Health and Healthcare Systems

If Rwanda can achieve universal access to vision treatment, why can't all countries? 

A man gets his eyes tested at a free eye-care camp set up by voluntary organisation 'Karm' in Mumbai February 15, 2009. According to a World Health Organisation report, 90 percent of the world's blind people live in developing countries with at least 9 million of them in India, where they are often victims of poverty and lack of access to quality eye care. REUTERS/Arko Datta (INDIA) - GM1E52F1GVB01

A man gets his eyes tested at a free eye-care camp set up by voluntary organisation 'Karm' in Mumbai Image: REUTERS/Arko Datta

James Chen
Chair, Chen Yet-Sen Family Foundation, Hong Kong SAR
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According to Moore’s Law computer processing speeds will double every two years, setting a rapidly rising beat for technological change. Whether or not you agree with this hypothesis there is no denying that we are in the grip of a breath-taking technological revolution. To me, the speed of progress is set by the rate at which human knowledge can be crowd-sourced and ideas scaled.

While we might now live in a world where a drone can deliver a can of coke to our doorsteps, we also live in a world where a third of the population - 2.5 billion people – still have poor vision and no access to glasses. An estimated ninety per cent of all cases of poor vision in the world today could be resolved by wearing glasses – a seven-hundred-year old invention that remains out of reach for a huge swathe of humanity.

More than one billion people in India and China needlessly suffer from poor vision. Of a staggering 2.5 billion people across the world who cannot see clearly, some 720m are in China and 477m in India, a global ranking of countries published by the Clearly campaign reveals. Most need a solution that has been around for centuries- a simple pair of glasses costing as little as £1 to produce.

1. China - 720m

2. India - 477m

3. Nigeria - 95m

4. Indonesia- 90m

5. Brazil - 79m

6. Bangladesh - 66m

7. Mexico - 55m

8. Ethiopia - 52m

9. Pakistan - 52m

10.Philippines - 51m

Poor vision is a vital, fundamental and utterly solvable problem, yet it is the largest unaddressed disability in the world. It is the problem the world forgot.

Poor vision is also a silent headwind to progress, costing the global economy $3 trillion a year.

From access to education to road safety, the impact is huge. Poor vision reinforces inequality, as ninety per cent of those without access to glasses live in developing countries. Nearly two-thirds of people with visual impairment are women.

This all adds up to a huge waste of human potential across the developing world. Seeing clearly is the golden thread that will help the world to reduce poverty, and deliver quality education, decent work and gender equality.

As the world faces a tipping point in technological advancement we have the power to transform access to good sight around the world and provide long-overdue solutions to this global problem. It can, and must, be done.

Seeing the Problem

So why isn’t more being done? In Silicon Valley tech brands are racing to provide augmented reality glasses to the mass market within the next year. Why is it that we can get this off the ground, but getting a pair of glasses onto the nose of everyone who needs them remains a bridge too far?

The reasons are complex – from the issue of diagnosing poor vision and distributing glasses in hard to reach places, to the stigma that persists in many parts of the world about the fear of looking ‘different’ or ‘unattractive’.

A lot of the problem comes down, of course, to funding. What little money is available from governments and NGOs is understandably channeled towards the 165 million people who need medical interventions to address sight loss.

But poor vision shouldn’t be competing with the world’s healthcare crises. While on one level it is a non-life threatening health issue, it is also fundamentally an economic problem of demand and supply.

In Europe and the US, vision correction and treatment relies on highly trained ophthalmic experts, high-cost equipment and complex, technical eyewear inventories. Without the education infrastructure or technical supply chain required, that model is near impossible to recreate in the developing world.

Focusing on Solutions

Yet around the world the problem of poor vision is being turned on its head through radical and disruptive thinking. For the first time, we have the technology in place, coupled with soaring rates of mobile use in the developing world, to support digital solutions.

Remote diagnostics is a stand-out area of innovation. Initiatives like Peek Vision, a social enterprise operating in parts of Africa including Kenya and Botswana, has developed a series of smartphone apps that offer a radical and accurate new way to test vision. Peek works with local communities and health providers to create new sustainable eye health solutions, such as mass screening programs, which harness the power of this new technology and increase access to diagnosis and care.

In South Africa the team behind another remote diagnostic application - Vula Mobile – is scaling up its efforts to connect primary healthcare workers in remote areas with on-call specialists, enabling primary health workers to perform basic eye tests. And then there are apps like Aipoly, which use artificial intelligence to help blind and visually impaired people understand their surroundings through colour and object recognition.

In the future AI is likely to play a major role in the way that vision is screened. The work that Deepmind is doing in partnership with Moorfields eye hospital in London to apply machine learning to diagnostics, is a case in a point.

Additionally, there is much buzz about the potential of 3D printing to dramatically reduce the cost of manufacturing glasses, which often face huge price inflation due to taxes and import levies?

In the same way, there is some impressive work being done in last-mile delivery. Will we be able to use drones to drop supplies of glasses to distant places one day? In Rwanda this is already being done with life-saving supplies of blood supplies and medicine via Zipline which connects aid workers and medical professional to fleets of their pilotless aircraft via SMS. But right now we are seeing initiatives springing up to hack the problem of delivering glasses in remote areas – such as Essmart, which delivers affordable reading glasses to local shops across India, supported by educational tools and materials.

The power of this type of cutting-edge technology is striking, yet it can overshadow the other simpler innovations that can be just as transformative. Ultimately, technology is only ever an ‘innovation’ once it’s genuinely innovating – changing lives at scale. More often than not, innovation begins and ends with forging partnerships, whether governmental or private, which require a willingness to innovate every aspect of the delivery chain, from regulation, to infrastructure, to final delivery.

Take Rwanda for example. Through the work of the Rwanda Government and the UK Charity, Vision for a Nation, 100% of the country’s population now has access to primary eye-care. We did this not through using smart-phone apps, but by training up nurses to have the basic skills needed to deliver primary eye screenings, and to make referrals where necessary.

With over 2,700 nurses trained in vision testing, reductions in taxes and import duties on glasses, and relaxed rules allowing glasses to be dispensed where they are needed, today Rwanda’s 11.8 million citizens have universal access to vision treatment – the first low income nation to provide all its people with local access to affordable primary eye care.

Future Vision

The world is on the cusp of a new technological revolution, with a future that could see the end some of the biggest issues that have plagued humanity. Right now there is a chance that our children will grow up to see the end of terminal cancer diagnoses and a human touch-down on Mars. Who knows - one day we might develop eye drops that correct vision through nanotechnology rather than spectacles.

Until then we need to make sure poor vision is part of the international agenda and is no longer a forgotten issue. We urgently need to help the world to see clearly so that everyone can realise their full potential.

There’s no doubt that technology will play a vital role in helping us to find solutions to this issue. But I’m also certain that the key to our success will lie in the development agencies, governments and NGOS commitment to adopting and emulating an innovative mind set.

Starting with the Commonwealth, over the coming year, as part of a global campaign called Clearly, we’re calling on the international community to address the issue of poor vision around the world, at the Commonwealth summit in London next year.

James Chen ( is the founder of Clearly ( and Founder and Trustee for ground-breaking foundation Vision for a Nation ( He is the author of the new book ‘Clearly: How a 700 year-old Invention Can Change The World Forever’.

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