1 in 3 people lives with uncorrected poor vision. 90% of them live in low-income and middle-income countries (LMICs), often in rural areas, where the capacity to provide products and services needed to address the problem is limited due to a lack of access to equipment and trained personnel and awareness about vision care.
Supply chains are complex due to the level of customization required for prescription eyeglasses. The cost of equipment and human resources required also means that points of access for eye care services in LMICs are scarce and principally located in urban areas. According to an estimate in the ATscale report for eyeglasses, setting up an optical assembly lab in LMICs costs upwards of USD 250,000. When individuals screened in a remote location are then referred to a vision center, they are often unable to make the expensive journey into the city and drop-out rates are high – a direct barrier to accessing eye care. There are also other indirect costs from the need for a long journey to appointments, including the loss of productivity and foregone earnings for the patient and/or caregiver.
To address this issue, the ATscale report for eyeglasses outlines as Strategic Objective 2: Strengthen global policy guidance around service delivery standards for low-resource settings to accelerate the adoption of innovative models, devices, and products that support simplified service delivery.
Similarly, Essilor’s ‘Eliminating Poor Vision in a Generation’ report suggests that creating sustainable access points and innovating for affordable solutions would have a significant impact in addressing uncorrected poor vision in LMICs.
In this article, we take a closer look at two of the five proposed approaches within Strategic Objective 2:
Develop guidance on a simplified delivery model to overcome human resource barriers
LMICs lack trained personnel to deliver refraction services. There is also a lack of training standards, accreditation mechanisms, and clear legislation. Developing guidance on a simplified delivery model, and on minimum competencies and training standards to refract, prescribe, and dispense eyeglasses in LMICs – such as by increasing the number of mid-level eye workers trained in refraction – could lead to a reduction in barriers related to personnel, infrastructure, costs, and reach of services.
Fre Seghers, Director at Clinton Health Access Initiative (CHAI), said, “With this report that we prepared for ATscale and AT2030, we suggest a simplified delivery model by decentralizing screening and refraction through task-shifting and new technology which can lead to a reduction in barriers related to personnel, infrastructure, costs, and reach of services. If this is supported by global guidelines it could help bring affordable, appropriate eyeglasses to many more people.”
An example of this is Essilor’s inclusive business 2.5 New Vision Generation which trains un(der-)employed individuals living in rural areas to become primary eye care providers. This benefits both remote communities by creating a sustainable channel to access vision care and would-be entrepreneurs by providing them with a livelihood.
Support uptake of innovative screening and refraction devices and ready-to-assemble eyeglasses
New technologies promise important changes to the delivery landscape and innovative screening and refraction devices that simplify service delivery should be supported by generating more evidence of their effectiveness.
Handheld, easy-to-use refraction devices adapted to low-resource settings are one example of this. They can be operated by a technician with minimal training, can be taken to the field, and typically require less time to do the refraction compared to traditional refraction devices. By using handheld autorefractors, existing primary eye care professionals can see more patients and travel more easily to remote communities. These devices also support task-shifting as they allow mid-level eye care workers to perform refraction.
Innovations such as Essilor’s ClickCheck have the potential to revolutionize vision screenings in rural communities. The ClickCheck is portable, easy-to-use and does not require electricity to operate.
Ready-to-assemble eyeglasses are another innovation that entered the market in 2015. Such eyeglasses can address 80% of the population’s need while alleviating supply chain challenges:
- FASTER, SIMPLIFIED DELIVERY: ready-to-assemble eyeglasses can, with limited training, be mounted on the spot in less than 5 minutes. This allows individuals to receive eyeglasses adapted to their prescription, gender and face shape on the spot, saving them a return trip.
- APPROPRIATE DESIGN: ready-to-assemble eyeglasses come with different styles and models adapted to different face shapes. For example, Essilor’s Ready2Clip offers over 30 different styles.
- AFFORDABLE: the price offering for ready-to-assemble eyeglasses typically ranges between USD5 for a basic model to USD15 for more specialized lenses. This price point is lower than the price of the majority of customized eyeglasses currently available in LMICs.
In the next article of the ATscale Series, we’ll look at what scalability means in the eye health sector and why partnerships with the public sector are key to bringing better vision care to the world.