Taking eye testing on the road to improve Uganda's vision

LONDON — When Brenda Katwesigye discovered she needed a pair of glasses, she was “overwhelmed” by the $160 price tag.

“If I had trouble with that price,” said Katwesigye, a former Deloitte employee from Uganda, “then definitely other people in the country had trouble with the price [of glasses]. ... I realized there was a problem.”

After discovering that eyeglass frames are more expensive than lenses — the most crucial components of eyewear — she recognized her unwelcome revelation was also an opportunity. In 2016, she co-founded Wazi Vision after receiving $75,000 from the U.S. African Development Foundation to conduct research and development.

The company started out by selling glasses made from recycled plastic to in-need populations, particularly children, at a substantially lower cost than the market rate. So far, its eyewear has reached 5,000 Ugandans, both in cities and rural areas, according to Katwesigye.

But the company was soon faced with another key challenge for vision health in Uganda and many other sub-Saharan African countries: a lack of ophthalmologists outside of major cities, meaning rural populations must travel long distances to get their eyes tested. Katwesigye estimates only 80 practices in a country of more than 43 million people, and according to Sightsavers, a U.K. charity working to prevent avoidable blindness, two-thirds of sub-Saharan Africa’s ophthalmologists and optometrists are based in capital cities.

Consequently, this need goes unmet for many children from low-income households, even before encountering the significant cost of suitable eyewear.

According to Imran Khan, chief global technical lead at Sightsavers, a simple pair of glasses can mean the difference between a brighter future and being trapped in a cycle of poverty for some children.

“If a child has poor eye health, doing well at school can be challenging and finding work can be harder as they age,” Khan said. If not corrected, refractive errors — such as shortsightedness or farsightedness — can be particularly problematic for children in countries where families may not be able to afford sight tests or spectacles. “Eye health is inextricably linked to quality of life,” he added.

Acknowledging this, Wazi Vision began to run “eye camps,” taking ophthalmologists and their vision-testing equipment on the road to rural districts where such tests are normally unavailable.

Wazi Vision works with local leaders to inform communities of forthcoming eye tests and uses truck-mounted loudspeakers to advertise the events. The tests were initially free for recipients, but a $1 charge was introduced after the costs of running the eye camps began to mount.

“Schools are the most effective” place to test eyes, according to Katwesigye. “Teachers can easily identify children who need glasses, and we can give them priority,” she said.

The field team conducts up to 200 eye tests per day and emails the results and prescriptions back to the Wazi Vision manufacturers in the capital city of Kampala. A batch of glasses is then produced and sent back to the community via a bus or courier in a few days. A pair can cost between $7 and $10 for a child, while spectacles for adults — who are more fussy about their design — can go for up to $20.

Costs are kept low by the use of recycled plastic, collected from the streets of Kampala and shredded before being mixed with other components and pushed through a plastic injection molding machine, Katwesigye said.

Despite some complications from working with used material, “it’s really simple and straightforward — it's just that not many people have done this with recycled plastic,” she added. “As of now, this is what we are good at.”

At first, Wazi Vision just served rural communities, taking its roadshow out for several days at a time to rural districts such as Kamuli and Iganga in eastern Uganda and Masaka in the western region.

But after Wazi Vision held eye camps in low-income informal settlement areas of Kampala, their affordable glasses grew in popularity among city dwellers.

Now, an increasing share of its market is slightly wealthier urban consumers. Katwesigye said that “[they are] people who have no insurance but do have a job” and are happier to spend comparatively higher prices for more customized frames without breaking the bank.

The profit Wazi Vision makes on these glasses is being used to subsidize its cheaper eyewear for the people in rural areas who can only afford $2 or $3 for a pair, according to Katwesigye.

Despite Wazi Vision’s success, the company has faced its fair share of challenges.

Along with the small number of ophthalmologists, eye testing equipment is costly.

Wazi Vision plans to counteract this issue by increasing the availability of eye tests with an app using virtual reality. The company’s concept, being designed with a team of programmers in Vienna, will be used by nonspecialist health workers in existing clinics. Currently, it is still far from completion; Katwesigye said the app is about 75% accurate, but the large margin of error needs to be reduced to just 2% or 3% before it can be rolled out.

Wazi Vision is not alone in turning to VR for eye tests. A Korean start-up, M2S, has already had success with its product, which is expected to be ready for the market later this year.

The production process is also expensive, demanding new molds costing $5,000 apiece for different designs, which limits the types of glasses Wazi Vision can affordably manufacture and sell. Katwesigye has identified this issue as a major bottleneck to scaling and is seeking to raise funds to buy 3D-printing machinery that she believes will give the company greater control and value for the money.

This issue feeds into the wider challenge of what Katwesigye characterizes as a “huge skills gap for manufacturing in Uganda,” which meant it took a long time to find employees skilled enough to make eyeglass frames through plastic injection molding.

Despite the obstacles, Katwesigye is confident that Wazi Vision can be a model of success.

“In Uganda, we could reach 4 million people who are visually impaired. Across Africa, we could reach 23 million people, if not more,” she said, adding that on a continent where approximately 26.3 million people have a form of visual impairment, there is a “huge opportunity, even if it looks like such a niche market.”

“We have a really big dream,” Katwesigye said. “With the right resources, we know we can go big.”

Devex, with financial support from our partner Essilor, is exploring challenges, solutions, and innovations in eye care and vision. Visit the Focus on: Vision page for more.