It’s one of the world’s oldest health technologies with recorded use by the Greeks and Romans – and modern eye glasses appearing on the noses of Venetian monks and scholars as early as the 13th century. 

And yet only about 36% of the estimated 1.25 billion people who need corrective eyewear for common distance vision impairments actually have a suitable set of glasses today, according to the latest WHO data. 

And that leaves some 800 million children, adults and older people struggling to study, work and perform basic life tasks safely, effectively and unaided. 

On Tuesday, a new WHO global effort that aims to change all of that launched at WHO headquarters in Geneva. The SPECS 2030 initiative aims to increase access to corrective eyewear for common vision problems like short-sightedness by 40% by 2030. 

Its engine of action includes a new WHO-hosted Global SPECS network, including some 31 intergovernmental agencies, philanthropies, and NGOs – which have committed to bring down costs and ensure better access to eyesight services, particularly at the community and primary health care level. 

SPECS 2030 – Reinventing Access to an Ancient Health Technology  

While hundreds of millions of people lack access to basic corrective eyewear, “if you live in a high-income country you are six times more likely to have access to corrective lens than low-income countries,” said Bruce Aylward, a senior WHO advisor who opened the two-day meeting of WHO member states,  NGOs and other network partners. 

“And men are more likely to wear corrective lenses as compared to women – so there is a gender element as well,” Aylward pointed out. 

“It’s not acceptable that a child has difficulty in school or a parent has trouble doing their job because they don’t have this simple tool,” added WHO Director General Dr Tedros Adhanom Ghebreyesus, in a pre-recorded message to the meeting.

Jane Waithera, who was born in a small Kenyan village, with alibinism that made her severely myopic as well as photophobic, described how she had trouble even seeing the cows while guiding her grandmother’s herd as a small child. 

“I would struggle to keep my eyes open when I walked outside,” she related.  “Sometimes the cows would get lost and I couldn’t find them.”

One mobile clinic with services was life-changing 

Waithera, now a disability and inclusion entrepreneur, also recalls the “life-changing” moment when someone in her village told her “you have low vision”.  Soon after that, a mobile clinic came to town. It happened to offer a basic eye test – and she got her first pair of reading glasses. Lifechanging, but still only a first step. 

“They did not help me outside, she observed, recounting the pain she endured in sunlight. “So it was not a comprehensive pair of glasses that met all of my essential needs,” she said. 

Subsequently, she had to travel five hours one way to get to an eye hospital where she could do more extensive tests.  

 “And then there was the cost of buying spectacles.” she remarked, “And if I have to wear transition lens that I can use inside and outside, they are more costly.”

All of that left her with the indelible conviction about the importance of expanding eye care services at primary health care level. 

“You can imagine if this more comprehensive screening had been available in my local village – how much time and travel that would have saved me,” she said. “And my village is not even that remote. 

“And unfortunately, the situation is still the same today,” she remarks noting that while the same basic services exist in the mobile clinic that visits her hometown village – it is no more comprehensive than when she was 10-years-old. 

Nor has eye care yet been incorporated as an “essential service,” in Kenya’s milestone new national public health insurance scheme. And that leaves people and families to bear the high costs of tests and eye glass purchases on their own. 

Boosting capacity at primary care level  

That’s a norm in many parts of the world – where the cost of eyeglasses must be borne by out-of-pocket by individuals or through private health insurance schemes, WHO officials say.  

Even in an upper middle-income country like Malaysia, where there is a significant professional capacity and a robust array of government eye care services, people prescribed with corrective lenses still go to the private sector to purchase their glasses, said Dr Nor Fariza Ngah, a Deputy Director General in the Ministry of Health.  

“So this is where we see that the ecosystem might not be complete,” she said, speaking at the meeting. 

She agreed with Waithera that more comprehensive care also needs to be made available at the primary health level, saying: 

 “In some of the remote areas it can take three days of walking to see the eye care professional,” Ngah explained. “So if we have a one-stop center where they get screened, prescribed and dispensed the glasses immediately, then they can go back to their village and come back maybe six months or more later for monitoring. 

