The value of sight: Unveiling the economic returns of eye care

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More than 1 billion people in the world live with unaddressed vision impairments of some sort, and Seva Foundation, a global nonprofit eye care organization that works with local communities around the world, is looking to combat that.

A recent paper from the organization says that, when prioritized, eye health could yield $36 in benefits for every $1 spent, meaning every dollar spent on refractive error or cataract correction produces $36 in benefits. This is 6 times greater than the typical $6 return seen in other development interventions.^1,2 The 2 highest returns outside eye care were seen in nutrition and noncommunicable diseases, which were at 13 to 1 and 9 to 1, respectively.^1,2

Kate Moynihan, CEO and executive director of Seva Foundation, talked about the worldwide problem during an interview with Ophthalmology Times. “There’s a worldwide health crisis around avoidable blindness that affects over a billion people,” Moynihan said. “And what’s really interesting about that is there’s this network of organizations, [with] Seva as one of the largest, that understands how to solve the problem effectively, cost efficiently, [and] safely.”

Moynihan noted avoidable blindness is believed to be a big reason why people are resource poor. “If we can alleviate avoidable blindness, we’ve made a very compelling case at the United Nations and elsewhere that it will help us achieve the sustainable development goals,” she said.

The systemic review looked at 21 case studies across 10 low- and middle-income countries to find the 36-to-1 investment return ratio. Case studies researched included school screenings in India, China, and Pakistan; glasses provided for myopia and presbyopia for farmers; and cataract surgery in Bangladesh and the Philippines.¹

Brad Wong, PhD, founder and director of Mettalytics, was one of the lead authors on a study looking into the issue and gave some insight on the numbers and an example of the economic return in an interview with Ophthalmology Times. “This paper is the first to rigorously and systematically make the case that eye care in developing countries is not only a good thing to do, it is not only a just thing to do, [but that] it might be one of the most effective things that people can do in global philanthropy,” he said.

Wong described a case they used in the study: tea pickers in Assam, India, who needed eye treatment. “A big chunk of them are [older than] 45 [years and have] presbyopia,” Wong said. “[Researchers] went to plantations in Assam, screened workers for presbyopia, and provided, in a randomized controlled trial setting, some of them with glasses and delayed the provision of glasses to another group.”

Wong said that when researchers went back to the group 11 weeks later, they found that those provided with glasses picked 22% more tea (approximately 5 kg more) than those without. Wong and the authors cross-referenced the tea costs to see that, at the time, tea was selling for “a little over $2.”

“On the first day of someone being given glasses, they were able to pick $12 more [in] tea than someone [without treatment],” Wong explained. “The cost of giving the glasses was $10, [and] the cost of diagnosing that person with the glasses [was] $10, so $20 in total. After 2 days of having those glasses, they were able to cover the cost of the investment. Expand that over the rest of the harvest season, and you end up with this incredible return.”

This not only results in an economic boost in this scenario but also a boost on a personal level. Wong pointed out tea pickers are compensated by how much tea they pick.

“Their incomes have also increased,” he said. “They’re able to go off and do other things within their daily life [such as] be at other jobs or domestic duties, caregiving. They can do all those things with much more agency, and that’s an example of some of the social and economic benefits that we’re talking about in the study.”

Moynihan says it is inexpensive to contribute to the solution as well, with current solutions to improve eye health costing approximately $10 to provide 1 person with good vision for 1 year. These are solutions that “we know work,” Moynihan said. “If we solve this health issue that you’re a specialist in, the ability to change the world is not even hyperbolic; it’s real. Letting people see again is a phenomenal ability that ophthalmologists and optometrists have.”

“We have the technology,” Wong stressed. “It’s just glasses and cataract surgery, technologies that have been around for decades and centuries.”

It isn’t all about the economic impact, as the caregiver burden could be greatly decreased with the added care, although this is not as easily measured. “It goes to the caregiving burden,” Wong said. “And that is a deeply underappreciated aspect of the economic gain from providing vision correction. [For] those who are unable to go about their daily lives, they require a caregiver.”

Wong noted that in developing countries, there are multigenerational households where mothers and fathers are living with grandmothers, grandfathers, great uncles, nephews, nieces, and other extended family members. “And typically, it’s the older generation who is taking care of the younger generation in that setup,” he concluded. “And if they don’t have their vision, they can’t do that.”

References

1. Wong B, Singh K, Everett B, et al. The case for investment in eye health: systematic review and economic modelling analysis. Bull World Health Organ. 2023;101(12):786-799. doi:10.2471/BLT.23.289863

2. Eye Health: A Best Buy in Global Health and Development. Seva Foundation. November 2023. Accessed February 4, 2024. https://www.seva.org/ site/DocServer/SevaPolicyPaper_EyeHealth.pdf