SIGHT, The Story of Vision2

determinants of health that we know that get in the way of kids getting the health care that they need. Poverty is the single largest determinant we have right now. About 72% of the students in this urban district, Cincinnati Public Schools are in the poverty range, so that's one of the base factors. The other factors are housing issues. One of the concerns that happen in being able provide a stable home environment is that families experience a fair amount of need to move during the school year. We also see a fair amount of homelessness. The other issues are related to food and security and we have a lot of programs at all of our schools that addresses food and securityWe have a lot of families units that frequently change due to divorce, separations, incarceration, being raised by someone other than their parents. These examples of the social issues really interrupt children and what we think of sometimes as their normal day. Over time we have gone from a limited number of school based health centers to a large number of school base health centers and from originally eight mandated vision screening program at the vision center to a partnership with OneSight. Around 2,000 students so far this year (2015) have gotten their exams. We think we'll finish with around between 3200 and 3400 kids who will get glasses as a result of this program which is way beyond what we were doing when it was at the vision center. One of the problems that we had with the vision center program as wonderful as it was, was that it was one week all year. We spent a lot of time planning for that week and then the kids who, for whatever reason couldn't make it during that week, then we didn't have any resources for them. Having the OneSight program means that all school year, everyday, children have access to come here and be examined and get their glasses.”Dr. Singh, goes on to say, “OneSight’s founding global sponsor is Luxottica, one of the leaders in the vision care industry. And, part 301

of our unique partnership is how we leverage those abilities to give back to people in under resourced communities around the world. The global vision care crisis is really a unique crisis. People are unaware that this social issue exists. We know about access to clean drinking water, we know about people who are going hungry but do people around the world know that there is a crisis that we can solve very simply. It is so great to be part of an industry that takes this opportunity and this responsibility to solve it... Image: Ilene Mattison-Shupnick Hon. Bob McMullan, President, International Agency for the Prevention of Blindness (IAPB) 302

What is the easiest thing, you can do to participate in the humanitarian effort?“The most immediate thing you can do of course is contribute to whichever charity you choose. All of our members are out there doing terrific work in Africa, India and China, helping people restore their vision. You can do that tomorrow. But, overtime I think people can do more things. First of all they can get involved in those organizations. They can help them. Maybe they can think about applying their skills. You know, people have all sorts of skills that they don't appreciate. Not all of us can be ophthalmologists, but, if you are an accountant, you can use your skills to help the organization. A lot of people feel they are not getting satisfaction out of their life. They might be making money but they are not getting satisfaction. Work for an organization like this, you get satisfaction. You get extra rewards. I think those are the things they can do but if in doubt, give money.”Vosh International Why We Focus On VisionApproximately 670 million people worldwide are functionally blind or visually impaired because they do not have a pair of eyeglasses.The lack of vision translates to failing at school, jobs, health and personal lives. Those who cannot see are too often mired in poverty.We travel the developing world and the U.S. providing free quality vision care services through short-term clinics to those 303

who need it. We also work to develop sustainable programs and local optometric capacity in the developing world in order to help local communities continue to provide quality vision care.Our goal is to eradicate untreated refractive error–that is– to help people see again by correcting their vision with glasses. And once they can see, they can improve the quality of their lives and their own vision for a future for generations to come. EYELLIANCE Jordan Kassalow, OD MPH, Founder, Co-chairman, Vision Spring, EYElliance Steering Committee ChairmanHow did you come to be involved in doing good?“I became involved in vision as a young optometry student. I was down in Mexico working to bring eye care to under served populations and I met a seven year old boy who was blind and we looked at his eyes and realized actually he wasn't blind. All he needed was a really really strong pair of glasses. And I was the lucky person to put those glasses on his face and when the lenses aligned with his eyes for the first time and he saw for the first time, this blank stare of a blind child and made into this most beautiful smile of joy and it changed both of our lives at the same time.”Uncorrected vision affects a lot of things, in general what should we know?“Vision definitely has a profound impact on education. It's pretty 304

