#svlimpact

“The simplicity, accuracy, speed, and portability were all very strong...The SVOne streamlined [our] whole process, thus allowing us to attend to almost three times the number of patients.”

Please tell us about your organization.

Friends of Bolivia Foundation, Inc. was founded in 1993, with the purpose of rendering medical attention to the poor people of Bolivia. Yearly Friends of Bolivia organizes a medical mission team of medical professionals and volunteers to go to Bolivia, South America, to fulfill this purpose.

Describe the types of patients you see.

The vision team sees patients from every economic group, most especially from impoverished communities. The range in ages is usually from seven through 80 years, although there have been remarkable exceptions — several 100 year old patients! In general the patients need eye sight correction of simple distance and/or close range deficiencies.

What is your biggest exam-related challenge?

In the past the biggest challenge was assessing the correct vision, but with the SVOne that was no longer the case. The biggest challenge now is the ability to fit the patient with the range of glasses supplied through the Lions Club. Another challenge is the inability to attend to the needs of individuals who require surgery.

What attracted you to the SVOne?

The simplicity, accuracy, speed, and portability were all very strong attractions.

How do you use the SVOne?

The SVOne replaces the former instrument that we used to measure vision, the focometer. This instrument is very time demanding and difficult for a patient to use — particularly when the directions involve language translation. Usual measurements could take from 30 minutes to one hour. The SVOne streamlined the whole process, thus allowing us to attend to almost three times the number of patients.

Tell us an SVOne story.

The Friends of Bolivia Medical Mission Trip in May and June of 2015 was the first opportunity to use this innovative instrument. The site for this mission trip provided an extra challenge — many of the elder patients spoke Quechua, a regional, indigenous language, that our team did not know. The use of the SVOne effectively eliminated the need to translate how to operate as icons and gestures easily conveyed the instructions to the patient. Our oldest patient was in his late 80s and without the ease of communication it is doubtful that we could have been a success. His wide smile as he donned his new glasses was a great gift to all of us!

How do you envision the SVOne will help you grow your organization?

In the fall of 2015, Dr. Huy Tran and Maya Major of Smart Vision Labs screened 316 students over two days at Tuckahoe Commons Schools in Southampton, Long Island. The students participating in the school screening (most who had not gone to the eye doctor in the past year) ranged from ages 4 to 13, grades Pre-K to 8th. The first day was a vision screening of all students in the school, and students who saw under 20/30 for visual acuity were brought back the second day for vision exams with Dr. Tran.

Why school screenings are important

This initiative with Tuckahoe Common School and the wonderful Nurse Wendy Meyer emerged after considering the AOA report exposing vision impairment as the most common handicap for adolescents. About 8% of children between age 0 and 5, and 25% of children between age 12 and 17 have a visual disorder. That equates to more than 13.5 million children in the US who may not be able to see the whiteboard clearly. At most, only 14% of children get an eye exam before they start school. Likewise, in a study of 5,851 children between 9 and 15, only 10% of the 20% who needed glasses had access to them.

Acknowledging school vision screenings as the best method to quickly identify common visual disorders, our team organized with Tuckahoe Common School to increase accessibility to vision care. Each exam consisted of measuring visual acuity as well as testing for color vision, as state laws require. The goal was to bridge the gap between the school nurse’s office and the eye doctor. Often nurses identify students in need of additional care, and a letter is sent home with hopes that parents will follow through with recommendations to see an optometrist. However, this method is not effective.

Smart Vision Labs brought the doctor and our smartphone-based technology, the SVOne autorefractor, directly to the school, and were able to provide prescriptions to students whose parents provided consent.

This is where the SVOne is key. It can play a major role in closing the gap for students needing glasses. The ease of use of the SVOne, paired with the device’s ability to store refractive data and final prescriptions, speeds and streamlines the process. The school nurse can keep a record of the prescription in the student’s file. If the student breaks or loses their glasses, they can obtain new glasses quickly with a copy of the prescription readily available. This can help optometrists meet the needs of the community and reach more and diverse patients. This model is not limited to just local schools. It can be applied to any organization seeking an on-site vision exam solution.

What we did: Day 1: Vision Screening

Groups of 5 to 7 students were brought into the nurse's’ office at a time. While one student was checked for distance visual acuity, the other students were being screened for color deficiency and near visual acuity. This took about 5 minutes per group. Students that failed the screening were invited back for refraction on day 2.

97 students (30.6%) had VA of 20/30 or worse in either eye

3 students (2.8%) were found to have color deficiency -- parents were informed by the school nurse

Screening took 7 hours to complete, averaging 45 students/ hour

Day 2: Refraction

Groups of 2-3 returning students were brought into the office at a time. Testing for distance visual acuity, pupillary distance, lensometry, autorefraction with the SVOne and refraction were performed on each student.  Prescriptions were then provided for students who required them and referrals for further testing were recommended to the nurse for follow up.

