The first-of-its-kind study commissioned by AMD Alliance International estimates that the global economic cost of visual impairment is estimated at a staggering US$2,954 billion in 2010 for the 733 million people living with low vision and blindness worldwide in 2010. Even more importantly, these costs are set to rise dramatically through to 2020 unless effective prevention and treatment strategies are adopted worldwide. This global cost includes direct health care cost expenditure, lost productivity and informal caregiver time.

The findings of the report emphasize the need to elevate vision as a global health and economic development issue. According to their estimates, more than half of all sight-loss globally occurs due to uncorrected refractive error, which is treatable with basic pairs of reading and/or distance lenses.

Recommendations

The study advances five recommendations to reduce the global burden of visual impairment, which emphasize broadening availability of affordable eye ware to correct refractive error. Additional recommendations include availability of cataract screenings and surgery in developing regions, funding and treatment of river blindness, increased glaucoma screenings for at-risk populations including seniors and those with diabetes.

Each of these recommendations, however, rests on an existing vision care infrastructure of each region, highlighting the critical importance of the availability of first-line vision care. In end of the road communities where VisionSpring operates, accessing vision care can require a full day trip to a city clinic – costing individuals a full day’s wages and travel expenses. By bringing vision care to these communities, VisionSpring hopes to be part of the larger process of developing the infrastructure of vision care systems in the developing world.

Awareness

One comment we repeatedly hear from new customers is that they had no idea that correcting their blurry up-close vision (or the headaches, neck strains and slow productivity caused by it) could be so easy and inexpensive. Had they been aware of the benefits relative to the cost, they might have resolved their vision problems years prior. For years, our Vision Entrepreneurs have referred customers whose vision required further attention to an optometrist or eye hospital – opening the door for a customer to feel empowered to treat vision issues he was once resigned to living with. Further, seeking the solution to age-onset blurry vision can lead to the discovery of a greater vision concerns such as cataracts, that while unable to treat patients directly, our Vision Entrepreneurs can help to diagnose and assist patients in locating treatment. Raising awareness of the treatment options available to those suffering with vision problems is a critical component of addressing these global costs – an issue our Vision Entrepreneurs tackle every day.

About AMDAI

AMD (Age Related Macular Degeneration) Alliance International is the only international organization in the world dedicated exclusively to promoting awareness, treatment and research into macular degeneration, the leading cause of vision loss in the developed world. It is a membership organization comprised of the worlds’ leading vision, seniors and research organizations from 25 countries.

The AMD Alliance International study and executive summary are available here.

VisionSpring 3.0 incorporates an urban optical shop that sells affordable distance glasses into its existing mode as a “hub” for VisionSpring’s “spokes “, i.e. our market-creating Vision Entrepreneurs working in rural regions. Latin-America Partner Manager, Caroline Misan, recently returned from the pilot of this new model and brought two short videos shot during one of the successful Vision Campaigns in Sant Ana.

Country Director, Heidy Serpas (seen in the videos) works with customers to select their frames. With a great understanding of what styles are popular in the region, Heidy’s expertise has resulted in highly positive response to our frame selection. During the first four campaigns, VisionSpring sold more than 140 pairs of prescription lenses.

Watch as customers choose among the selection of frames in consultation with Heidy and their families:

With support from the Rockefeller Foundation, VisionSpring had the opportunity to partner with the design firm IDEO to develop a model for integrating eye care for children into our existing work in India. Anitha Gopalan, Sales Innovations Manager for VisionSpring India, reflects on the experience.

When our team was called to design an approach for our Vision Entrepreneurs to screen and sell eyeglasses for children, a completely new model for rural India and for VisionSpring, we knew we would need to take an innovative approach in order to listen to the market and ensure we design a program that really works. We reached out to IDEO, pioneers of Human Centered Design, and were lucky enough to have Jocelyn Wyatt and Sandy Speicher conduct workshops and training sessions centered on this challenge.

