New alliances to scale up access to a 700-year-old technology

SAN FRANCISCO — Collins Yeboah Asomani is an optometrist in Ghana, where only 5 percent of people who need eyeglasses actually have them.

Last week, on World Optometry Day, he shared a story about meeting a 55-year-old woman who walked into a vision camp in Ho, the capital of the Volta Region, complaining of consistent eye strain and headaches.

She had presbyopia, or farsightedness, meaning all she needed was reading glasses to see up close, said the optical technical adviser for VisionSpring, a social enterprise that together with its partners distributed close to 20,000 eyeglasses in Ghana in 2018.

Most adults over 50 need reading glasses, which can be accessed over-the-counter in certain countries, but remain out of reach for many people in low-income countries. There is growing awareness that addressing uncorrected refractive error —  often nearsightedness for children and farsightedness for adults — is a simple way to improve lives. Still, more than a billion people, and as many as 2.5 billion people according to some estimates, need eyeglasses but don’t have them.

New alliances are forming across sectors to scale up access to this 700-year-old technology, as governments, international organizations, and private sector companies see the benefits of eyeglasses beyond health.

Partnerships across sectors

Glasses have failed to reach the base of the pyramid because of “diagnosis, distribution, dollars, and demand,” said James Chen, founder of international eye care initiative Clearly and author of a book by the same name.

Clearly is the organizer of Sightgeist, a conference taking place in London this Thursday that will highlight solutions across what Chen calls “the four D’s.” One of his key messages is that businesses who want to do good should consider playing a role in tackling poor vision by providing vision correction to their workforce.

American retail company Williams Sonoma, for example, has started providing its low wage workers with low-cost glasses, while also implementing eye tests for its workforce. The company is working with VisionSpring to deliver these vision services to its factory workers, as part of a Clear Vision Workplaces program the nonprofit created to provide glasses to workers on the job.

Meanwhile, VisionSpring founder Jordan Kassalow started the nonprofit EYElliance to do some of the systems work that required the involvement of a coalition of actors. Members of the coalition include an international disability NGO, Light for the World, an American eyewear company, Warby Parker, and Aravind Eye Care System, which has a chain of hospitals in India.

EYElliance is also forming partnerships at the country level, such as in Liberia, where the nonprofit worked with partners to launch a national, government-led school eye health initiative that is on pace to screen 58 percent of all Liberian schoolchildren.

The nonprofit sees a path for governments to integrate provision of eyeglasses into their national education plans as well as their community health worker plans.

“We also see an important role for scaling with private capital,” said Elizabeth Smith, co-founder and chief executive at EYElliance.

Smith compared the potential of the “inclusive optical sector” to off-grid solar, saying that while philanthropy can provide bridge funding, private capital and development finance can scale this industry, and efforts are underway to create investable businesses in Latin America.

“Just about everything we do involves convening multiple sectors, getting everyone to the table, bringing new actors into the solution, and leveraging these wonderfully successful interventions that have been pioneered by NGOs by asking: How can others come in with their resources?” she said.

There are a number of emerging partnerships that Smith said make access to eyeglasses a more solvable problem than it has ever been.

Examples include ATscale: A Global Partnership for Assistive Technology, which is an effort joining several donor agencies, UNICEF, the Kenyan government, and other partners to reach 500 million people by 2030 with the assistive technology they need. EYElliance, working together with other partners such as Clearly, was successful in advocating for the near term prioritization of eyeglasses along with other assistive devices including wheelchairs, prosthetic limbs, and hearing aids.

Smith also noted the significance of Essilor, a company that designs, manufactures, and markets lenses, and is the largest private sector player in eye care, committing to eradicating poor vision by 2050.

And EYElliance is highlighting the cross-cutting impact of access to eyeglasses in an effort to get their provision included in new funding mechanisms, such as the Senate State, Foreign Operations, and Related Programs Committee budget.

Challenges moving forward

In Bangladesh, VisionSpring partnered with the NGO BRAC to train shasthya shebikas — or community health volunteers — to sell glasses.

Comprehensive eye exams are ideal, but in places where they are hard to come by it is also possible to train people who can raise awareness around eye health, dispense reading glasses, and make referrals to professionals, said Ella Gudwin, president of VisionSpring.

VisionSpring is part of a new Clear Vision Collective to make glasses available through four vision centers, 25 optical shops, 100 rural medical providers, and 400 health workers to conduct community vision camps and perform cataract surgeries in the Sherpur district.

Where there are efforts to demedicalize access to eyeglasses, there can also be pushback from optometrists or ophthalmologists, Gudwin said. They say the rise of community health workers performing vision screenings and emerging technologies, such as handheld refractive devices, will lead them to miss opportunities to catch other issues, including glaucoma. But reading glasses should remain a consumer good rather than a medical device, Gudwin said.

VisionSpring was founded on the premise that “vision is a livelihoods, economic, and income intervention, first and foremost,” Gudwin said.

And yet, she finds that donors often want to put her in touch with their health team, or say they do not focus on health, leading her to explain again and again why eyeglasses are more than a health intervention.

For example, she points to how eye glasses increased earnings and productivity for tea pickers in India: “Eyeglasses are an input for a lot of things you are putting money against,” she said. “You would be surprised how much we can unlock with this essential cost-effective intervention.”

Gudwin is speaking at Sightgeist on Thursday, which she said is an opportunity to highlight how vision underpins five of the Sustainable Development Goals. Access to vision can help people in the workplace, children in the classroom, and drivers on the road, she said. Gudwin also mentioned the example of how critical eyesight is for mobile financial services, and how women are at a higher risk of myopia, or nearsightedness, than men, meaning there is also a gender equality lens for access to vision.

“If you can’t see your mobile phone, the expectation that you’re going to be an active user of mobile banking is dramatically diminished,” she said.

Despite the momentum of more dollars, better diagnosis, and wider distribution — three of “the four Ds” — demand may be the missing link, said Nathan Congdon, director of research at Orbis International, an international nonprofit focused on fighting avoidable blindness, who led the study on tea pickers.

“One reason people get so excited about reading glasses is because that’s an intervention that sells itself — because adults are in the workplace and they see the value and can share that experience with their coworkers,” he said.

But sometimes students do not realize they could be seeing more clearly, or parents do not want their children to wear glasses, and Congdon is researching ways to address these issues in the classroom and in the household.