This is a reality in the developing world. There are more than one billion people globally who cannot see clearly because they do not have access to corrective eyeglasses. This lack of eyecare causes a loss in quality of life, employment prospects, productivity and general health. The World Health Organization reports that refractive error, as it is known, is the largest cause of low vision and the second largest cause of preventable blindness (after cataracts) globally today.

The problem is caused by the combination of a lack of trained optometric personnel and the cost of eyeglasses to those living in poverty:

• In most developed nations, there is around one optician for every 8,000 people, but in the developing world this ratio is much worse: in many countries it can be as bad as one optician for every million people - in Mali the figure is one optician for every 8 million people.
• But even if tens of thousands of optometrists descended on the developing world to address this issue, the cost of eyeglasses is impossible to bear for many people - the average cost of a pair of eyeglasses in the developing world is far too large for someone living on less than a dollar per day.
• There is also a lack of access to suitable dispensing facilities in rural areas, and even major cities have very few opticians' clinics available.

The issue will get worse, particularly in the industrializing nations of south-east Asia and South America as the prevalence of refractive error is rising globally and countries are unable to cope with the public health demands increasingly imposed upon them.

Using the World Health Organization's standard measure of the effect of a given health issue (the Disability Adjusted Life Year), refractive error will rise into the top 10 global health issues affecting productivity and opportunities by 2030, passing HIV/AIDS in its global burden.

Conventional techniques have been unable to address this huge and vital issue as the numbers involved are simply too massive. The problem requires a new approach, and Global Vision 2020 provides the solution.

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