IDEO provided us us valuable insight on the processes behind ideation and prototyping. With their help, we conducted field research and identified key barriers to the challenge of empowering our Vision Entrepreneurs to screen children for eye conditions. Some of the results of our research were unexpected; for example, we learned early on that kids are afraid to reveal their imperfections. Through the design process, we came up with innovative ways to help kids overcome their fear and embarrassment, such as having children practice screening other children and putting up pictures of movie stars who wear glasses on the walls. We found that these tools helped children feel empowered in the screening process, as well as helped to destigmatize eye problems.

We also learned that children can be a major lever in providing eye care to families. This is a lesson that had already been learned in relation to other health care issues; for example, parents we interviewed explained that many of them learned to boil water from their children, who learned about the benefits of this in school. Thanks to the success of campaigns such as these, many parents now look to their children for guidance on basic health and hygiene issues. We believe that if we can educate children about eye care and empower them to get their own eyes screened, we may well be able to access their parents as well. These insights proved to us that, while we still have a ways to go in designing our model, we are well on our way to establishing a new model for effectively serving children in need while strengthening our overall sales.

Thanks to our work with Jocelyn and Sandy, as well as our past work with Acumen Fund Fellow and IDEO employee John Tucker, we have come a long way with our innovations processes. In the last year, we have tested and successfully launched a line of photochromic glasses. We also designed a flip chart for our Vision Entrepreneurs to standardize our communication and win credibility in C-Towns (mid-size rural cities in India). We are excited about our ability to continue replicating the Human Centered Design process to create and bring to scale new approaches to providing eye care in the developing world.

The following is a post from Tim Johnson-Aramaki, a student at the University of Michigan’s Ross School of Business, who spent the summer with VisionSpring India working on a data-collection methodology to measure the long-term impact of VisionSpring’s work on the lives of Vision Entrepreneurs and customers. His project is part of a multi-year impact study conducted by Professor Ted London at Michigan’s William Davidson Institute.

“Over the last few months, I’ve been working to develop a survey instrument with the VisionSpring team here in Hyderabad and the William Davidson Institute team in Ann Arbor. The first step was survey pre-testing, which involved conducting countless interviews in rural village throughout the state of Andhra Pradesh. These interviews are meant to help us discover whether the questions we’ve come up with are understood by respondents with varying semantic and cultural backgrounds, and if they prompt valid and appropriate responses. Some of the results we’ve gathered have been really interesting.

For example, one of the most critical pieces of data in measuring VisionSpring’s impact is the income of its Vision Entrepreneurs and customers. It also happens to be one of the most difficult things to measure as there are challenges when it comes to discussing money. Through our interviews, we’ve found that while people are relatively open in assigning a number to their income, that number may not be accurate. There are a variety of reasons for this, but one is that they fear the income figures may be passed on to state or national agencies, potentially jeopardizing the public assistance they receive. To avoid this, they often provide income figures lower than that which they actually earn.

Responses can also be skewed because interviewees seem to identify the interviewer as higher up on the social ladder. With that in mind, the interviewees often attempt to please the interviewer with superlatively positive answers about product or service quality and refuse to make any constructive criticism. Moreover, in areas of the survey that allow for subjective self-measurement, many interviewees have attempted to “impress” the interviewer with potentially inflated responses. For example, we had to alter an entire section that measured an individual’s self-assessed capacity in tasks such as interpersonal communication because nearly all the responses to these questions were either a four (“agree”) or five (“strongly agree”). There would have been no improvement to measure!

Working through these issues to get an effective impact-assessment tool for the base of the pyramid has been challenging but rewarding. What’s so great about this project is that while it’s being made for and by VisionSpring, ultimately the survey and survey-development practices developed here in Hyderabad could really benefit other organizations working at the base of the pyramid in helping them measure the success of their work.”

VisionSpring’s Maruti Ram on how Salesforce.com helps motivate entrepreneurs, improve sales, and penetrate rural markets.

One of the biggest challenges we face in India is that our Vision Entrepreneurs return from the field claiming that their markets have been saturated.

