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Restoring the world’s vision

International Development
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School Vision Camp: a young boy in India is screened for glasses as part of a Clear Vision school project.
VisionSpring/Joel Collins 2015
School Vision Camp: a young boy in India is screened for glasses as part of a Clear Vision school project.
Poor vision is among the greatest health problems in the world today, but it is also one of the least addressed. The World Weekly speaks to venture philanthropist James Chen about his new campaign to raise awareness of the issue.
T he problem of poor vision is the number one unaddressed disability in the world today,” James Chen, a venture philanthropist and founder of ‘Clearly’, a new campaign attempting to raise awareness of the issue, tells The World Weekly. “Humans have advanced in so many areas yet we have neglected sight - one of our most basic needs. It’s the problem that the world forgot.”
Today, in the developed world, easy access to eye-care is taken for granted, but in many developing economies, the financial and social implications of uncorrected eyesight are substantial, and often overlooked. Ask someone to name the biggest global health issues and they are unlikely to suggest the problem of poor vision.
The Vision Impact Institute has estimated, based on the latest UN data available, that around 2.5 billion people around the globe - more than a third of the world’s population - suffer from some form of poor vision and have no means of improving it.
The vast majority of these people - around 2.2 billion - only suffer from minor refractive errors, while another 285 million have more serious visual impairments - or vision loss - caused either by severe refractive errors or diseases such as glaucoma.
These problems disproportionately affect the developing world: 90% of those who need access to eye-care live in developing countries. However, because suffering from poor vision is not life threatening, the issue has fallen under the radar of the global development agenda.
So how does the problem of poor vision manifest itself in the developing world?
The human and economic cost to communities and the crippling effects on the life chances and opportunities of individuals who suffer are wide-ranging.
According to a World Health Organisation (WHO) report, uncorrected refractive errors can impair quality of life, hamper performance at school, and reduce employability and workplace productivity.
For people who are reliant on good vision in order to do their job properly, changes in their sight can prevent them from working, leading to job loss and destitution.
Meanwhile, estimates of the economic cost of poor vision to global productivity range from around $270 billion a year, according to the WHO, to as high as $700 billion. Furthermore, a report by Access Economics estimates that the total direct and indirect global economic cost of poor vision stands at a staggering $3 trillion – more than the total GDP of Brazil, the seventh largest economy on Earth.
The link between productivity and vision is clear. The Vision Impact Institute conducted research at a factory in India which boosted its productivity by 45% when many of the workers – 80% of whom unknowingly had vision problems - were provided with vision correction.
James Chen, founder of Vision for a Nation and the Clearly campaign
James Chen, founder of Vision for a Nation and the Clearly campaign. Seven Hills
In school, if children cannot see the teacher’s workings on a blackboard, their education, and consequently their career prospects, will be severely hampered, meaning literacy rates can also be affected. Some estimates suggest that good vision is equivalent to an additional year of schooling in terms of educational outcomes.
However, the implications can often be more difficult to quantify. To illustrate the unintended knock-on effects, Mr. Chen cites the example of a community in northern Ghana – which was the subject of a World Bank literacy programme - where many people suffered from vision problems.
“Many of the women in the community, whose main function it was to look after the family, had poor eyesight. This had multiple effects because it meant they could no longer play as productive a role in family life due to the fact that they had difficulty cooking and doing other basic chores. This then meant that some of the younger women and girls couldn’t go to school because they had to help out. So there’s a lot of interesting dynamics going on there that you can’t really capture in a quantitative study. Often, having poor vision in these cases can lead to a loss of dignity,” he tells The World Weekly.
Poor vision can also have deadly consequences: unsurprisingly, one recent study in India showed that 80% of drivers in car accidents had at least one visual disability.

