Dignity, income, opportunity: how making eyeglasses accessible can change the world

Laureate
Jordan Kassalow
Program
McNulty Prize
Location
Global
McNULTY PRIZE WINNER

This is part of a series of leadership case studies featuring McNulty Prize Laureates.


Jordan Kassalow’s purpose became apparent to him in the time it took to fit a pair of glasses onto a child’s face.


He was a first-year optometry student at the time, on a field trip to Mexico to bring a vision clinic to very poor communities which had never before received any eye care. “My first patient was a seven-year-old boy from the school for the blind. The teacher described him as having been blind from birth.


“Blindness in that part of the world is more than just a physical disability: people think you are jinxed or cursed. His condition had social implications for his whole family.”

It turned out that the boy wasn’t blind, just extremely short-sighted: his prescription was minus-20. Hunting through the boxes of donated spectacles for the strongest pair, the team found a minus-18, close enough. “I got to be the person who put those glasses on his face, and watch his face change as he saw for the first time.

“It was a moment that fundamentally changed both our lives,” he says. “I often feel that in that moment, I gave him his vision, and he gave me mine.

“I was so moved. My heart was looking for proof that I mattered. This was my proof point. If the work I was doing meant that I mattered to him, I could matter to other people.”

About 10 patients later, Jordan shared another profound interaction. This time it was a woman, aged about 50, who had lost the ability to see close-up. “She had her Bible clutched to her chest and she came in with a simple request: she wanted to be able to read it. I had a look at that Bible, it looked as if it was designed to torment presbyopic people: the print was so small. Even as a first-year student I could figure this out: she needed reading glasses. I found some plus-2s, and I put them on her face and she looked down at her Bible, which she hadn’t been able to read in a decade, and her knees literally buckled, and she just cried.

Public health entrepreneur, practicing ophthalmologist and partner in his family’s optometrist business in New York.

Founder and Co-Chairman of VisionSpring

Fellow of Draper Richards Kaplan, Skoll, Ashoka, and the Schwab Foundation.

“The next day she came back to the clinic; she was the first person in line. I was a first-year student; I was insecure. I thought she had come back to complain about something.

“But she was carrying four chickens, two in each hand, and she handed them to me. She said something very profound. ‘Doctor, to you they’re a pair of glasses. But for me, you’ve given me back my God.’

“Those words still resonate with me. It was the dawning of real empathy. I hadn’t understood the real value of glasses.”

One thing that also became clear, however, was the scope of the problem. On that first mission to Mexico, the group had arrived to the daunting sight of more than 2,000 people snaking around the venue. VisionSpring was born out of that scale of need.

It seems remarkable but it is a truth: a simple pair of reading glasses, which we see every day in corner drug stores, can have a huge and profound impact on someone’s life.

— Jordan Kassalow

There are profound personal, social and systemic implications in the fact that 2.5bn people globally are living with impaired vision.

Poor vision limits the potential of schoolchildren, for instance – it is now known that the impact of a pair of glasses on a child’s education is equivalent to up to a full year of schooling. And vision decline puts middle-aged people out of jobs when they still have decades of useful work still in them – studies have demonstrated that a pair of glasses increases productivity by 35 per cent. There’s a safety component, too: a study from Italy showed that poor vision plays a role in 59 per cent of road traffic accidents. And, of course, the use of new technology is linked to vision: millions of people depend on reading glasses to see their mobile phones for communication, work or banking. 

In blocking human potential, poor vision stands in the way of a more inclusive global marketplace. Vision problems thus constitute a profound drag on economic growth.

It’s not simply the size of the challenge that defines Jordan’s thinking. Over more than 30 years, his perspective has been formed by pivotal interactions that add depth and resonance to his understanding of both the problems and the solutions. In Cameroon, for instance, Jordan had a conversation with a woman in her 40s that proved formative. “I always ask people what matters to them, and their answers are universal – health, better housing, clean water, safety. Her answer to my question was profound: ‘We have only one real need, and that is opportunity,’ she said. Self-reliance, she was saying, is the meta-need: if you have opportunity and are self-reliant, you can make everything else happen; everything else falls into place. 

94%
Of presbyopia sufferers (near-vision loss) can’t access glasses to keep working.
2.5 Billion
People have poor vision and no glasses; 624M have severe vision loss that glasses can help.
8 Million
Pairs of glasses distributed by VisionSpring’s NGO partners, according to EYElliance’s 2016 report.

