Globally, at least 1 billion people have a vision impairment that is uncorrected or could have been prevented. Refractive error is the most common cause of vision impairment. Refractive error occurs when the shape or length of the eye prevents light from focusing directly on the retina, resulting in blurred vision. Globally, myopia and presbyopia, the two most common refractive errors, affect 2.6 billion and 1.8 billion people respectively. These numbers will continue to increase due to population growth, ageing, and lifestyle changes: for example, 3.4 billion people – or 40% of the global population – are projected to have myopia by 2030.
Correcting refractive error with eyeglasses is a simple and effective intervention. At least 826 million people suffer from vision impairment due to uncorrected refractive errors and can benefit from eyeglasses. Some estimates that include milder vision loss place this number at more than 2 billion. The unmet need is concentrated in low- and middle-income countries (LMICs), yet demand for eyeglasses in LMICs remains low due to lack of awareness around vision impairment and stigma towards the wearing of eyeglasses. Uncorrected refractive errors cause an approximately USD270 billion annual loss in productivity to the global economy. Uncorrected refractive errors also have a negative impact on the health, education, quality of life, and general wellbeing of affected individuals.
The global eyewear market focuses primarily on developed markets or high-value market segments in LMICs, such as wealthier, often urban populations with expensive prescription eyeglasses. Reading eyeglasses are relatively affordable. The supply chain for prescription eyeglasses is complex due to the level of customisation required to meet a prescription. The leading global supplier of lenses and frames controls the full value chain, from manufacturing of components to retail sales. In LMICs, markets are small with limited public provision of eyeglasses, even though the World Health Organization (WHO) recommends that eyeglasses should be provided within the context of comprehensive eye care, and integrated within the healthcare system and national health plans.
Key market barriers that perpetuate the current situation of low access to eyeglasses in LMICs include: low levels of investment by governments; high costs to the end-users; complex in-country supply chains; a service delivery model that requires high levels of resources in terms of personnel and infrastructure; limited number of points of services and sales; and low awareness and acceptance of eyeglasses. Innovations in identification of refractive errors, refraction devices, service delivery, and eyeglasses themselves may provide opportunities to address some of these barriers.
Increasing access to eyeglasses to eliminate the burden of uncorrected refractive errors in LMICs will require a multisectoral approach that brings together the public and the private sector, multilateral organisations, and donors. This will require an approach that increases demand for eyeglasses, raises the number of access points for screening and provision, and accelerates the availability of affordable products. To achieve this, we propose five strategic objectives that can strengthen the market in both the short and longer term:
Strategic Objective 1: Mobilise key stakeholders, including donors, multilaterals, NGO implementers, and the private sector, around reliable data and scalable proven models to accelerate efforts against vision impairment caused by refractive errors.
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 a simplified service delivery.
Strategic Objective 3: Support governments to develop comprehensive eye care plans integrating validated models of vision screening and provision within the public health system, and facilitate scale-up of those models.
Strategic Objective 4: Engage the private sector to expand delivery of affordable, quality eyeglasses and related services in LMICs.
Strategic Objective 5: Build and drive awareness and consumer demand for eyeglasses.