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The three A’s of eyecare

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Availability, affordability and awareness are the three key A’s to help break down the barriers for addressing uncorrected refractive error (URE), tells Ella Gudwin, President, VisionSpring, to Prathiba Raju

Why do you think eye health should be a public health priority in a developing country like India?

Poor Vision remains number one unmet disability need worldwide and in India, too. According to a World Health Organisation (WHO) study (2013), over 550 million people in India need eyeglasses and 25 per cent of the world’s blind population reside in India.

The problem in India needs attention right now. In a recent programme assessment for truck drivers, we found that 68 per cent of drivers had never undergone an eye examination prior to receiving or renewing their driving license. Across communities in India, we have found the first-time glasses wearer rate is between 50-70 per cent, i.e. for many in India, their first experience with preventive eye care is at a VisionSpring programme camp.

What are the barriers to Uncorrected Refractive Error (URE) and how can these be addressed?

Loss of clear vision is sometimes gradual and thus it is de-prioritised over others which are more urgent healthcare needs. Lack of awareness, lack of eye care infrastructure, minimal access to affordable eyewear and cost are the major barriers faced by low-income people globally. Moreover, these barriers are heightened for those who belong to rural communities. For rural communities, the cost of correcting vision includes income loss, travel costs to the nearest urban eye care centre, besides treatment and eyeglasses expenses. Also, social stigma continues to be a barrier, especially for young women who need corrective eye wear.

Access is comprised of the three key mantras we live by – availability, affordability and awareness. We believe these three A’s are the key to help break down the barriers to address URE. Availability creates many points of distribution to increase the convenience and reduce the cost of getting glasses; affordability involves durable, attractive eyewear priced within one-to-two days’ wages for low-income consumers and awareness increases end-consumers’ knowledge about the eyeglasses for their personal use and stakeholder’s understanding of eyeglasses as a powerful tool for increasing social and economic development.

Where does India stand when it comes to URE?

The Government of India had long recognised vision as a nodal health issue and had launched the National Programme for Control of Blindness and Visual Impairment (NPCBVI) in 1976. However, a lot remains to be done to build a system which can be effective, considering India’s size. The Vision 2020 of ‘The Right to Sight’ initiative shared that there are about 18,000 ophthalmologists in India for its 1.3 billion population, resulting in a ratio of one ophthalmologist for every one lakh people. In rural India, this ratio is even worse: one ophthalmologist for every 250,000. The ratio of availability of qualified optometrists, approximately one for every 25,000 people, is also lower.

On one hand, India has world-class institutions like the Aravind Eye Hospital, renowned for their innovative low-cost eye care models, and then there are villages in Talaseri in Maharashtra where over 90 per cent villagers have never had their eyes tested, ever in their lives.

How does URE directly impact the socio-economic set up of the country?

URE is costing the global economy an estimated $227 billion with low-income countries disproportionately affected. 550 million Indians are needlessly suffering from poor vision, which can be easily fixed by a pair of eyeglasses. Women are disproportionately affected as they suffer from lack of access to healthcare or similar interventions. For a human resource-rich country like India, poor vision impacts at two levels – economic and human potential.

It is estimated by WHO that the impact of poor vision on the Indian economy is over Rs 2.5 lakh crores ($37 billion). Every person who does not have access to clear vision is not leveraging his or her full human potential – whether weaving or at a factory or farming, learning at school, mothers helping children with homework or cleaning rice or anybody being able to read text messages on mobile. The results of a recent study trial of tea pickers in Assam (which we undertook with Clearly, Queens University Belfast and Orbis) has shown that the provision of glasses improved their productivity by 21.7 per cent – and for those aged over 50, the increase was 31.6 per cent. This means if farmers and agri workers are provided eyeglasses, India’s agri sector can be boosted by over Rs 14,000 crores ($20 billion). Imagine the impact that can be created if we provide preventive eye-care for workers, sector by sector, across India — all with a pair of eyeglasses costing barely Rs 150 per pair.

What is VisionSpring’s role in India? Do you have any specific targets?

The optical market is not meeting the needs of consumers earning fewer than Rs 280 per day. VisionSpring provides end-to-end services, including pre-screening, technical screening, training and eyeglasses on demand across India. We reach our customers using innovative B2B distribution models and advance our social impact along three themes: See to Earn, See to Learn, and See to be Safe. We focus on Bihar, Odisha, Madhya Pradesh, Uttar Pradesh and Rajasthan, in particular, to strengthen the existing healthcare infrastructure to provide preventive eye care.

