Rad Geek People's Daily

The study [Sehrin et al. (2024), “The effect on income of providing near vision correction to workers in Bangladesh: The THRIVE (Tradespeople and Hand-workers Rural Initiative for a Vision-enhanced Economy) randomized controlled trial”] — published Wednesday in PLOS ONE — found a dramatic increase in earnings with a very low-cost change: a new pair of reading glasses.^[1]

The researchers went to 56 villages in Bangladesh and found more than 800 adults ages 35 to 65 who are farsighted – that is, they could not see well up close. Half were randomly selected to get glasses; the other half got glasses after eight months. In that time, the researchers found that income grew by 33% for those with glasses – from a median monthly income of $35 to $47 – and that people who were not in the workforce were able to start jobs after getting reading glasses.

This is a really big study, says Dr. David Friedman, a professor of ophthalmology at Harvard Medical School, who was not involved in the project. This is the first time we can really say that something that will improve [someone’s] quality of life from a visual standpoint will also help with poverty alleviation, which is an enormous finding.

— Gabrielle Emanuel, Glasses aren’t just good for your eyes. They can be a boon to income, too
NPR Morning Edition, April 3, 2024.

O.K., so if cheap, commodity reading glasses are such a big economic benefit, why don’t lots more people in poor countries get reading glasses? Or why don’t development or aid outfits give lots more glasses out? Is it because they’re cheap for people in affluent societies, with affluent incomes, but just turn out to be an unaffordable expense for poor people, or for people in poor countries? If the problem were some unavoidable cost structures of making or distributing commodity reading glasses, in any case, this would seem like an obvious case for a really, really low-cost charitable intervention by NGOs. But even that seems like a real stretch — you can pick up commodity reading glasses for $10, retail, at Wal-Mart. That’s a lot more to a poor person than it is to a rich person — or to anyone in a rich society. But it’s not the real bottleneck.

The real bottleneck is a story that is as old and familiar as it is frustrating.

In the U.S., the U.K. and many other European countries, reading glasses are readily available over-the-counter at most drugstores. That’s not the case elsewhere.

A pair of glasses can be hard to find

In a lot of low- and middle-income countries, glasses are still tightly regulated, says Dr. Nathan Congdon, a co-author of the study and chair of Global Eye Health at Queen’s University Belfast. People often have to get a prescription from a vision specialist before they can purchase glasses, even reading glasses. This proves to be a huge hurdle for those living in poverty and those in remote areas, he says.

. . . The glasses themselves cost maybe $3-4. And using village health workers, we can make the cost of delivery very inexpensive as well, said Congdon. So the whole thing can really just be a handful of dollars to deliver something that’s potentially quite life changing.

. . . Congdon would like to see regulations loosen to improve access to reading glasses. He says the regulations, the cost and a general lack of awareness have meant many people who need glasses go without. When searching for participants, his team met almost nobody in the Bangladeshi villages with glasses.

The state of global vision care: in need of correction

Congdon, who is an ophthalmologist himself, largely blames his own profession.

**Ophthalmologists and optometrists may be advising the government that they should tightly regulate access to these products [to] strengthen their professions. They may see themselves as gatekeepers of quality, he says. I wouldn’t be recommending that we just hand out distance glasses, but I do think that for near [vision] glasses that’s a reasonable thing to do.

— Gabrielle Emanuel, Glasses aren’t just good for your eyes. They can be a boon to income, too
NPR Morning Edition, April 3, 2024.

Well, hell, if he won’t, I will: I would be recommending that we just hand out distance glasses. Come on, seriously, why in the world not?^[2] But in any case, the big lesson here is — once again — the real barriers, which build the structure of global poverty as we know it and confine people to it, are not a matter of the economics of eyeglasses in a market society or whatever; it’s a specific dysfunction of the political economy of optometry and medical professions. The best solution — and the thing that matters even more for the poorest people in the poorest societies — is to get regulation out of the way.

1. ^[1][Abstract from PLOS One: Presbyopia, the leading cause of vision impairment globally, is common during working years. However, no trials have assessed presbyopia’s impact on income. In April 2017, we conducted a census among 59 Bangladesh villages to identify persons aged 35 to 65 years with presbyopia (presenting distance vision > = 6/12 bilaterally and correctable inability to see 6/13 at 40 cm with both eyes), who never had owned glasses. Participants were randomized (1:1) to receive immediate free reading glasses (intervention) or glasses delivered 8 months later (control). Visual demand of different jobs was stratified into three levels. Outcomes were between-group differences in the 8 month change in: self-reported monthly income (primary) and Near Vision Related Quality of Life (NVRQOL, secondary). Among 10,884 census participants, 3,655 (33.6%) met vision criteria and 863 (23.6%) comprised a sample enriched for near vision-intensive jobs, but 39 (4.52%) could not be reached. All participants allocated to intervention (n = 423, 51.3%) and control (n = 401, 48.7%) received the appropriate intervention, and follow-up was available for 93.4% and 96.8% respectively. Groups were similar at baseline in all characteristics: mean age was 47 years, 50% were male, 35% literate, and about half engaged in “most near vision-intensive” occupations. Glasses wear at 8-month follow-up was 88.3% and 7.81% in intervention and control respectively. At baseline, both the intervention and control groups had a self-reported median monthly income of US$35.3. At endline, the median income for the intervention group was US$47.1 compared with US$35.3 for control, a difference of 33.4%. Predictors of greater income increase in multivariate models included intervention group allocation (OR 1.45, 95% CI 1.12, 1.88, P = 0.005), male sex (OR 2.41, 95% CI 1.84, 3.16, P <0.001), and not engaging in income-producing work at baseline (OR 2.35, 95% CI 1.69, 3.26, P<0.001). —RG]↩
2. ^[2]If people need a professional exam and prescription to get glasses that work well for them, then there are lots of ways they can figure that out and go get the professional exam and prescription. No doubt you need careful measurement by a professional to get a good tailored suit, too. But this is a matter of judgment where the customer can easily judge for themselves how much they need and how well it worked out. There’s no need for a regulatory requirement here, either.↩