Why six million Kenyans are missing out on essential eye care

Six million Kenyans are going without eye care they need, forfeiting earnings gains that research shows can reach 33 per cent, as the country reflects on this year's World Optometry Week, which closed on March 23.

World Optometry Week, observed from March 17 to 23 and culminating in World Optometry Day on March 23, is an annual observance that highlights optometry's role in global health and the contribution of optometrists worldwide to expanding access to eye health care as a human right.

 This year's theme, "Eyes to the Future: Optometry Improving Global Wellness," set by the World Council of Optometry (WCO), sought to emphasise optometry's far-reaching impact and its role in shaping the future of eye care.

An estimated 7.5 million Kenyans, representing 15.5 per cent of the population, need eye health services, yet only 1.6 million have access to them from public and private facilities, according to the International Agency for the Prevention of Blindness (IAPB).

The scale of the shortfall is partly structural. Kenya has only 56 registered optometrists, who are not regulated by the government, and eye care services remain centralised in urban areas with weak referral systems.

In Sub-Saharan Africa, one optometrist serves an average of 50,870 people, and none of the region's countries meet the internationally recommended ratio of one optometrist per 10,000 people.

A randomised controlled trial by VisionSpring, BRAC and Queen's University Belfast found that reading glasses raised the median monthly income of low-income workers by 33 per cent within eight months, underscoring the economic toll of inaction.

"The impact of clear eyesight is immediate and profound. You can see it in a child who suddenly engages in class, or an adult who regains confidence in their work. But the challenge is that many people never reach that point of care," said Faiza Saida, an optometrist at Dot Glasses Kenya.

Kenya's National Eye Health Strategic Plan (NEHSP) 2020 to 2025 identifies cataracts, refractive errors and allergies as the leading causes of eye disease, conditions that are largely preventable or correctable with early intervention.

Yet refractive error services are not integrated into Kenya's national health services, forcing patients to seek care in the private sector at higher cost.

The access gap deepens along income lines. The health sector suffers from a scarcity of skilled eye care specialists, a skewed distribution of the eye care workforce and limited productivity of existing staff, according to the Ministry of Health.

Most permanent providers are concentrated in urban centres, leaving low-income and rural communities dependent on intermittent outreach programmes that are often unsustainable.

"Most of the people who need basic eye care are not reached consistently. They are either too far from services or cannot afford them, so they continue living with poor eyesight, even when the solution is simple," Saida observed.

The World Health Organisation (WHO) and the IAPB estimate that more than one billion people globally live with poor eyesight that could have been corrected, with the burden falling disproportionately on low and middle-income countries.

Among solutions working to close the gap is Dot Glasses, a social enterprise co-led by Adam Boxer and Bradley Heslop, which deploys trained community health workers and simplified dispensing tools to bring basic eye tests and affordable glasses to underserved communities without displacing the role of optometrists.

The WCO has called on optometrists, healthcare leaders and policymakers around the world to ensure eye care remains a priority in the global health agenda, noting that optometry must continue to educate policymakers about its importance in that agenda.

The systemic cost of inaction extends beyond individuals. The IAPB estimates that vision problems result in more than $410 billion in lost productivity globally each year, a figure that points to eye care as an economic and development imperative, not merely a health one.