We have the following projects:

Wholesale partnerships: We sell bulk quantities of eyeglasses coupled with training and marketing to a network of hospitals, eye care centres, NGOs and government partners. In 2019, over 300 organisations in India count on our quality product, timely delivery, favourable payment terms. Our partners are from across India — Siliguri Greater Lions Eye Hospital, HV Desai Eye Hospital (Pune), Sri Sankaradeva Nethralaya (Guwahati), Tara Netralaya (Rajasthan and Delhi), Gandhi Eye hospital (Aligarh), LV Prasad Eye Institute, Akhand Jyoti Eye Hospital, etc.

Third-party subsidised vision access solutions: We bring eyeglasses to workplaces, schools and rural communities pairing philanthropic funds with the purchasing power of end-consumers and governments. Corporate social responsibility: In India, we have partnered with 35 CSR offices of major businesses to bring free-vision screenings and low-cost glasses to communities. These include programmes for the Bajaj Group, RPG Foundation, ICICI Foundation and Shell India, among others.

Clear vision workplaces: We work with an alliance of leading brands to dramatically increase eyeglasses coverage rates among low-income workers who produce textiles, garments, home goods, tea and coffee in their supply chain. Our ‘clear vision workplaces’ projects introduce worker well-being initiatives to these globally-recognised corporations like Levi Strauss, Target, VF, etc.

Government: We also collaborate with government agencies to reach low-income children and communities. Our partners include various government bodies like the National Health Mission (NHM), Government of Telangana; National Programme for Control of Blindness and Visual Impairment (NPCBVI), Artificial Limbs Manufacturing Corporation of India (ALIMCO) and AIIMS, New Delhi. We are conducting vision screening for one lakh weavers in Varanasi in partnership with the Smart City Varanasi.
In India alone, VisionSpring has distributed over three million eyeglasses. Over the past few years, we have executed projects in over 180 districts and 1,200 villages. In the last 12 months, we have screened 80,000 garment, handicraft workers and weavers, so that they can earn more; helped 30,000 drivers to drive safely and checked vision needs of over 2,50,000 school children, so that they can learn better. One of our goals is to normalise eyeglasses wearing among workers in the manufacturing and agricultural sectors by 2030.

Can you tell us about the subsidised glasses by VisionSpring and how has it helped people to recover from poor vision?

VisionSpring’s mission is to create access to affordable eyewear, everywhere. We expand the optical market using innovative distribution strategies to sell radically affordable, durable and attractive eyeglasses. We pair philanthropic funds with the purchasing power of end-consumers, B2B clients, CSR and government partners.

For instance, Shell India and VisionSpring committed in July 2019 to help 3.65 lakh commercial drivers and allied transportation workers to see clearly and drive safer by the end of 2020. 20/20 being the measure of perfect vision, the ‘#DriveSafeIndia’ initiative will accelerate access to vision correction and advance national goals to improve road safety. The Road Safety initiative follows a programme assessment conducted by VisionSpring which evidenced a deep need for eyeglasses among heavy and light commercial vehicle drivers who are driving with uncorrected blurry vision.

VisionSpring found that 25 per cent of drivers participating in the pilot phase of the programme failed to meet the standard required for a driver’s license. It means that without eyeglasses, these drivers were unable to see road signs at 20-30 metres and meet the Indian Motor Vehicles Act eligibility requirement of 6/18 vision or better for both eyes. In the follow-up interviews with 385 drivers, 68 per cent reported that they never had a vision test which is required for a driving license or license renewal. After getting glasses for the first time in their lives, 76 per cent of the drivers articulated that driving safely and optimal job performance would be the most important results of their new clear vision.

Do you think innovation is critical when it comes to ophthalmology? Reasons?

Two-and-a-half billion people need eyeglasses and 624 million are visually impaired, costing the global economy an estimated $227 billion each year. The problem is too big to solve just with charity and philanthropy. It requires market-based approaches and collaboration with government.

Nevertheless, a number of things are happening in eye-care including technology innovations like hand-held refraction and telemedicine that are making it possible to serve many more people in areas with a limited number of eye care specialists. Innovations are changing the way we conduct school-screenings to reach more children – for example, by training teachers and other education advocates to identify students suspected of having a vision error so that they may be prioritised to see an optometrist or specialist. Also, organisations are working on a variety of business models that are creating market-based access to eyeglasses and other vision care.

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