For most of his adult life, Abraham made a living as a cobbler, supporting his wife and raising six children on his earnings. But several years ago, he started having trouble threading needles. Initially, he pricked himself repeatedly, and eventually, he couldn’t get the needles threaded at all. Due to his poor eyesight, Abraham had to shut down his shoe repair business.
His story is a common one. Global estimates suggest that people with moderate to severe vision impairment are about 30 per cent less likely to be employed than those with good eyesight.1 For lack of a pair of eyeglasses, for want of a simple cataract surgery, millions of people are unable to work. It can keep entire families stuck in the cycle of poverty.
Abraham’s story has a happy ending. After meeting a community health volunteer during a door-to-door eye health screening, he was diagnosed with bilateral cataracts and got sight-restoring surgery on both of his eyes at one of our partner hospitals. He started taking in shoes for repair once again.
But many people won’t get back to work like Abraham did. And that’s because basic eye care isn’t available or accessible to them. According to estimates, about 2.2 billion people worldwide have vision impairment, and in roughly half of those cases, the vision loss could have been prevented or hasn’t yet been treated.2
Lack of access to eye health care
For many people across the globe, the neighbourhood optometry clinic simply doesn’t exist. While people in Western Europe enjoy a ratio of one optometrist to every 3,877 people, countries in central sub-Saharan Africa reported a ratio of one to every 1,198,141 people, according to a 2023 study.3 Even when there is an eye care provider in a nearby city, the barriers to reaching them can be insurmountable for some people living in remote and rural areas. Many can’t afford the bus or train fare, let alone the fees for diagnosis and treatment. And for women and children, travelling alone can be dangerous, so they often need to wait for someone – usually the family breadwinner – to take time off work to escort them. For those with seriously impaired vision or other disabilities, travel might be nearly impossible.
Every day, the community health workers who do eye screenings on our behalf meet people who have previously tried to solve their vision issues without success. Many patients had visited the nearest healthcare provider, often a local dispensary, and were sent home with eyedrops or told their vision couldn’t be treated. Some had bounced around from clinic to clinic, others had resigned themselves to living out their days in blindness. That is why we are working hard to provide eye health care services at the community level.
By connecting people with our partner vision centres and hospitals, helping cover fees and offering safe transportation to the hospital, we can help restore vision to people who may never have gotten treatment otherwise. It’s just one of the ways we are working towards the United Nations Sustainable Development Goal number one: No Poverty. By addressing some of the root causes of poverty, like poor eyesight, we can help people stay employed and stay in school.
How eyeglasses can improve income
The global productivity loss attributed to impaired vision is estimated at US $411 billion annually.4 And those effects can be seen on the individual level as well.
A recent study looking at workers with presbyopia between the ages of 35-65 in Bangladesh found that those who had reading glasses made 33 per cent more than those who did not.5 The study, published in PLOS ONE, tracked the incomes of more than 10,000 participants who work in near-vision intensive occupations – like tailors, mechanics and carpenters – over eight months. Half of the participants received reading glasses right away, while the control group only got a pair after the eight months of data collection. The eyeglasses themselves cost only about US$3-4 per pair but had the potential to transform the lives of the workers.
Another study of tea pickers with presbyopia in India found similar results in 2018.6 In that case, the three-month study found that a pair of reading glasses increased productivity for the plantation workers – who are paid by the kilogram of leaves picked – by about 22 per cent, and 32 per cent for those over the age of 50.
As these studies show, addressing vision loss can increase productivity and provide greater economic opportunities for individuals.
The chicken or the egg
Like many other health issues, it can be difficult to untangle the relationship between low incomes and eye health problems. Poor vision can lead to poverty because people often lose or quit their jobs when they’re no longer capable of doing them effectively or safely.
Take Junmoni in India, for example. The mother of two dreamed of sending her daughter to college with her earnings making handwoven fabrics on her loom. But when her vision became blurry, she had to stop weaving. Money got so tight that she was on the brink of selling her handloom. Fortunately she met a community health worker who told her she just needed to visit the local vision centre to get a pair of eyeglasses. Junmoni now wears her prescription eyeglasses while working at her handloom, her dreams for her daughter back on track.