Finally, the issue of workforce capacity to deliver services needs to be addressed, Waithera said, pointing again to her own personal experience. 

“This clinic that I found at 10 years of age, I still find the same personnel in the clinic. But who is going to take the mantle when they retire? We need to increase the number of personnel.” 

Eye care may be first entry point to universal health coverage 

Meanwhile, eyecare is not about glasses alone, stressed Alarcos Cieza, head of WHO’s unit for rehabilitation and disability in the Department of Noncommunicable diseases. 

“It’s about a whole range of services,” she said, with particular emphasis on the word “services”.  These include not only testing, diagnosing and treating so-called “refractive errors” – nearsightedness or farsightedness, but also for cataracts and other vision-related impairments and diseases, such as glaucoma. 

Conversely, cataract surgery, on its own may sometimes be insufficient to correct a person’s vision impairment if they lack a diagnosis and prescription for correct spectacles at the end of the procedure, said Stuart Keel, a WHO technical officer leading the SPECS initiative, describing how issues are intertwined.   

All in all, because it is such a fundamental sense, vision issues may often be the “very first door” through which many people may be motivated to get a broader health check. This, in turn, may lead to the identification of other underlying risk factures and health issues, said Warapat Wongsawad, an ophthalmologist at the Thai Ministry of Public Health. 

“In fact, SPECS may be the very first door that people check their health and integrate into the community levels of the health system,” he said, referring to the new WHO initiative.

No one-fits all solution for countries 

While the new WHO initiative aims to tackle the full range of systemic issues impeding access to eye care, from diagnosis to affordability of spectacles, there are no one-size-fits-all solutions, speakers and participants at the event stressed. 

Not only are the health systems around eye care very diverse, but vision problems can differ widely by country. For instance, in some fast-developing Asian countries, an increasing percentage of children are now being diagnosed with myopia because they spend insufficient time outside in natural sunlight – which is essential for the development of distance vision capacity as they grow up. 

A recent study undertaken in Thailand pointed to this emerging problem, noted Wongsawand: “The study is very clear that we need more outdoor activity in the sunlight, maybe just an hour a day and it’s a very easy concept. 

“But it’s still very hard to tell the Ministry of Education to implement this and this is essential to  ensure the prevention and control of an epidemic of myopia in children.

In other countries, such as Kenya, spectacles for near-sightedness are still not universally available. And there is also a lack of awareness about the causes and solutions to vision impairment, said Dr. Michael Gichangi, an ophthalmologist in Kenya’s Ministry of Health.  

“People may think, for instance, that if you use spectacles for some time that will cure them and they won’t need them again,” he said.

Adapting goals to countries 

“In Asia we have a myopia boom – a huge number of children in the population, versus some places in Sub Saharan Africa where there’s still a very low average of access to simple reading glasses for near vision impairment,” said Keel. “So while we have developed these global desired outcomes, these of course need to be adapted to countries.”

A World Health Assembly Resolution, approved in 2021, makes it clear that access to eye-care is essential to attainment of universal health coverage (UHC) – with two main goals set for increased access to cataract surgery as well as to spectacles. 

And a key objective of UHC is integration of such services into public health systems, affordable and available to everyone, pointed out Silvio Mariotti, senior WHO manager in the NCDs Department. 

“But how to go about integration?” he asked. Taking cataracts as an example, he pointed out that more than 50% of cataract surgeries worldwide are performed by the private sector. 

“At the same time, that’s the overall number. In many countries, the majority of surgeries are done by the government sector, and in some high income settings, almost all are done by the private sector. 

“So while the ultimate aim is universal coverage, and global targets are necessary to move countries together toward a common goal, country level plans will decide what is feasible.”

-Correction: The initial version of this story quoted an official at the meeting stating that upwards of 500 million people who need corrective eyeglasses, lack access. The correct number is upwards of 800 million, according to WHO.  

Image Credits: Miguel Jeronimo – WHO, Stuart Keel/WHO, WHO / NOOR / Sebastian Liste Vision in Peru, 2018, WHO/Stuart Keel .