 Correcting the problem 

Although the scale of the issue at hand may appear overwhelming, apart from those who suffer from disease or severe vision problems, the solution is relatively simple.
The 2.2 billion people who only suffer from mild to moderate refractive errors, and the 120 million who have more severe refractive impairments, only require a pair of glasses for their vision to be effectively restored.
However, in much of the developing world, access to adequate eye-care is lacking or prohibitively expensive, a problem often compounded by the limited numbers of eye care professionals, as well as poor infrastructure.
This has presented an opportunity for James Chen and a host of NGOs, philanthropists and entrepreneurs trying to find practical solutions to the problem of poor vision in the developing world.
In addition to his latest ‘Clearly’ campaign, Mr. Chen founded Vision for a Nation (VFAN), a UK based charity whose goal it is to provide the people of Rwanda – a country with only one ophthalmologist for every million people - with local access to eye care and affordable glasses.
In cooperation with the Rwandan government, VFAN has helped to train around 2,000 nurses, who are now armed with a simple protocol which enables them to carry out a 10-15 minute screening and then either provide treatment for simple problems, or refer more serious cases to a hospital. These nurses have been stationed across 502 health care centres nationwide to provide primary eye care, even in the most remote regions of the country.
“For the first time in the history of a developing country, there’s been this comprehensive primary eye care service,” Mr. Chen said proudly. “I guess the remarkable thing is that when we started, people were saying no, no, no this can’t be done, and now, five years later, we did it.”
With glasses this Bangladeshi potter was able to increase her production from two pieces a day to 10
With glasses this Bangladeshi potter was able to increase her production from two pieces a day to 10. VisionSpring/Joel Collins 2015
New technologies hold great potential to support schemes such as this, particularly through the use of smartphones, which are becoming ever more ubiquitous across the developing world.
"In the future primary eye testing could be done on a smartphone, which would mean you could have people with minimal training in charge of that. There's actually a number of different apps that are emerging which approach different parts of an eye test so you can carry out a comprehensive eye exam... The technology could be a game changer," Mr. Chen says.
Through the use of phone apps, eye exams can now be conducted where they couldn’t before, and without the need for expensive equipment, developed infrastructure or a trained professional in charge of the testing.
In addition, medical data and GPS coordinates collected by the apps could in the future help health officials build up a digital map of what problems are affecting certain areas. All of this could mean that Rwandan health authorities will be able to better target resources where they are needed, significantly increasing efficiency and reducing costs.
“Now the local population does not need to spend much time and money to search for basic eye treatment because VFAN has made the primary eye care a local and decentralised service”, Abandibakobwa Delphine, one of the nurses trained by VFAN, tells The World Weekly. “This programme will reach those people who would not come to the health centre due to various challenges such as old age, lack of transport fees and lack of education about the seriousness of eye diseases.”
The benefits for those that the initiative has helped can be transformative. Felicen Senzoga is married with five children and has worked at a factory for 13 years, sewing clothes, stamping, buttons and ironing. Over the past four years he began experiencing vision problems and was struggling with his work. Through VFAN’s initiatives, he received glasses to correct his vision.
“After I got glasses, things became easier. Where it used to take me 10 minutes now it takes me five minutes”, he tells The World Weekly. “When my vision problem became bad, I couldn’t teach my kids. But after getting glasses, that helps me in my family life. After finding that I can read books again, I was excited, because I really love my children and I want to teach them and prepare them for their future life.”
VFAN’s hope is that the model, which has worked successfully in Rwanda, can be applied to other countries across the world, although Mr. Chen admits that the Rwandan health system is relatively efficient in comparison to many nations with similar levels of economic development.
While new technologies are helping to address the vision crisis, a decidedly less complex piece of kit has traditionally been one of the most useful tools in combating the problem. Mr. Chen is also the founder of Adlens, a global enterprise leading the development and distribution of adjustable focus eyewear, which VFAN provides to some of its patients in Rwanda. 
Adlens’ co-founder, Josh Silver, a physicist at Oxford University, pioneered the technology of so-called self-refractive glasses in the 1990s and 2000s.
By following simple instructions, each pair can be tuned precisely to the wearer’s own prescription by adjusting two flexible membranes made from a liquid. These glasses can correct most simple refractive errors while removing the need for an ophthalmologist to conduct an eye test. They’re cheap as well, costing just $19 a pair.
While adjustable glasses will not replace the need to see an eye specialist, it is an effective fix for a common problem. However, the invention has only been distributed to 30,000 people across 20 countries so far. There are at least two other organisations developing similar products but neither of those have begun large scale manufacturing either.
Despite this, Mr. Silver’s lofty ambition is to ensure that one billion people have the glasses they need by 2020. This would mean massively scaling up the Adspecs initiative while also cutting costs tenfold to $1 a pair, a move that could be hampered by lack of investment. “I don’t want to see a situation where the poor in the developing world don’t get access to the technology because it is controlled by people determined to make money out of it,” he has said.

