Half a billion people need reading glasses. Why can't they get them? (Encore)

Summary

The Indicator from Planet Money: Half a Billion People Need Reading Glasses. Why Can't They Get Them? (Encore)
Release Date: December 27, 2024
Host: Adrian Ma, NPR

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Introduction: The Global Vision Crisis

In this enlightening episode, Adrian Ma explores a perplexing global issue: while reading glasses are readily available and affordable in the United States, an estimated 510 million people worldwide suffer from unaddressed vision loss that could easily be remedied with a simple pair of reading glasses (00:23). This discrepancy not only hampers individual productivity but also has significant economic repercussions on a global scale.

The Economic Impact of Vision Impairment

Vision impairment due to presbyopia—the age-related difficulty in seeing things up close—goes beyond personal inconvenience. Pelin Muniz, CEO of the nonprofit Restoring Vision, highlights the staggering economic loss associated with this issue:

“The data shows that there's $410 billion of economic loss annually due to vision impairment and lack of access to eyeglasses, which is pretty staggering.”
— Pelin Muniz (03:30)

This loss affects various sectors, from office environments to agricultural fields, where clear near vision is essential for productivity.

Understanding Presbyopia and Its Global Reach

Presbyopia typically begins in one's 40s in developed countries but can onset as early as the 30s in many low and middle-income nations. Muniz explains:

“Presbyopia happens usually in your 40s, but in a lot of countries it can happen as early as in your 30s. So just when you're in your prime working years, you're going through sight loss and that has really long term implications.”
— Pelin Muniz (03:59)

The lack of awareness and insufficient access to eye care professionals exacerbate the problem, leaving millions unaware that a simple solution like reading glasses exists or are unable to afford them even if they do.

Barriers to Access: Supply and Demand Challenges

While reading glasses are inexpensive and easily accessible in the U.S.—often costing just a few dollars at pharmacies or online—this is not the case globally. In regions like Mexico's Zacateca State, glasses can cost around $20 USD, a significant expense in areas where the average monthly salary is approximately $280 USD (04:50).

Muniz identifies the core issue:

“Eyeglasses have existed for over 700 years. It's the access to them that's really the challenge.”
— Pelin Muniz (05:39)

The absence of a viable market means that local retailers have little incentive to stock or sell reading glasses, perpetuating the scarcity and high costs.

Restoring Vision's Strategy: Building Demand and Supply

Restoring Vision addresses this problem through a two-pronged approach:

1. Creating Demand: By partnering with local NGOs and governments, they screen individuals for presbyopia and provide their first pair of reading glasses at no cost. Muniz states:

   “Individuals will get their first pair of glasses at no cost to them. And this is where we start to see the markets.”
   — Pelin Muniz (05:59)

2. Enhancing Supply: To sustain the market, Restoring Vision works on increasing the availability of reading glasses by expanding retail channels and engaging employers to provide glasses to employees, which can boost productivity by up to 32% (06:42).

Overcoming Regulatory Hurdles

Regulatory barriers further complicate access to reading glasses. Some countries impose restrictions on the marketing of medical products or classify imported glasses as luxury items subject to high tariffs, making them unaffordable for the average person.

“And making it more expensive for any would be customer to buy.”
— Pelin Muniz (06:55)

Restoring Vision aims to navigate these regulations to lower costs and increase accessibility, hoping to reach a tipping point where the market sustains itself.

Case Study: Nigeria's Vision Program

Dr. Oteri Okolo, an ophthalmologist in Nigeria, provides a practical example of Restoring Vision's impact. Her program focuses on rural areas, screening individuals and dispensing glasses efficiently. However, an unexpected challenge arose when healthcare workers themselves suffered from presbyopia, slowing down the distribution process.

“And when they were able to get their spectacles, the queues just moved quicker. They were able to dispense those spectacles faster.”
— Dr. Oteri Okolo (09:10)

This revelation underscored the universal need for reading glasses and the direct correlation between providing them and improving service delivery.

