Around the world today, 217 million individuals suffer from untreated but correctable visual impairment. Those in the more developed world who reap the benefits of contact lenses and cataract surgeries might find this figure surprising. However, a staggering portion of those in the developing world either remain unaware of treatment or unable to access it. Of those who suffer from vision impairment, 89 percent live in low or middle-income countries, where access to eye care is severely compromised. And even though over three-quarters of vision impairment cases are avoidable, the unequal distribution of eye care resources has, quite literally, kept people in the dark. Eye care disparities shed light on an alarming trend: As innovation progresses at blistering speeds in the Western world, if even the simplest technologies are only available to those able to pay, then development remains an impetus, rather than a solution, to inequality.
Poor vision isn’t just a hindrance, it’s a disability. In regions where education is key to escaping the poverty cycle, children who cannot see the blackboard are put at a major disadvantage. In places where job opportunities are scarce, those with poor vision are practically excluded from the workplace. And in villages where the nearest optometrist’s clinic is hours away, the elderly can do nothing but watch their world slowly turn into a blur as their cataracts remain untreated.
Unfortunately, the areas where good vision has the potential to most improve quality of life are also the places where accessible, affordable vision care is the most limited. A 2014 study which mapped human resources for eye care in 21 countries in sub-Saharan Africa found that the ratio between the population and certified optometrists was over 400,000 to 1. Comparing this to the ratio in Rhode Island—under 2000 to 1—illustrates the dearth of healthcare practitioners available to treat and prevent eye diseases.
But the scarcity of professionally trained specialists is not the only barrier to vision care in low and middle-income countries. A Cambridge Ophthalmological Symposium listed “awareness, bad services, cost, and distance” as the four obstacles which deter people from seeking cataract surgery in the developing world. These barriers also apply to the broader issue of vision care, or lack thereof.
And unlike the most popular solution to modern society’s problems, the solution to eye care inequity is not simply the advancement of technology. The two leading causes of global vision impairment are cataracts and uncorrected refractive errors, together accounting for 75 percent of all cases of untreated vision issues. In the US, cataract surgery, during which a patient’s natural lens is replaced with an artificial one, has a success rate of over 98 percent. For uncorrected refractive errors, a simple pair of prescription glasses will suffice to bring a patient’s world back into focus. But for those who make just a few dollars a day, finding an optometrist will do little good if a pair of glasses costs more than a week’s income.
Fortunately, some have begun to realize that the true need for innovation lies in the distribution of technology. OneDollarGlasses is an organization dedicated to providing durable, affordable glasses to those living in the most remote, destitute regions of the world. The 2015 winner of the renowned Tech Award, OneDollarGlasses combines user-friendly production with cheap yet durable materials to create glasses for as little as one dollar per pair. In addition to giving clear vision to over 150 million people around the world, OneDollarGlasses has also provided numerous employment opportunities to citizens in the areas that need them most. Since each pair of glasses can be made at home with a non-electric bending machine, locals can easily be trained to become self-sustaining optical craftsmen.
While OneDollarGlasses addresses the concern of cost, another organization called ADSPECS combats the barrier of distance. ADSPECS are self-adjustable glasses developed by Dr. Joshua Silver, an atomic physicist at Oxford University. Wearers of ADSPECS are able to self-adjust the thickness of their spectacles, giving themselves clear vision in less than two minutes. With the ability to continuously update their prescriptions, the glasses eliminate the need for patients to make grueling trips to their nearest optometrist. Though a pair of ADSPECS currently costs around $20, Silver is working to bring this down to one or two dollars. Already, 40,000 pairs of these glasses have been distributed in nations including India and China, the two most clinically-myopic countries in the world, and the government of Ghana has ordered an additional 100,000 pairs to support literacy programs in rural villages.
Though these private efforts to aid avoidable vision impairment are helping the lives of millions, much has yet to be done. The vision care model of the developed world must be modified to fit the needs of each individual nation, instead of simply imitating a standard Western framework. For instance, in places where ophthalmologists and optometrists are in short supply, these professionals should maximize the time they spend on major eye concerns while opticians or nurses perform less-demanding tests and clerical work. Training for ophthalmologists should focus more on addressing the most pressing eye concerns, reducing the time prospective eye surgeons spend in school, and maximizing their efforts on helping patients. The US educational model, which requires an aspiring ophthalmologist to go through eight additional years of training after completing an undergraduate degree, is unfeasible for nations with a scarcity of cataract surgeons. In East Africa, for example, audits show that medical assistants who receive intensive training in cataract surgery can produce the same results as a procedure performed by a certified ophthalmologist can. Though far from ideal, with the help of portable microscopes and simple sanitation devices, surgeons can now perform cataract operations in people’s homes, which are often far from many surgical clinics.
The staggering disparities in access to centuries-old technologies like glasses force us to re-examine the role of scientific development in a world increasingly defined by socioeconomic inequality. In a free market, investing in high-tech gadgets for high-income consumers is much more profitable than developing affordable, charity-driven technologies for all. Therefore, there must be added incentives for innovators to create products which serve the global poor. As the effectiveness of traditional international aid has increasingly come into question, Western governments should divert aid funds towards subsidizing technological distribution. In addition to state efforts, private investors can also fund specific case competitions and awards for humanitarian technologies. Such initiatives can broadcast the work done by past inventors and draw in ideas for life-changing technologies.
In the more developed world, it is easy to take simple technologies like glasses for granted. After all, the most useful innovations flourish more often in well-off regions, and are thus tailored to the convenience of the world’s upper class. But when these technologies become the prerequisites to a secure, fulfilling life, they must be made available to all. Perhaps with more attention from the private sector and governments alike, this solution to inequality can finally come into focus.