Uncorrected Vision: The Largest Public Health Crisis You’ve Never Heard of and How to Tackle It

I met Raul in 1984. He was seven years old and blind. When I examined his eyes, I discovered that he was, in fact, not blind at all; he was a 20-diopter myope who had never had an eye examination. When I rested a pair of eyeglasses on his nose, he saw for the first time.

Raul is far from alone. Worldwide, uncorrected refractive errors are the leading cause of visual impairment and the second leading cause of blindness after cataracts, affecting 1.3 billion people.¹

Although this is the world today, it does not have to be the world of tomorrow. Playbooks exist that prove large-scale public health problems can be addressed in their entirety. Campaigns to address diseases including malaria, polio, and river blindness have benefitted from and made major strides by using this approach. As in these efforts, we know how to solve the problem of uncorrected vision. What we need is political will, resource mobilization, a grand plan, and coordinated action by private- and public-sector actors.

Although many organizations have powerful programs to address uncorrected refractive errors, they have collectively addressed less than 1% of the problem. These interventions tend to be effective and efficient; however, they lack the necessary scale. Most tend to be isolated, poorly integrated into larger public- and private-sector systems.

With that in mind, with my colleague Liz Smith, I established EYElliance, a multisector coalition driving global strategy to increase access to eyeglasses at scale. To start, we convened a steering committee comprising individuals representing the World Bank, US Agency for International Development, Essilor, the Skoll Foundation, Brien Holden Vision Institute, and VisionSpring; today, EYElliance has 60 members working together to address the global unmet need for eyeglasses.

We then began to raise awareness to elevate our issue beyond the realms of vision and health to propel it to the center of the global development agenda. We aimed to influence leaders at the highest possible level in both the private and public sectors by copublishing a report with the World Economic Forum: Eyeglasses for Global Development: Bridging the Visual Divide.

The report summarized the compelling evidence that supports the rationale that correcting people’s vision with eyeglasses advances socioeconomic development. Data demonstrate that correcting vision improves test scores by the equivalent of up to half a year of schooling, which translates into an increase in future earnings by up to 5%.² Stanford University professor and development economist Scott Rozelle states, “Based on my 25 years of research experience, correcting vision with glasses is the single most effective health intervention when it comes to improving academic performance.”^2(p16)

Research from various regions of the world promotes the idea that proper vision is crucial for economic development and public health. For instance, providing reading glasses to rural Indian tea pickers as part of a 2017 study increased their overall productivity by 21%, and up to 32% for those aged older than 50 years. If that improvement were replicated across India’s crop industry it would mean an extra $19 billion in growth from productivity gains alone.³ Similarly, the economic burden of road traffic injuries and deaths in low- and middle-income countries can mean losses of up to 5% of gross domestic product. In Ghana, a study found that more than 12% of commercial drivers were on the road with vision below the minimum standards required by law, and 6.8% were visually impaired.²

Based on estimates from Fricke et al., poor vision caused by uncorrected refractive errors results in a $227 billion annual loss to the global economy.⁴ This number will only grow given the rampant rise in uncorrected refractive error across the world, which will leave 50% of the world myopic by 2050.⁵

The first principle—and the organizing theory of EYElliance—is that only the private sector or governments can adopt innovative models and scale them to reach billions. Nongovernmental organizations are excellent at creating new, low-cost approaches to solving problems but in general lack the resources and reach to radically scale these interventions.

On the government side, our strategies include school- and community health worker (CHW)–based approaches. At present, 239 million children globally live with poor vision that is correctable with eyeglasses.⁶ Of those, 12 million need prescriptions so strong that, without them, they are classified as visually impaired or blind.⁷ Given the strong link between vision, learning, and then earning, we believe governments should consider eyeglasses a public good and provide children with their first pair for free or at a heavily subsidized price.

EYElliance works with governments to build the capacity to establish national school screening and eyeglass provision programs and over time incorporate the cost of those activities into their education sector plans. For 65 of the poorest countries, education sector plans are eligible to receive resources from the Global Partnership for Education, a multibillion-dollar fund.

The use of CHWs is a key strategy used to address the acute shortage of health workers. EYElliance will work with ministries of health to position these CHWs as frontline providers of primary eye care. They can be trained to screen for presbyopia, the most common vision problem and, when appropriate, dispense ready-made near-vision glasses for free or at low cost. Individuals with more advanced vision problems are referred upstream into the eyecare system.

EYElliance members have systemized best practice models to deliver eyeglasses via both school- and CHW-based models. We are actively engaged in a pilot program with the Ministries of Health and Education in Liberia to embed the models into a national plan to scale countrywide; if successful, we hope to replicate the model regionally and, ultimately, globally.

For the private sector, our strategies include creating an inclusive optical sector and mass distribution via last mile retailers: those final destination points where billions of the rural poor source all manner of products. EYElliance is working with these retailers and those that serve them—last mile distributors—to ensure ready-made near-vision glasses are ubiquitously available. Our members have proven models of how to ensure these distributors and retailers successfully integrate eyeglasses into their product offering.

Our long-term objective is to help create a significant number of profitable inclusive optical businesses. This will demonstrate to investors that they can simultaneously make a profit and support development. If that can be achieved, international finance institutions and impact- and market-based investors will deploy greater amounts of capital to catalyze growth of the optical sector.

It is possible to create a world where no child fails out of school or adult loses his or her livelihood because of a lack of eyeglasses. With 60 committed members, budding interest from the US and UK governments, and private sector actors stepping in to play primary roles in solving the problem, there is promising evidence that uncorrected refractive errors can be eliminated as a leading cause of visual impairment and blindness.