Economic Progress

The biggest curable disease ... that no one is talking about

Andrew Bastawrous, an eye specialist, examines a patient at a temporary clinic by International Centre for Eye Health at Olenguruone in the Mau Summit 350km (217 miles) west of Kenya's capital Nairobi, October 29, 2013.

Image: REUTERS/Noor Khamis

Roy Hessel
Chief Executive Officer, Adika
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The raw facts are staggering. Right now, 4.4 billion people are afflicted. The global economy hemorrhages nearly $300 billion in lost productivity yearly as a result. In Africa, it leads to more deaths than malaria. In China, it affects 80% of high-schoolers.

The epidemic: poor vision, among the least talked about but most pervasive of diseases. Broadly, poor or impaired vision is defined as a limitation in one or more functions of the eye. The most prevalent affliction is myopia, commonly referred to as nearsightedness, i.e. the inability to see things at distance.

Incredibly, estimates are that by 2050 more than 5 billion people will have myopia, nearly 50% of the projected global population. More than half of those people won’t get the treatment they need. And the consequence is far more than just inconvenience: educational outcomes, road safety and long-term health are all tied up in the problem of uncorrected vision. Myopia is also associated with serious eye diseases such as cataracts, glaucoma, and myopic macular degeneration, which can all cause irreversible blindness.

 Graph showing the number of people estimated to have myopia and high myopia for each decade from 2000 through 2050. Error bars represent the 95% confidence intervals.
Graph showing the number of people estimated to have myopia and high myopia for each decade from 2000 through 2050. Error bars represent the 95% confidence intervals. Image: American Academy of Ophthalmology

Having been in the online optical space since 2004, I’ve seen this problem up close. Across large parts of the globe, people simply aren’t aware that they’re suffering from a curable condition or don’t have access to the right treatments.

What’s most striking about this epidemic, however, is not its size or impact, but how easily it could be cured. Indeed, my mission is to help ensure we find a way forward. The technology to treat poor vision has been around for more than 700 years, but in many parts of the world it remains less available than smartphones. The solution? A pair of glasses. Only, as with most global challenges, there’s more to this issue than meets the eye.

Ignorance is blindness

The first challenge: simple awareness. This is most critical in the developing world. In China, the world’s largest country with a populaiton of 1.4 billion people, four in five students aged 16-18 are nearsighted. By 2020 - ironically the term for perfect vision - half of all Chinese over the age of five will have myopia. But many people in China and throughout the developing world still think vision problems are merely a normal - and inevitable - byproduct of aging, no different than grey hair or wrinkles. In parts of rural China, some even believe glasses actually weaken your eyes.

Sometimes, this impact can be felt in surprisingly personal ways. I worked for more than a decade to develop a homegrown online optical company in China. But, eyeglasses still aren’t reaching the people who need them. I frequently travel to Shanghai on business and am shocked every time my taxi driver has to stop the car and hold my business card up to the headlights just to read the address written on the back. Is it any wonder that each year China has the most road deaths of any country in the world?

The first real step toward a solution is putting this on the global radar of health disorders. We’re all aware of the debilitating effects of Alzheimer’s disease, for instance, but in terms of only numbers its 44 million sufferers pale next to the billions of visually impaired around the world. Educating people on vision conditions, their causes and cures, could yield a massive return.

But increased awareness and education is only part of the puzzle.

Access and apps

In sub-Saharan Africa, optometrists are outnumbered 8,000,000 to 1. In North America, for comparison it’s 6,000 to 1. Vision problems persist globally in part because there aren’t nearly enough eye care professionals to serve everyone in need.

In practical terms, this means there are many more people in Africa and India - two of the least-serviced geographies - likely to operate machinery or vehicles with uncorrected visual impairments. Traffic accidents have now surpassed malaria as the number one cause of death in most African countries and poor vision is to blame for most of them.

In Southern India, more than 80% of textile workers have poor sight and providing glasses for them could boost productivity almost 50% (not to mention the impact on safety). One study showed that improving vision among workers yields a four-fold return in output.

The challenge: finding ways to administer proper eye exams to people in developing nations who are too far from an optometrist. Here’s where technology can be a gamechanger. Peek, Opternative and EyeNetra are just three tech companies attacking the space with devices that attach to your smartphone to give a cheap, accurate eye test. These peripherals are far less expensive and far more portable than the traditional devices used in opticians’ offices (which can run into the tens of thousands of dollars). Giving professionals a way to quickly, cheaply determine a prescription - from anywhere - promises to radically change vision health for the better.

And the technology may one day go even further. Soon, users in remote regions lacking health-care access may be able take their own eye test using just the camera on their mobile phone. Only then will the process be truly accessible to everyone, reaching people in areas where mobile phones are more prevalent than drinking water.

The great equalizer: price

Even with a prescription, there’s still one last barrier: cost. Ninety percent of the world’s vision impaired are poor, making corrective eyewear a luxury. Even in North America a set of glasses can easily run into the hundreds of dollars. For buyers on a budget, that hurdle is often too high to clear. This is compounded by the fact many people for convenience get their prescription and buy their eyewear from the same store, perhaps never realizing they can take their Rx elsewhere for economical alternatives. But it doesn’t need to be that way.

Consumers have been buying eyewear online for more than a decade. I started my online eyewear company in 2004, and I’ve seen up close how economies of scale can radically reduce cost and improve efficiencies. A complete set of prescription glasses can now be found for as little as $20 in the U.S. Online offerings also give people access to glasses in remote regions where opticians are hard to find. Yet online sales account for just 4% of all eyewear purchases, a figure projected to grow to 10% by 2026 - still accounting for just a fraction of the market.

Until then, the problem of poor vision persists and countless people continue to suffer, unaware and just out of reach of an affordable solution. This problem continues not because we can’t make enough glasses. It’s not because we can’t get those glasses to the people who need them. It’s because most people don’t know they have a problem or don’t have access to something as simple as a proper eye exam.

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