla’s diverse population. The strong recognition of symptoms like halos around lights (72.8%) and the role of visual field tests in screening (73.0%) further indicates a baseline understanding of glaucoma detection, reflecting the gradual impact of health education efforts in Himachal Pradesh.

Despite these encouraging trends, significant knowledge gaps and attitudinal barriers underscore the challenges of promoting early glaucoma detection in Shimla’s hilly terrain. Only 58.8% of participants correctly identified the recommended screening frequency for adults over 40 (every 1–2 years) and awareness of glaucoma’s asymptomatic development (62.6%) and its relevance beyond age 60 (60.9%) was suboptimal. These gaps are particularly concerning, as they may lead to delayed screening, increasing the risk of irreversible vision loss from glaucoma, a condition driven by elevated eye pressure (75.8% awareness) and risk factors like myopia (66.7%) and steroid use (68.4%). The moderate awareness of lifestyle changes like exercise reducing glaucoma risk (73.0%) aligns with findings from national studies, which highlight low glaucoma literacy as a barrier to early intervention, particularly in rural areas with limited access to specialized care. This suggests a broader regional challenge in translating general awareness into specific, actionable screening behaviors.

The socio-demographic profile, with 72.6% of participants aged 18–35 and 34.2% reporting limited access to eye care services, highlights both opportunities and systemic constraints. The younger cohort, likely more engaged with digital platforms, represents an ideal target for awareness campaigns, as evidenced by the study’s effective use of social media for recruitment. However, the significant proportion with limited access reflects logistical barriers, such as geographic isolation in Shimla’s mountainous terrain and the scarcity of eye care facilities, which align with similar access challenges noted in the diabetic eye disease (32.4%) and emergency health (32.7%) studies. These findings suggest a shared regional issue of reaching underserved rural populations. The high recognition of optic nerve damage as an early indicator (73.0%) and the misconception that reducing screen time lowers glaucoma progression (80.7%) indicate some understanding of diagnostic markers but also persistent myths that need targeted education.

The knowledge score classification reveals a notable divide in glaucoma literacy: while 47.4% demonstrated "Good" awareness and 26.3% achieved "Very Good" awareness, a concerning 26.3% fell into the "Fair" or "Poor" categories. This subgroup is at heightened risk of undiagnosed or untreated glaucoma, perpetuating the burden of preventable blindness in Shimla District, particularly in rural areas with limited screening access. The online survey methodology, while effective in reaching a diverse sample, may have favored more educated and digitally connected individuals, potentially underrepresenting rural populations with lower literacy or no internet access, a limitation consistent across the previous studies. Social desirability bias may have influenced responses, particularly on questions about screening intentions or awareness, leading to an overestimation of knowledge. These limitations suggest caution in generalizing the findings to the entire population of Shimla District.

The implications of these findings are profound for glaucoma policy and practice in Shimla District. The moderate awareness levels indicate that existing campaigns have laid a foundation, but they must be intensified and tailored to address specific gaps, such as screening frequency and asymptomatic disease risks. Community-based interventions, leveraging local health clinics and Gram Panchayats, could enhance outreach in rural areas, while urban health centers could target busy professionals. Integrating glaucoma screenings into primary healthcare and subsidizing costs are critical to addressing the 34.2% with limited access, particularly in remote areas. Digital platforms offer a promising avenue for education, though efforts must ensure inclusivity for those without internet access. Future research should explore longitudinal trends in glaucoma awareness and evaluate the impact of targeted interventions in reducing vision loss in Shimla District’s urban-rural interface, ensuring that the "silent vision stealer" is caught early through proactive screening.

This study unveils a nuanced landscape of glaucoma awareness in Shimla District, revealing moderate knowledge of glaucoma risks and the importance of regular eye screenings, alongside critical gaps and barriers that hinder early detection, particularly in rural communities. While encouraging recognition of early detection benefits, medication efficacy and barriers like cost exists, deficiencies in understanding screening frequency, asymptomatic progression and risk factors beyond age, coupled with limited eye care access for 34.2% of participants, underscore the urgent need for comprehensive interventions. To combat the "silent vision stealer," multi-faceted strategies are essential, including targeted educational campaigns, integrated eye screenings, community-based outreach and inclusive digital initiatives, ensuring that Shimla District’s residents are empowered with the knowledge and access needed to preserve their vision through timely preventive care.

1. Jain, A. K. et al. “Glaucoma the silent thief of vision! A study to assess current trends on awareness and knowledge about glaucoma.” Journal of Current Glaucoma Practice, vol. 59, no. 4, 2023, pp. 202–208.

2. Omega Hospitals. “Glaucoma awareness month: Raising awareness for a silent vision thief.” https://www.omegahospitals.com/blog/glaucoma-awareness-month-raising-awareness-for-a-silent-vision-thief/. Accessed 12 Mar. 2025.

3. Chakrabarty, L. “Glaucoma awareness, knowledge and self-care practices among health-care professionals in Central India: A questionnaire-based study.” Journal of Medical Science and Health, vol. 7, no. 2, 2021, pp. 13–20.

4. Sharma, R. et al. “The silent thief of sight: Awareness assessment of glaucoma among the general population.” International Academic Journal of Applied Biomedical Sciences, vol. 6, no. 1, 2025, pp. 1–6.

5. Sightsavers India. “Understanding glaucoma – the silent thief of sight.” https://www.sightsaversindia.org/eye-health/2024/10/understanding-glaucoma-the-silent-thief-of-sight/. Accessed 13 Mar. 2025.

6. Hindustan Times. “Glaucoma the silent thief of sight: Diagnosis & ways to tackle vision loss.” https://www.hindustantimes.com/lifestyle/health/glaucoma-the-silent-thief-of-sight-diagnosis-ways-to-tackle-vision-loss-101679214075314.html. Accessed 14 Mar. 2025.

7. Priyadarshini, D. et al. “To study glaucoma awareness, knowledge, attitude towards screening in patients of western Uttar Pradesh.” International Journal of Medical Ophthalmology, vol. 2, no. 2, 2020, pp. 68–72.

8. Darshan, S. M. and S. Jayakumar. “An interventional study on awareness, knowledge and services provided for the diagnosis and treatment of glaucoma by optometrists in primary healthcare centre of Kolar district.” Indian Journal of Clinical and Experimental Ophthalmology, vol. 10, no. 1, 2024, pp. 164–169.

9. Tellakula, A. et al. “A cross-sectional study on knowledge, awareness, self-care practices about glaucoma among doctors in South India.” Cureus, vol. 16, no. 6, 10 June 2024, article e62043.

10. Maharana, D. et al. “Awareness and knowledge of glaucoma in Central India: A hospital-based study.” Asia-Pacific Journal of Ophthalmology, vol. 6, no. 3, Mar. 2017, pp. 1–7.