Personal Impact: Transforming Lives

The episode features personal stories that illustrate the profound impact of access to reading glasses. Caroline Isaiah, a seamstress from Congee State, shares her experience:

“And these eyeglasses that I'm wearing, I've seen enormous improvements because now I can see clearly. And I even came with my needle this morning because I was not able to fix my treacherous my needle. But this morning I was able to.”
— Mrs. Caroline Isaiah (09:42)

Such testimonials highlight how a simple pair of glasses can enhance daily functioning, increase earnings, and improve overall quality of life.

Conclusion: A Multifaceted Solution

Restoring Vision's efforts in addressing the global vision crisis demonstrate that providing access to reading glasses is not merely a health initiative but also a social and economic imperative. By creating demand, building supply chains, and navigating regulatory landscapes, they are paving the way for sustainable market solutions that can benefit millions worldwide.

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Production Credits:
Produced by Cooper Katz McKim
Engineering by Patrick Murray
Fact-checked by Sierra Juarez
Edited by Cake and Cannon
Produced by NPR's The Indicator

Transcript

[Adrian Ma]

This week we're running some of our favorite episodes from the past year. This episode digs into why reading glasses are so available in the US and yet why so many people around the world are living without them.

[NPR]

NPR.

[Adrian Ma]

It'S one of those annoying facts of life that the the older you get, the more often you find that your body just doesn't work like it used to. Case in point, I'm almost 40 years old and for the past year or so I find that just reading things has become more difficult. Like I find myself squinting to read an article on my computer or just like constantly enlarging the font. And I know that this is only going to get worse in the coming years. And the fact of this would be personally and professionally devastating if the solution were not extremely easy and cheap to come by. Reading Glasses right I can get reading glasses at any pharmacy or convenience store for just a few bucks. Online, I could get five pairs of reading glasses for a little more than a dollar apiece. And that's why I was super surprised to learn this. According to a report by the Lancet Global Health Commission, the number of people who have unaddressed vision loss that could be solved with a simple pair of reading glasses is around 510 million. That is more than the populations of the U.S. mexico and Canada combined. So if reading glasses are so available and cheap here in the US Why are so many people around the world living without them? This is the indicator for Planet Money. I'm Adrian Ma and today on the show we'll answer that question and we'll learn the economic solution to this reading glasses shortage.

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[Adrian Ma]

[e-mail] across large parts of Asia, Africa and Latin America, unaddressed vision loss is a really common problem. And it doesn't just affect individuals, it affects economies. Because think about it, almost any job you can name, whether it's in an office or a factory or on a farm, it requires having at least decent near vision.

[Pelin Muniz]

The data shows that there's $410 billion of economic loss annually due to vision impairment and lack of access to eyeglasses, which is pretty staggering.

[Adrian Ma]

Pelin Muniz is CEO of Restoring Vision. It's a nonprofit whose mission is to help address what it calls the global vision crisis. And the main thing they're trying to tackle is helping people who are experiencing near vision loss as they age. In medical terms, this is called presbyopia.

[Pelin Muniz]

Presbyopia happens usually in your 40s, but in a lot of countries it can happen as early as in your 30s. So just when you're in your prime working years, you're going through sight loss and that has really long term implications.

[Adrian Ma]

Problem is, as people get older, they often are not aware that their vision is slowly getting worse. And even if they are, in many low and middle income countries, there aren't enough eye doctors. And then on top of all that, Palin says some people may not even realize that their vision can be fixed with something as simple as a pair of reading glasses.

[Pelin Muniz]

Oftentimes they don't know that glasses exist. In cases where they do know that glasses exist, oftentimes they're very expensive and they're not within reach. So it could take them more than a day travel, for example, to go to a location where there are glasses. But then those won't be affordable.

[Adrian Ma]

Think about the difference from here in the US where reading glasses are super cheap, partly because they're also simpler to make than prescription eyewear. Basically, they're just little magnifying glasses that you wear on your face. But in countries where the average person has a lot less wealth than the average American, reading glasses can actually cost a lot more, Palin says. A few years ago, Restoring Vision did a study in a part of Mexico's Zacateca State and community leaders there told her that reading glasses cost around $20 US and this is an area where the average salary is around 280 bucks a month. And so what is the root of the problem here? Palin says it basically boils down to in many places there isn't a demand for reading glasses and also there isn't a supply. In other words, there isn't a market.

[Pelin Muniz]

Eyeglasses have existed for over 700 years. It's the access to them that's really the challenge.