But just as vision loss can lead to poverty, the opposite may also be true.
An infectious eye disease, called trachoma, continues to cause vision loss and blindness in dozens of countries around the world. It is widespread in some rural areas, and also in regions where there are high rates of poverty. The bacteria spreads through personal contact, via hands, clothes and bedding, and by flies that have been in contact with discharge from an infected person. It is most common in areas where people don’t have access to clean water or have to travel long distances for water.
If left untreated, trachoma causes the eyelashes to turn inward and scratch the cornea, leading to severe pain, vision loss and even blindness.
The spread of trachoma can be managed when people have access to clean water, allowing for more frequent hand and face washing, and the cleaning of clothing and bedding. Antibiotics can also help prevent and treat trachoma in areas where it is endemic.
We work with partners and communities in Ethiopia, Kenya and Zambia to prevent the spread of trachoma by helping establish water boreholes and latrines and administering antibiotics.
Ninety per cent of vision loss is preventable or treatable, but people living in underserved communities are more likely to go blind. In fact, 90 per cent of people with vision loss live in low- and middle-income countries, which is why we’re working in these areas.
Reaching the unreached
Lack of education is another factor that keeps vision loss in lockstep with poverty. Some people don’t seek eye health care simply because they believe their condition is untreatable. Many older patients believe that vision loss, even blindness, is just an inevitable part of aging. In some communities there may be additional fear or distrust of medical authorities based on previous experiences, myths or other cultural stigmas.
By reaching people in their homes and communities through door-to-door eye screenings and eye camps, we can offer basic eye health education and choice to those who might never get treatment otherwise. And in cases where a patient might be hesitant to get surgery, our community-based approach enables health workers to continue counselling patients over weeks and months, reassuring them, explaining the benefits of a procedure and often convincing them to get treatment in the end.
Another way we work to prevent the devastating effects of vision loss is by making sure the youngest people in our project areas learn about eye health. By offering eye screenings and education in schools, organizations like ours can reach thousands of families through their children, who go home brimming with excitement over the vision test they took at school, and what they learned about eye health. By providing children with referrals to the nearest vision centre or partner hospital, the whole family is made aware of the services that are available to them.
Effects on the whole family
The effects of a cataract surgery often ripple down through the beneficiary’s entire family. We hear of many young women who have given up jobs or dropped out of school to care for a senior family member who has gone blind. Once the family member has had their vision restored through cataract surgery, they often regain their independence, freeing up their caregiver to devote that time to work, school or other economic opportunities.
And parents who have had their vision problems corrected, like Junmoni, are better placed to keep their children in school longer, and even send them off to advanced education, potentially lifting future generations out of poverty.
Finally, children with vision problems who get corrective eyeglasses or treatment fare better at school. In fact, prescription eyeglasses have been shown to have a greater impact on academic achievement than other health interventions, like nutrition and deworming programs.7 This is why we are currently expanding our school eye health programs, so we can help more children thrive in school so they can get the best possible start on their working lives.
The road ahead
While many organizations like ours are collaborating with partners, governments and funders to address vision loss and blindness, aging populations and population growth mean that the problem will increase if we don’t act quickly. Some estimates say that by 2050, half of the global population will have myopia.8
You can help us continue our mission to prevent blindness and restore sight by following us on our social media accounts, signing up for our newsletter and sharing what you’ve learned with friends and family. Join our global community today.
- https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00132-2/fulltext ↩︎
- https://iris.who.int/bitstream/handle/10665/328717/9789241516570-eng.pdf ↩︎
- https://www.researchgate.net/publication/375055096_Global_mapping_of_optometry_workforce ↩︎
- https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30488-5/fulltext ↩︎
- https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0296115 ↩︎
- https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30329-2/fulltext ↩︎
- https://educationcommission.org/updates/providing-eyeglasses-school-age-children-high-impact-investment-education/ ↩︎
- https://www.essilorseechange.com/wp-content/uploads/2020/02/Eliminating-Poor-Vision-in-a-Generation-Report.pdf ↩︎