clear if you can't see, you can't learn. And we've seen some studies from China recently that have come out that shows that a pair of glasses has the most powerful impact on academic performance of any other health intervention studied. Ten times more then deworming the gut, three times more then nutritional supplementation. A pair of glasses is equivalent to half a year of education for people. And so there's a profound and an important link between vision and education. Vision also has an impact on driver safety. Again, if you can't see it's hard to be safe in the world. There is a study from Italy that showed that 59 percent of road traffic fatalities had a vision component to them. Yet, only three percent of Nigerian commercial drivers have access to glasses, and you can imagine what that results in. Vision also has a huge impact on productivity. Again, if you can't see you can't work. It's tough to work particularly in the developing world. So many people earn their living with their eyes and their hands, and if you can't see the fine details a weaver, a tailor, or artist, or a mechanic then you loose your productivity and you loose your livelihood. About 35 percent increase in productivity is yielded by just getting a simple pair of eye glasses. There are a number of fantastic organizations that are working on the issue of vision globally. Organizations like the Brien Holden Vision Institute, Vision Spring, OneSight, organizations like Helen Keller International, Sight Savers International, Christofell-Blindenmission, there are dozen of others but there are wonderful organizations that are working everyday to solve these very important problems. In terms of local involvement there are a lot of church based groups, and Lions Club groups that collect glasses to be used internationally. There are a lot of organizations that deal with vision in the United States because it's also a problem in the United States. About 20 percent of inner city school children in 305

the poorest reaches of our cities need glasses and don't have them to learn. Organizations like Hellen Keller International have a wonderful program called the Child Sight Program that brings vision screenings to, and eye glasses, to inner city schools.”You are the Eye Alliance Steering Committee Chairman, why an EYElliance?“The EYElliance is important and it's a new concept because although there are a lot of organizations that are addressing the issue of uncorrected refractive error, meaning that people who need glasses. Organizations like the Brian Holden Vision Institute, Essilor, Vision Spring, are doing wonderful work putting glasses on faces of people who wouldn't have glasses otherwise. There are certain barriers to the marketplace that fall beyond anyone individual organization. Barriers like creating demand. It's too expensive for one organization to create demand for eye glasses. It's too expensive and too difficult to move national policies to get kids eye screenings in schools and to get people glasses so they can be safe on the roads. So, there are certain barriers to getting vision services out there that fall beyond the individual organization and have to be done by an industry facilitator. The alliance is that industry facilitator that is trying to bring together the key sectors of society that can make a difference, government, private sector, and civil society, all together in a concerted effort, working together to make sure 2.5 billion people can see.”In your view, what will the EYElliance be in 5 years?“In the next five years we hope EYElliance will look as follows, there will be a broad set of actors from government, from private sector, and civil society, all working together to raise the importance of vision on the global development agenda. People don't realize that vision has a profound impact on education, on road traffic safety, on labor, on productivity, economic productivity. And so we are trying to bring together the three 306

main sectors of society to raise the importance of the issue area, mobilize significant new resources to solve the problem, and bring a broader set of actors to help distribute eye glasses to the millions and millions of people that need them.”RESTORING VISION Mark Sachs, Restoring Vision Founder“In 2003, we received the first donation of new glasses. The glasses arrived at my home and I repackaged and shipped them to charitable organizations across the US. But soon the volumes became overwhelming. Fortunately, I found an organization of people with disabilities who sorted, packed and shipped the orders.As supply increased, I knew there were more organizations who could use the glasses. I discovered that not only optical groups but also non-optical missions were willing to take reading glasses and sunglasses to those in need. They saw for themselves how easy it was to distribute glasses and how life-altering these glasses were. Their success made them tell others. And so we grew by word of mouth. With time, the donations from manufacturers increased, and so did the number of partners who would take the glasses to developing countries. To date, we have built a network of over 1,400 organizations that collectively distributed 6M pairs of glasses to those in need! As more people are helping, more people are helped. They are 307

experiencing the joy of transforming lives in a simple way. And we’re glad to have been helpful in allowing others to give the Gift of Sight.”Mark Sachs, Founder​OPTOMETRY GIVING SIGHT From the Optometry Giving Sight website, “Optometry Giving Sight is the only global fundraising initiative that specifically targets the prevention of blindness and impaired vision due to uncorrected refractive error – simply the need for an eye exam and a pair of glasses. More than 600 million people around the world are blind or vision impaired because they do not have access to the eye examination and glasses they need.’ President and Mrs. Carter help measure people's heights to determine how many Mectizan® treatments should be received to prevent the parasitic disease river blindness. President Carter provides a single annual treatment of the drug to a young girl after she is measured. (image and caption from CarterCenter.org)One humanitarian effort has been very effective and that is the Carter Center in its efforts to eradicate river blindness and trachoma. 308