[Adrian Ma]

So the way that Restoring Vision tries to take on this problem is by tackling the demand side of the equation first. They do that by working with local NGOs and governments in dozens of countries to try and get people screened for presbyopia.

[Pelin Muniz]

You could work with a community healthcare worker. You could work with a primary health clinic. So a lot of the work we do, individuals will get their first pair of glasses at no cost to them. And this is where we start to see the markets.

[Adrian Ma]

But the market isn't really working until there's supply. To meet demand, you know, you have to increase the number of places that sell the product. The thing is, if you owned a little pharmacy or a shop and you never have customers coming in asking for reading glasses, you wouldn't bother to sell them, or if you did, you would charge a lot of money for them. So Palin says they're working on building out those supply channels and even talked with employers about the benefits of providing reading glasses for their employees.

[Pelin Muniz]

By providing somebody with a pair of reading glasses in order for them to do their near vision work for their employment purposes, you see productivity increases of up to 32%, which is pretty significant.

[Adrian Ma]

But Palin says making these glasses accessible to people can be made more difficult by regulations. So for example, some countries have rules restricting the marketing of medical services that might make it more difficult for a would be retailer to put up a sign that says, hey, reading glasses sold here. Other countries might import glasses from China, but classify them as luxury goods that are subject to a tariff or import tax. And that makes it more expensive for any would be customer to buy.

[Pelin Muniz]

And then naturally, at some point there would be a tipping point and markets will start to develop. And that's really what we're hoping for.

[Adrian Ma]

You're essentially like trying to jumpstart a market that in a lot of countries doesn't really exist.

[Pelin Muniz]

Correct.

[Adrian Ma]

And the hope is eventually that market will become self sustaining. So when people need their second, third or fourth pair, getting them won't be so difficult and expensive. Now, if you're wondering what does this market creation process look like on the ground, you could look to Nigeria. That's where Dr. Oteri Okolo lives.

[Dr. Oteri Okolo]

I'm an ophthalmologist working at the Department of Public Health in Nigeria.

[Adrian Ma]

Oteria oversees this program aimed at getting people who are living in rural areas screened for vision problems, including presbyopia. And if needed, they give them a free or low cost pair of reading glasses. She describes this process as demand generation.

[Dr. Oteri Okolo]

You can easily train just about anyone to be able to dispense the glasses, reading glasses to the general population. You don't need, shall I say, a sophisticated equipment or a sophisticated test that a trained eye care worker would have to carry out.

[Adrian Ma]

So this program has been going on for about a year. And Oteri says at first the rollout hit an unexpected obstacle. The eye exams were taking a weirdly long time.

[Dr. Oteri Okolo]

So the lines were building up and people, the crowds, you know, are becoming uncontrollable. And when we investigated, we realized that the primary healthcare workers were slow because they themselves couldn't quite see clearly.

[Adrian Ma]

Turned out a lot of these healthcare workers could not see clearly because they themselves had presbyopia. They needed reading glasses, too.

[Dr. Oteri Okolo]

And when they were able to get their spectacles, the cues just moved quicker. They were able to dispense those spectacles faster.

[Adrian Ma]

Oteri says this just goes to show how reading glasses don't just benefit older folks with vision issues, but also younger folks who are in their prime working years. When her program reached out to those who received glasses, they met people like Caroline.

[Mrs. Caroline Isaiah]

My name is Mrs. Caroline Isaiah. I'm from Congee State.

[Adrian Ma]

Carolyn works as a seamstress.

[Mrs. Caroline Isaiah]

And these eyeglasses that I'm wearing, I've seen enormous improvements because now I can see clearly. And I even came with my needle this morning because I was not able to fix my treacherous my needle. But this morning I was able to.

[Dr. Oteri Okolo]

We're talking about improving their earnings, their potential, so they're earning more and also improving their ability to thrive.

[Adrian Ma]

For Oteri and Palin at Restoring Vision, this is a health issue, a social issue and an economic issue rolled into one. And they say it's solvable. This episode was produced by Cooper Katz McKim with engineering by Patrick Murray. It was fact checked by Sierra Juarez. Cake and Cannon edits the show and the indicators of production of npr.

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