Half a billion people need reading glasses. Why can't they get them? (Encore)

0:00This week, we're running some of our favorite episodes from the past year. This episode digs into why reading glasses are so available in the U.S., and yet why so many people around the world are living without them. N.P.R.

0:23It's one of those annoying facts of life that the older you get, the more often you find that your body just doesn't work like it used to. Case in point, I'm almost 40 years old. And for the past year or so, I find that just reading things has become more difficult. Like, I find myself squinting to read an article on my computer or just like constantly enlarging the font. And I know that this is only going to get worse in the coming years. And the fact of this would be personally and professionally devastating if the solution were not extremely easy and cheap to come by. Reading glasses. Right?

1:03I can get reading glasses at any pharmacy or convenience store for just a few bucks. Online, I could get five pairs of reading glasses for a little more than a dollar a piece. And that's why I was super surprised to learn this statistic. According to a report by the Lancet Global Health Commission, the number of people who have unaddressed vision loss that could be solved with a simple pair of reading glasses is around 510 million. That is more than the populations of the U.S., Mexico, and Canada combined. So if reading glasses are so available and cheap here in the U.S., why are so many people around the world living without them?

1:44This is The Indicator for Planet Money. I'm Adrian Ma. And today on the show, we'll answer that question. And we'll learn the economic solution to this reading glasses shortage.

1:59This message comes from NPR sponsor Zendesk. Introducing the next generation of AI agents built to deliver resolutions for everyone. With an easy setup that can be completed in minutes, not months, Zendesk AI agents resolve 30 % of interactions instantly, quickly giving your customers what they need. Loved by over 10 ,000 companies, Zendesk AI makes service teams more efficient, businesses run better, and your customers happier. That's the Zendesk AI effect. Find out more at zendesk.com. Across large parts of Asia, Africa, and Latin America, unaddressed vision loss is a really common problem. And it doesn't just affect individuals.

2:39It affects economies. Because think about it. Almost any job you can name, whether it's in an office or a factory or on a farm, it requires having at least decent near vision. The data shows that there's$410 billion of economic loss annually due to vision impairment and lack of access to eyeglasses, which is pretty staggering. Pailin Munis is CEO of Restoring Vision. It's a nonprofit whose mission is to help address what it calls the global vision crisis. And the main thing they're trying to tackle is helping people who are experiencing near vision loss as they age. In medical terms, this is called presbyopia.

3:21Presbyopia happens usually in your 40s, but in a lot of countries, it can happen as early as in your 30s. So just when you're in your prime working years, you're going through sight loss, and that has really long-term implications. Problem is, as people get older, they often are not aware that their vision is slowly getting worse. And even if they are, in many low - and middle-income countries, there aren't enough eye doctors. And then on top of all that, Palin says some people may not even realize that their vision can be fixed with something as simple as a pair of reading glasses. Oftentimes they don't know that glasses exist.

3:58In cases where they do know that glasses exist, oftentimes they're very expensive and they're not within reach. So it could take them more than a day travel, for example, to go to a location where there are glasses, but then those won't be affordable. Think about the difference from here in the U.S., where reading glasses are super cheap. partly because they're also simpler to make than prescription eyewear. Basically, they're just little magnifying glasses that you wear on your face. But in countries where the average person has a lot less wealth than the average American, reading glasses can actually cost a lot more.

4:31Palin says a few years ago, Restoring Vision did a study in a part of Mexico's Zacatecas state. And community leaders there told her that reading glasses cost around$20 U.S. And this is an area where the average salary is around$280 a month. And so what is the root of the problem here? Palin says it basically boils down to this. In many places, there isn't a demand for reading glasses. And also, there isn't a supply. In other words, there isn't a market. Eyeglasses have existed for over 700 years. It's the access to them that's really the challenge. So the way that Restoring Vision tries to take on this problem is by tackling the demand side of the equation first.

5:14They do that by working with local NGOs and governments in dozens of countries to try and get people screened for presbyopia. You could work with a community health care worker. You could work with a primary health clinic. So a lot of the work we do, individuals will get their first pair of glasses at no cost to them, and this is where we start to see the markets. But the market isn't really working until there's supply to meet demand. You know, you have to increase the number of places that sell the product. The thing is, if you owned a little pharmacy or a shop and you never have customers coming in asking for reading glasses, you wouldn't bother to sell them.

5:52Or if you did, you would charge a lot of money for them. So Palin says they're working on building out those supply channels and even talked with employers about the benefits of providing reading glasses for their employees. By providing somebody with a pair of reading glasses in order for them to do their near-vision work for their employment purposes, you see productivity increases of up to 32 percent, which is pretty significant. But Palin says making these glasses accessible to people can be made more difficult by regulations. So, for example, some countries have rules restricting the marketing of medical services.

6:29That might make it more difficult for a would-be retailer to put up a sign that says, hey, reading glasses sold here. Other countries might import glasses from China, but classify them as luxury goods that are subject to a tariff or import tax. And that makes it more expensive for any would-be customer to buy. And then naturally, at some point, there would be a tipping point and markets will start to develop. And that's really what we're hoping for. You're essentially trying to jumpstart a market that in a lot of countries doesn't really exist. Correct. And the hope is eventually that market will become self-sustaining.

7:10So when people need their second, third, or fourth pair, getting them won't be so difficult and expensive. Now, if you're wondering, what does this market creation process look like on the ground, you could look to Nigeria. That's where Dr. Oteri Okolo lives. I'm an ophthalmologist working at the Department of Public Health in Nigeria. Oteri oversees this program aimed at getting people who are living in rural areas screened for vision problems, including presbyopia. And if needed, they give them a free or low-cost pair of reading glasses. She describes this process as demand generation. You can easily train just about anyone to be able to dispense the glasses, reading glasses, to the general population.

7:56You don't need, should I say, sophisticated equipment or a sophisticated test that a trained eye care worker would have to carry out. So this program has been going on for about a year. And Oteri says at first, the rollout hit an unexpected obstacle. The eye exams were taking a weirdly long time. So the lines were building up and people, the crowds, you know, becoming uncontrollable. And when we investigated, we realized that the primary health care workers were slow because they themselves couldn't quite see clearly. Turned out, a lot of these healthcare workers could not see clearly because they themselves had presbyopia.

8:39They needed reading glasses too. And when they were able to get their spectacles, the cues just moved quicker. They were able to dispense those spectacles faster. Oteri says this just goes to show how reading glasses don't just benefit older folks with vision issues, but also younger folks who are in their prime working years. When her program reached out to those who received glasses, they met people like Caroline. Caroline works as a seamstress. And these eyeglasses that I'm wearing, I've seen enormous improvements because now I can see clearly. And I even came with my needle this morning because I was not able to face my treachering my needle.

9:23But this morning I was able to. We're talking about improving their earning, their potential, so they're earning more. And also improving their ability to thrive. For Oteri and Palin at Restoring Vision, this is a health issue, a social issue, and an economic issue rolled into one. And they say it's solvable. This episode was produced by Cooper Katz McKim with engineering by Patrick Murray. It was fact-checked by Sierra Juarez. Cake & Cannon edits the show and the indicators of production of NPR.