Better Vision for the World, on a Budget

VEGHEL, the Netherlands — With AIDS, malaria and other diseases costing millions of lives every year, worrying about the vision of people in the developing world may seem like an indulgence.

A study published in a World Health Organization journal in June estimated the cost in lost output at $269 billion a year. Moreover, tackling vision problems early can help prevent later blindness.

Now efforts are under way to find a means of distributing inexpensive glasses on a wide scale. One promising technology is self-adjustable spectacles, which let untrained wearers set the right focus themselves in less than a minute, greatly reducing the need for trained optometrists, who are rarely available in Africa and many parts of Asia. Though these adjustable glasses cannot yet help with conditions like astigmatism, at least 80 percent of refractive errors can be fixed.

At least three organizations are now offering their own versions of low-cost adjustable spectacles. Two are relatively new groups based in the Netherlands that have received little international recognition. The third, based in England and championing a British invention called AdSpecs, has been attracting widespread media attention for more than a decade.

AdSpecs, which allow the corrective power of the glasses to be adjusted by means of a clear fluid injected into the lenses, were developed by Joshua Silver, a physics professor at Oxford University who directs a research institute there called the Center for Vision in the Developing World.

Since introducing the glasses in 1996, Professor Silver has set an ambitious goal of distributing a billion pairs of low-cost adjustable glasses by the year 2020.

In the intervening 13 years, though, only about 30,000 AdSpecs have been distributed; they cost about $19 a pair.

One of the Dutch groups, the Focus on Vision Foundation, says it can produce its Focusspec glasses for about $4 a pair. The group’s founders say the price will drop substantially once the glasses are being made in large volume. They plan to distribute about 30,000 pairs in early 2010, initially in Afghanistan, Ghana and Tanzania.

The other Dutch offering, called U-Specs (universal spectacles), is being promoted by the VU University Medical Center and a charity called the D.O.B. Foundation.

Both Dutch models are based on a design pioneered in the 1960s by Luis W. Alvarez, an American who won a Nobel Prize in physics. The design uses two lenses that slide across each other to alter their focus. U-Specs were initially developed in 2003 by Rob van der Heijde, a physicist at the VU University Amsterdam.

Frederik van Asbeck, a former student of Professor van der Heijde, struck out on his own to develop the Focusspec in 2005. Though the Dutch camps have had sporadic contact, they are not working together.

The tangled provenance of the designs demonstrates the unspoken yet occasionally palpable sense of rivalry among the various camps.

“I view them as good friends,” Professor Silver, the inventor of AdSpecs, said. “We’re not competitors. I’m just rather keen on origins and facts being clearly stated.”

He said they all agreed that the developing world needed a “low-cost design that can be produced at very high volume,” conceding that “none of the enterprises around today can do that.”

But each camp is convinced that it has the best approach to supply the millions or even billions of inexpensive glasses the developing world needs.

Focus on Vision says its advantage is the unique injection-molding process that allows its Focusspec eyeglasses to be made cheaply. It was developed by a Dutch engineer, Ron Kok, who grew wealthy in the 1980s by streamlining the manufacture of compact discs and contact lenses.

Focus on Vision invited Mr. Kok to work that same magic on its glasses. “I saw immediately that you could make it simpler,” he said. “They’re designed to be easy and cheap to produce.”

The U-Specs team emphasizes its scientific pedigree. “We took more of an academic approach, or at least a scientific approach, rather than an entrepreneurial one,” said Sjoerd Hannema, who was in charge of the U-Specs project until the middle of 2009. “Having a university and an eye hospital behind it,” he said, “helps build recognition and authority around this project.”

Mr. Hannema now leads a nonprofit organization called Adaptive Eyewear, which is running a distribution project in Rwanda called Vision for a Nation. It uses a combination of U-Specs, a version of Professor Silver’s lenses and traditional reading glasses.

Although they are not made using Mr. Kok’s special production technique, supporters of U-Specs say they will ultimately cost about the same to produce as the Focusspec.

“It will be around one to two dollars, depending on the quantity,” Mr. Hannema said. “If you make a million glasses, then automatically your cost price goes down dramatically. But then the challenge is where are you going to bring those glasses? Ultimately the cost of distribution is what matters.”

“They’re basically all at the same level,” he said, “and at the first stage of a very complicated journey.”

The Focusspec team contends that it is the closest to reaching mass production. “I think we’re the furthest,” said Dr. Ben van Noort, an ophthalmologist who is president of Focus on Vision. “But we’ll see. As soon as we make a million per year, the price will drop to a euro.”

He suggested that fluid-based spectacles, like those promoted by Professor Silver, were more sensitive to shifts in temperature, which made them less stable, especially in the challenging climates where many of these glasses are to be distributed.

Yet the Focusspec has also had its early problems. In a recent visit to the production facility in Veghel, which is about 50 miles southeast of Amsterdam, the adjustment wheel was not working properly on a large batch of glasses. They had to be repaired before they could be sent to Afghanistan, where they were eventually to be distributed by Dutch soldiers stationed there.

“Once you start to produce them on a large scale, you bump into things like this,” Dr. van Noort said. “It’s trial and error. There’s no handbook for this.”

Professor Silver said his fluid-filled spectacles would eventually cost less as well. “The Focus on Vision work is very interesting in that it shows that significant cost reduction is possible,” he said. “But from my perspective, the jury is still out. There’s no reason why Alvarez would be cheaper” in the long term.

When it comes to choosing sides, many of the charitable groups involved say they are open to whatever glasses do the job. J. Kevin White, a former Marine who runs Global Vision 2020, a foundation that distributes adjustable glasses, said fluid-filled lenses generally offer better optical quality and correct a greater range of refractive error. The Alvarez designs, by contrast, are cheaper, smaller, better-looking and less likely to break.

For his part, Mr. Hannema of Adaptive Eyewear considers the occasional strife between the groups counterproductive.

“Kids in India don’t benefit from that,” he said. “It’s like if Unicef and the Red Cross would quarrel about a patent on a medicine from a hundred years ago.”