The truth is that all of our Vision Entrepreneurs are assigned territories of 20 villages – each which have populations of around 50,000 – where they can return once every three months to conduct vision campaigns. The notion that they have reached out to everyone who might be in need of glasses after just a few sales campaigns is false; it just feels that way to them because the first and second visits are often immediately successful, while the third starts to become less so.

To combat this, we’ve begun to use Salesforce.com to generate simple charts that we print out and share with our Vision Entrepreneurs. We input data on population, sales, estimated target market, and the number and kinds of campaigns that have been conducted in each village. These territory reports help combat the Entrepreneurs’ misperceptions as they prove that there are many people they have not yet reached and that their markets cannot possibly be saturated.

We also use these reports as a jumping off point to come up with sales strategies. For example, we can see from these statistics that we are missing a large number of “non-functional Presbyopes” — those who experience near vision loss but have not yet lost their jobs or experienced declining productivity. Eyeglasses can still help them improve their quality of life, and we are developing strategies for educating them on these benefits.

In order for this data to help us effectively reach every potential customer, we must also enhance our marketing techniques. Just conducting sales campaigns is not enough – we need to also focus on viral marketing, or word of mouth. For example, Vision Entrepreneurs could be addressing the town council and teachers meetings that occur every few months and using them as a platform to educate villages in their territories about vision care. Vision Entrepreneurs are not yet taking advantage of all these kinds of opportunities, but they are beginning to. Thanks to the tools we have created, our feedback loop is tighter and has immediate impact on our work.

VisionSpring’s Miriam Stone interviews Acumen Fellow John Tucker, stationed with VisionSpring in India since November ‘07.

MS: What was your background before coming to VisionSpring?

JT: Before becoming an Acumen Fellow I was doing consulting work for a technology services firm and then a design firm. I applied to the Acumen Fund program because I wanted to take a break from pure advising work to do something more entrepreneurial and with more of a social impact.

MS: What is your project with VisionSpring?

JT: Originally when I joined VisionSpring in November, Neil Blumenthal (VisionSpring’s Director) designed a project in which I would collect stories and develop sales/marketing techniques to help start up VisionSpring’s innovation program. But it’s ended up that I’ve gotten involved in everything: operations, marketing, and training.

MS: What is it like to start an innovation program for a Base-of-the-Pyramid sales and marketing organization?

JT: I think the principles of these programs are essentially the same, regardless of whether you’re selling luxury items in the US or affordable products at the Base of the Pyramid. You have to experiment, learn quickly, take iterative approaches, and make things replicable.

At VisionSpring, we’ve focused on determining when we’ve gathered enough information to proceed with launching a new product and when we have enough evidence to know that an innovation is going to be beneficial to the overall model.

MS: What are some of the things that make VisionSpring’s market unique?

JT: Cultural barriers certainly shape our sales and marketing strategies. For example, women Vision Entrepreneurs have more success selling to women because they are able to actually enter the homes of other women. But at the same time, they cannot travel freely because of strict family obligations and because of the large role that approval from fathers and husbands play in their professional decisions. Also, geographically, rural markets are by nature very spread out, so traveling times are high.

The result of these two factors is that we attract a lot of women Vision Entrepreneurs, but the duration of their time with us remains on average around 6 months. By understanding the roots of this pattern, we can take steps to work with the environment and be successful.

MS: Do you have any advice for someone coming in to do a project with an organization based in the developing world?

JT: You need to be a really good listener for the first few months, and recognize the deep experience of the people you’re working with. The learning curve at the beginning is incredibly high. Then, after some time, you get to better understand the market and the individuals you are working with and can actually begin to add value.

View John Tucker’s short film on Rama Devi, one of VisionSpring India’s most successful entreprenuers, on YouTube at http://www.youtube.com/watch?v=HkKoXJTC5I4

Read more from John Tucker at the Acumen Fund http://www.acumenfund.org/investment-story/walkabout.html website