If you’re 50 or older and reading this article, chances are you are wearing a pair of glasses to correct your presbyopia, the age-related decline in vision that makes it progressively more difficult to see fine print and tiny objects.
Eventually, nearly everyone gets the condition.
But for nearly one billion people in the developing world, glasses are a luxury that many cannot afford. According to the World Health Organisation, the lack of access to corrective eyewear inhibits learning among young students, increases the likelihood of traffic accidents and forces millions of middle-age factory workers and farmers to leave the workforce too early.
Uncorrected presbyopia, not surprisingly, makes it harder for breadwinners to support their families. That’s the conclusion of a recent study which found that garment workers, artisans and tailors in Bangladesh, who were provided with free glasses, experienced a 33 per cent increase in income compared with those who were not given glasses.
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A normal part of ageing, presbyopia occurs when the eye becomes increasingly rigid, making it harder to focus on nearby objects.
The study, published in the journal PLOS One, included more than 800 adults in rural Bangladesh, many of whom work in jobs that require intense attention to detail. Half the participants – a mix of tea pickers, weavers and seamstresses between the ages of 35 and 65 were randomly chosen to receive a free pair of reading glasses. The others were not given glasses.
Researchers followed up eight months later and found that the group with glasses had experienced a significant bump in income, receiving an average monthly income of €44, compared with €33 for the participants who did not have glasses. The study subjects were evenly divided between male and woman, and slightly more than one-third were literate.
Dr Nathan Congdon, the study’s lead author and an ophthalmologist at Queen’s University Belfast, said the results added to a mounting body of evidence that quantifies the economic impact of uncorrected vision in parts of the world where the cost of roughly €1.40 to buy a pair of glasses is out of reach for many.
“All of us would be happy with a 33 per cent jump in income,” said Dr Congdon, who specialises in low-cost models of eye care delivery. “But what makes the results especially exciting is the potential to convince governments that vision care interventions are as inexpensive, cost-effective and life-changing as anything else that we can offer in healthcare.”
Dr David Friedman, a professor of ophthalmology who was not involved with the study, said he was struck by the results and hoped future studies would confirm the findings. “These economic impacts are large, real and could have a substantial impact on people’s lives,” he said.
Eye care has long been the neglected stepchild of public health in the developing world; infectious diseases such as tuberculosis, malaria and AIDS tend to draw more robust government and philanthropic support. But vision impairment is a serious global issue, with a projected cost of more than €375 billion in lost productivity, according to the WHO.
Experts say spending on eye care can have a considerable impact on communities, both in terms of increased economic output and improved quality of life. Compared with other, more intractable health problems, addressing presbyopia is fairly inexpensive. Glasses can often be produced for less than €2 a pair, and fittings are usually carried out by community workers who can be trained in a day.
When it takes longer to sew and clean, or you can’t pick out all the stones from the rice, in some households it results in domestic violence
— Misha Mahjabeen
Misha Mahjabeen, the Bangladesh country director for VisionSpring, which along with another non-profit organisation, BRAC, participated in the study, said a lack of resources was just one impediment to the increased distribution of reading glasses. In many Bangladeshi villages, she said, community workers must contend with the social stigma associated with wearing glasses, especially for women. Overall, the health needs of women in Bangladesh take a back seat to those of men. “In our male-dominated society, when the man has a problem, it requires immediate attention, but women, they can wait,” she said.
But the effects of declining vision can be especially pronounced for women, who are often responsible for earning extra income for their families in addition to childcare and household chores, Mahjabeen said. “When it takes longer to sew and clean, or you can’t pick out all the stones from the rice, in some households it results in domestic violence,” she said. VisionSpring distributes more than two million pairs of glasses a year throughout South Asia and Africa, up from 300,000 in 2018.
These glasses are like my lifeline. I could not do my job without them
The study in PLOS One builds on previous research involving tea pickers in India that found a significant jump in productivity among study participants given glasses. The paper, a randomised study published in The Lancet Global Health in 2018, documented a 22 per cent increase in productivity among workers who had been given glasses. For those older than 50, productivity increased by nearly 32 per cent.
Agad Ali, (57), a Bangladeshi tailor in the town of Manikganj, was among those who received a pair of glasses as part of the new study. In an interview conducted by a community health worker and sent via email, he described how worsening presbyopia had made it increasingly hard to thread needles and stitch clothing, adding to the time required to finish each tailoring job. Over time, he said, some customers went elsewhere, and his income began to decline. “It made me feel very helpless,” he said.
Since receiving the glasses, he said, his income had doubled. “These glasses are like my lifeline,” he told the community health worker. “I could not do my job without them.” – This article originally appeared in the New York Times
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