 Are these aims achievable? 

Chris Wray, chief executive officer at the Centre for Vision in the Developing World (CVDW) – the non-profit Mr. Silver set up in 2009 to realise his goal – tells The World Weekly about some of the possible hurdles.
“Of course, you have to provide a high optical quality, low cost, aesthetically attractive product if large numbers of people are going to wear it. Developing such products - and carrying out clinical trials to prove effectiveness - have been some of the main obstacles. This has to be financially sustainable as well as massively scalable. We need more evidence of impact to persuade governments and international organisations to support this work.”
“Awareness is also an obstacle - among health and development professionals, as well as the public. For a long time, the World Health Organisation and many researchers focused only on the most severe cases of refractive error. CVDW's target of giving one billion people access to glasses by 2020 was always very ambitious, but I hope it has shocked people into paying attention to the scale of this problem.”
Abandibakobwa Delphine, one of the nurses trained by Vision for a Nation in Rwanda
Abandibakobwa Delphine, one of the nurses trained by Vision for a Nation in Rwanda. Vision for a Nation
Other groups, such as VisionSpring, believe the vision crisis could be effectively solved through a model of social entrepreneurship. Founded in 2001, it started out by providing reading glasses to correct farsightedness and aims to create access to affordable eyewear, everywhere.
The initial aim was take reading glasses out of the hands of professionals and make them a consumer product. It did this through a business model in which screening services and reading glasses were provided to people living in rural villages in several countries. The glasses were sourced from China to keep costs down, while VisionSpring trained local women as independent sales representatives to reach out to rural villages and sell reading glasses for $4 a pair, thereby improving the livelihood of community members who purchase their products.
“Refractive error and presbyopia are – pun intended – overlooked. Vision screening and eyeglasses are an affordable, simple interventions,” Ella Gudwin, president of VisionSpring, tells The World Weekly. “Almost 70% of people with blurry vision have presbyopia, a condition associated with aging and the natural thickening and stiffening of the eye’s lens. Presbyopia can be solved in a matter of minutes with an inexpensive pair of reading glasses – which are basic magnifying lenses, do not require a prescription in most countries, and can be sourced for less than $1.”
It is clear that there is a growing community of individuals and organisations around the world trying to address this issue of poor vision in the developing world, many of which appear to share CDVW’s grand ambitions. Since 2001, VisionSpring has helped to distribute 2.5 million pairs of corrective glasses and plans on selling 10 million more by 2020, as well as providing 50 million school-aged children with glasses. Meanwhile, James Chen predicts that by 2030, we will have a “really great chance” of solving the problem of poor vision due to refractive error.
Despite these ambitions, and a WHO initiative which has prompted governments around the world to take action, there is general agreement that more organisations need to start working together to increase awareness of the issue. With this in mind, Mr. Chen’s year-long global ‘Clearly’ campaign is seeking to open up the debate to a wider audience by bringing together leading businesses and innovators to rally around the cause.
He will certainly take encouragement from a recent PwC report that estimated that for every $1 invested in improving vision, there is an average $4 economic gain.
“It amazes me that 700 years after glasses were invented, billions of people across the developing world still do not have access to them,” Mr. Chen says.
The CVDW predicts that by 2030, eyesight will be one of the world’s top 10 health issues, taking a bigger toll than the HIV virus. However, Mr. Chen is hopeful that with the backing of business leaders, governments, NGOs, scientists, investors and others, the problem can be solved in our lifetime.
“We’ve given ourselves an internal benchmark. Let’s get this done before people land on Mars [NASA are aiming for 2025] because, you know what? We want those 2.5 billion people to see that.”
More information about ‘Clearly’ can be found here.
Aristos Georgiou
INSIGHT
02 June 2016 - last edited 02 June 2016