“I realized the power of giving people access to opportunity, and that if, rather than giving glasses away, we used a network of salespeople to sell them, we’d be meeting two fundamental needs, giving people access to economic opportunity at both ends of the transaction.”

It is not a far-fetched notion that salespeople with no training in optometry might be able to distribute spectacles: of those who need them, more than 50% need reading glasses, and a simple test – which VisionSpring devised and produces in a kit – would allow laypeople to know which glasses to offer, and which clients needed to be referred for clinical assessment.

Taking a market approach also has benefits over and above the creation of economic opportunity. Jordan tells a poignant illustrative story: at one clinic in Colombia, one of the patients was known as “the blind woman” in her village. Like the seven-year-old boy of Jordan’s first clinic, it turned out she wasn’t in fact blind: just extremely short-sighted. Once again, digging around in the box of donated spectacles, the team found a pair that were close enough to her prescription to change her world; and once again they witnessed the joy of someone seeing properly for the first time.

“But three days later she was back. She told us that everyone laughed at her.

“She was right,” Jordan, says. “The only glasses we had that remotely matched her prescription had 1950s cats-eye rims with rhinestones. They were culturally inappropriate.

“We explained that these were the only pair strong enough for her.

“She listened, and then she did something that stopped me in my tracks. She put the spectacles down on the wooden table, and got back into her canoe to paddle home again.

“She chose ‘blindness’ over what we were giving away for free.

“It was clear there was something fundamentally wrong with what we were doing.”

What the market offers, Jordan could see, was dignity and a critical feedback loop. “If people pay for what we’re giving, they can require us to design and develop products that reflect what they want, that are right for their social circumstances and are at price points appropriate to their means.” 

Self-reliance is the meta-need: if you have opportunity and are self-reliant, everything else falls into place.

— Jordan Kassalow

There was another consideration to the market model: volume. Increasingly, Jordan was aware that no number of clinics and missions was enough to make a dent in the global need. It had taken VisionSpring 10 years to issue its first million pair of spectacles. It took just two years to achieve the second million. In 2016 alone, VisionSpring sold over one million pairs; and by 2020 the ambition is to reach 10 million customers every year.

But there are 2.5 billion people in need of optical care.

VisionSpring was acutely aware that it needed to scale up. It needed to prove that there is a commercial argument for engaging with the “bottom of the pyramid” market. If VisionSpring could develop a model that was self-sustaining, even profitable, Jordan knew he would be able to attract others to the work, and could begin to dream about a world in which all who needed optical care had access to it. However, most of both the supply-side barriers and the demand-side barriers to distribution of glasses fall outside VisionSpring’s zone of control. Tariffs and taxes, for example, are big obstacles on the supply side. On the demand side, social norms can be a challenge. In some regions, for instance, girls believe that wearing glasses will make them less likely to marry. Other cultures have a prejudice against being sold glasses by anyone other than a registered ophthalmologist. 

In order to overcome these barriers, and to “set free” the estimated $227 billion of the global economy that is drawn down by vision issues, a systems approach and a longer perspective were needed.

“But I had a lot of questions,” said Jordan. “How do we go from building an enterprise, like VisionSpring, to building a movement? How do we build a multi-sector, multi-stakeholder ecosystem aimed at placing vision issues more centrally on the global economic development agenda?”

Jordan was able to appreciate that his own role needed to change. With decades of experience and extensive networks, particularly through the Aspen Global Leadership Network, he was in a unique position to act as a catalyst. So he stepped away from his role as head of VisionSpring, putting in place a leadership team which continues to drive its critical work. Then, from his new position on the Board, he raised his eyes to new horizons.

Together with leaders brought together with the help of Secretary Albright, EYElliance was formed to bring together different enterprises, with different skills sets to those contained within VisionSpring, and which would complement VisionSpring’s work.

Within EYElliance, Jordan and VisionSpring are now working closely with the BrienHolden Vision Institute, the Skoll Foundation, USAid, Essilor, the World Bank and others to engage national governments and harness market forces to address the problem.

“We’re looking at the whole system of what’s broken, trying to engage governments, private sector and civil society to all collaborate to dismantle those barriers that are systematically keeping over half a billion people vision impaired or blind simply because they don’t have a product that’s been around for 700 years.”

The scale and complexity of the challenge remain daunting, requiring patience, concentration and resilience in equal measure. If VisionSpring’s example is anything to go by, the success of EYElliance will depend on combining doggedness with the “low ego and the beginner’s mind” that allows frequent iteration of ideas and solutions.

Jordan is up for it.

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