This study assessed the use of spectacles and its demographic associations in a sample representative of the population of the Indian state of Andhra Pradesh. A total of 11,786 subjects of all ages were sampled from 94 clusters in one urban and three rural study areas of Andhra Pradesh using stratified, random, cluster, systematic sampling. The eligible subjects underwent detailed interview and eye examination including dilated examination of the posterior segment. The data on the use of spectacles were analysed for subjects > 15 years of age. A total of 7,432 subjects > 15 years of age participated in the study of whom 1,030 (13.8%) had a refractive error of spherical equivalent +/- 3.00 Diopter or worse. The prevalence of current use of spectacles in those with spherical equivalent +/- 3.00 Diopter or worse, who were likely to be visually impaired without refractive correction, was 34.2% (95% confidence interval 30.3-38%) and of previous use of spectacles was 12.3% (95% confidence interval 10.3-14.3%). The odds of using spectacles currently were significantly higher for those with any level of education, those living in the urban area, and for those with aphakia or psuedophakia as compared with natural refractive error. Among those who had used spectacles previously, 43.8% had discontinued because they felt that either the prescription was incorrect or that the spectacles were uncomfortable, suggesting poor quality of refractive services, and another 19.6% had lost the pair and could not afford to buy another pair. These data suggest that the use of spectacles in this population by those with refractive error was not optimal. Two-thirds of those with spherical equivalent +/- 3.00 Diopter or worse were not using spectacles. Of those who had discontinued the use of spectacles, a significant proportion did so for reasons related to poor quality of refractive services. Strategies such as vision screening programmes and eye health promotion need to be implemented, the quality of refractive services monitored and the cost of spectacles regulated, if the substantial burden of visual impairment due to refractive error in this population is to be reduced.