Illustration by Dave Cutler
I n developing nations, tens of millions of people – some estimate as many as two billion – need glasses. “The problem is not just a health problem,” British physicist Joshua Silver told a 2009 global conference on innovation. “It is an educational problem, an economical problem, and a quality-of-life problem.”
Bob Martin, a member of the Rotary Club of Rockville, Md., USA, has set up one vision clinic in the Mexican state of Yucatán and is working on a second. “If you can’t see, you can’t work and you can’t learn,” he says. Martin and Silver are among the scientists, vision specialists, and advocates who are using innovative technologies to bring eyeglasses to people in developing countries who can’t get to an eye doctor or afford prescription lenses.
Vision issues called refractive errors, which include nearsightedness, farsightedness, and astigmatism, result from irregularly shaped corneas that don’t focus light properly. One solution to nearsighted and farsighted vision is a self-adjusting pair of glasses. Two designs are currently being distributed.
Silver has developed glasses with frames that have a small dial at each outer edge. The dials control a clear silicone oil that is pumped into a flexible membrane between two hard, noncorrective plastic lenses. More fluid expands the membrane to correct farsightedness and presbyopia – an age-related condition that’s usually addressed with reading glasses. Less fluid causes the membrane to contract, which corrects nearsightedness.
The UK-based Centre for Vision in the Developing World, where Silver is director, has already distributed more than 30,000 pairs of this type of self-adjusting glasses in 15 countries and aims to give out a total of one billion pairs by 2020.
A different approach is based on a concept that U.S. physicist and Nobel Prize laureate Luis Alvarez developed in the 1960s. In this design, two lenses, each having a flat side and a curved side, are positioned with the flat sides together. The wearer turns a small wheel on each side of the frames to slide the lenses across each other, producing different thicknesses that correct degrees of refractive errors.
Two Dutch organizations have been working to develop and issue designs based on the Alvarez model. The Focus on Vision Foundation, which calls its glasses Focusspecs, has tested them in Africa and Asia and planned to provide 30,000 pairs to Afghanistan, Ghana, and Tanzania in early 2010. U-Specs, devised at the VU University Medical Center in Amsterdam, were first distributed in Afghanistan in 2009; this year, the university plans to produce one million pairs.
“In both types of glasses” – the Silver and Alvarez models – “the technique is clever,” says Lee Duffner, an ophthalmologist in Hollywood, Fla., and spokesman for the American Academy of Ophthalmology. “But neither one is an ideal solution, because the cost is still prohibitive.”
Sjoerd Hannema, who headed the U-Specs team until last year, says the two models range from about US$2 to $20, depending on the quantity. “The target consumer in developing countries will have to pay between $2 and $3; the rest of the costs should be covered by donors or sponsors,” he notes. Hannema is CEO of a UK-based nonprofit called Adaptive Eyewear, which plans to provide more than one million pairs of fluid-filled and sliding-lens designs, as well as ready-made reading glasses, to people in Rwanda over the next five years.
Martin, meanwhile, has a different approach. He founded the Global re-Vision Network to collect, sort, and distribute used eyeglasses. Lions Clubs International collects most of the glasses, which Martin ships to a clinic in Mérida, the capital of Yucatán. Workers there clean each pair and enter the prescription information into a database. The clinic’s employees test patients’ eyes, determine the type of prescriptions they need, and input that data into the computer. A program then finds the best match among the thousands of pairs of glasses in the clinic’s inventory.
Martin learned about the system eight years ago during a trip to Mexico City, where he visited Devlyn Optical, headed by Frank J. Devlyn, past president of Rotary International. Devlyn used it in his own clinic to provide patients with used eyeglasses. “I thought it was incredibly clever,” Martin recalls.
He got in touch with the database developer, who gave him permission to use the program. Every month, it helps about 2,000 patients who come to the Mérida clinic. “The approach we’ve taken addresses the gamut of refractive error problems,” Martin says.
Still, some experts prefer an even more low-tech approach.
“The story is about building capacity,” says Brien Holden, chair of the global fundraising initiative Optometry Giving Sight and CEO of the former Institute for Eye Research in Sydney, Australia, which recently was renamed for him.
Holden says that while self-adjusting and used glasses can be useful in the short-term, efforts should focus on training people as optical and vision technicians who can perform basic eye exams and make glasses to meet each patient’s specific needs. These sorts of organized programs have been successful in establishing self-sustaining vision centers in India, he notes.
“A billionaire could fly over Africa and give out glasses, but that’s wasteful,” says Holden. “What we need is a coordination system.”