From the Carter Center website, “River blindness, also known as onchocerciasis, is a parasitic infection that can cause intense itching, skin discoloration, rashes, and eye disease that often leads to permanent blindness. The parasite is spread by the bites of infected black flies that breed in rapidly flowing rivers. Trachoma is a bacterial eye infection found in poor, isolated communities lacking basic hygiene, clean water, and adequate sanitation.It is easily spread from person to person through eye-seeking flies, hands, and clothes. Repeated infection leads to scarring and inward turning of the eyelid — a very painful condition called trichiasis — eventually causing blindness if left untreated.Globally, 200 million people are at risk for trachoma, and over 3.2 million are at immediate risk for blindness from trichiasis.”One must recognize the contributions of two individuals in particular in this area of work for trachoma and river blindness. They are Professor Hugh Ringland Taylor, AC, MBBS, BMedSc, MD, DipOpthal(Melb), FRACO, FRACS, FAAO, FACS, FAICDFrom Dr. Brien Holden, “Hugh is most known for his trachoma research for his work to advance aboriginal eye health and for global leadership in ophthalmology - he is the incoming president of the ICO and a very good friend. Most known for his trachoma research and for his work to advance aboriginal eye health; long career in research into the causes and prevention of blindness in both developed and developing countries; friend of Brien Holden and with Vision CRC.”The most widely published ophthalmologist in Australia, Hugh’s research into two of the leading causes of world blindness, trachoma and onchocerciasis, has earned him a prominent reputation in the field of international ophthalmology. His work with the World Health Organization (WHO) has done much to address the scourge of blindness across the globe, including, most recently, his work for the Vision 2020 Global Initiative 309

project to eliminate avoidable blindness by the year 2020.”And, Serge Resnikoff, MD. PhD. French Society of Ophthalmology, Organization for the Prevention of Blindness (OPC), President of the Board, International Council on Ophthalmology, Board of Trustees, Director for Eye Care DeliveryAgain, from Dr. Brien Holden, “Serge, of course, as the former blindness and deafness head at WHO is fully conversant with oncho and every other major condition causing vision impairment, blindness and threats to eye health. He is expert on lots of global vision problems, cataract – river blindness – uncorrected refractive errors and was the first to bring this to the World Health Organization” 310

IF YOU WERE TO LOSE YOUR VISION OR YOUR HEARING...00:00 / 00:00 Rebecca Alexander summits Mt. Kilimanjaro, narration by Sir Elton John. As human beings, our sight will diminish as we age and we will all face a vision crisis. When that time comes in our life, technology, science and medicine will be there to minimize these crises or completely restore our sight. Guided by the humanity of those selfless individuals that have dedicated their lives so that others might see. 311

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Table of Contents 1 3ForewordThe Sight Project 9 In Memoriam, Preface 14The Science of Vision 20 30 Structures of the Eye 38 Vision, The Way We See The 3 O's 42 53Ultraviolet Radiation, Light, Blue Light 75There Are Too Many That Cannot SeeEye Conditions, Myopia, Hyperopia, Astigmatism, Presbyopia 86 Children's Vision 94 102Managing MyopiaGetting Framed 118 128 Sunglasses A Brief History of Eyeglasses 153 165Contact Lenses 172Coolest Optical System in an Animal On the PlanetCommon Eye Diseases 186 197 Cataracts 202 Glaucoma 208 Age Related Macular Degeneration 222 Corneal Disease, Eye Banking 229 Retinal Disease, Detachment 237 Whole Eye Transplant? Dry Eye 247Think About Your Eyes 249 Your Journey ... 251 276Low Vision, Visually Impaired, Blind 287The Not So Distant Future of Vision 311HumanityEnd 314

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