87 students (89.7%) who failed the initial screening returned for a re-check and refraction

22 students (25.2%) achieved better than 20/30 acuity

22 students (25.2%) already had glasses at the exam but still didn’t pass the initial screening and received a new prescription 

Results:

51 glasses prescriptions were dispensed

9 students were referred for further testing

5 students already had 20/20 vision and no visual complaints

Observations:

Children passing distance visual acuity testing the second time can be due to many factors including nervousness being around other students or now familiarity with the test.

Many children also failed the initial screening due to glasses issues such as forgetting them, breaking them or not wanting to wear them because of aesthetics and/or social pressures.

Using a ruler instead of a pupillometer to measure pupillary distance also quickened the process and is less intimidating for students.

A small waiting area with books and coloring materials outside the nurse’s office was essential.

A motivated nurse, in this case Wendy Meyer, is key. Her knowledge of the school and students (e.g. shy, nonverbal, language barriers) was invaluable.

Having a liaison at the school who knows the community will help mitigate language barriers and better prepare screening staff before the event.

Limitations:

A vision screening is just that, a screening of general visual disorders. Nationally, about 65% of visual disorders amongst adolescents are refractive errors that can be corrected with glasses. The other 35% are binocular vision disorders, dealing with coordination of both eyes. These students must be referred to offices and cannot be accommodated in school screenings.

Statistics found in:

American Optometric Association, Optometric Clinical Practice Guideline: Pediatric Eye And Vision Examination

Know a school that would be interested? 

NEW YORK, Sept. 11, 2015 /PRNewswire/ -- Smart Vision Labs (www.smartvisionlabs.com), the makers of the SVOne smartphone-based autorefractor, has partnered with VOSH/International (www.vosh.org), an organization that provides vision care to people in need. For every 10 SVOne devices that it sells, Smart Vision Labs will donate one SVOne to a student chapter of VOSH (SVOSH).The partnership combines Smart Vision Labs' advanced refraction technology with VOSH/International's global reach.

More than 10 VOSH chapters have purchased the SVOne autorefractor for mission trips to date, and the donation program will enable active student chapters to use the technology for their work. VOSH first field-tested the SVOne during a 2014 mission trip toHaiti led by VOSH President Dr. David McPhillips.

"Our VOSH chapter has used the SVOne with success on remote outreach eye missions in Haiti," said McPhillips. "It performed extremely well in side-by-side comparisons with larger autorefractors and with traditional refraction methods. The instrument is portable, its battery lasts much longer than the typical autorefractor, and, most importantly, it's accurate. It has been an important tool in our fight against preventable blindness.

"In my private practice, I have also found the SVOne to be great for providing nursing home care, as it can be used in any position and is perfect for patients in wheelchairs," said McPhillips. "I can literally create a new exam lane anywhere and be more efficient and productive."

Smart Vision Labs co-founder and COO Marc Albanese accompanied Dr. McPhillips on the Haiti mission. "The VOSH mission is to bring vision to every person on the planet -- this complements our mission of utilizing technology to improve access to vision care," said Albanese. "Our newly announced partnership with VOSH will enable student optometrists to use the latest refraction technology for providing vision care for people globally and in their own communities."

Smart Vision Labs plans to jump-start the program by donating two SVOne units to SVOSH. VOSH International will pick the receiving SVOSH chapters at the 2015 VOSH/International Annual Meeting in New Orleans this October. "Technology is changing at such a fast pace with smart phones, e-readers, and other handheld devices," said Ellen L. Weiss, OD, FVI President-Elect, VOSH/International. "In the field of optometry, the appearance of SVOne adds to this excitement. I've had great experience testing this portable handheld autorefractor in the field and see great potential in the SVOne."

About VOSH/International

The primary mission of VOSH (Volunteer Optometric Services to Humanity) is to facilitate the provision of vision care worldwide to people who can neither afford nor obtain such care. There are over 75 VOSH regional, state, and school chapters worldwide working to accomplish these goals.

About Smart Vision Labs

Smart Vision Labs was founded in 2013 by photonics researchers Yaopeng Zhou and Marc Albanese, who met more than 10 years ago while developing a scanning laser ophthalmoscope in a joint program between the Schepens Eye Research Institute andBoston University. Recognizing the need for revolutionary and efficient technologies to enable regular eye exams, Smart Vision Labs launched its flagship product: the SVOne smartphone-based autorefractor powered by wavefront aberrometry.

Today, eye care professionals are using the SVOne across the United States and in 21 different countries. Zhou, Albanese, and the rest of the Smart Vision Labs team are working to make their technology accessible globally.

Contact:

Jessie Tang Smart Vision Labs 212.796.6124 x7002 Email

SOURCE Smart Vision Labs

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                                 Guatemalan youth Allan trying on glasses

Soluciones Comunitarias, a Smart Vision Labs strategic partner, recently held a vision campaign with the SVOne autorefractor in the small, rural town of Malacatancito, Guatemala.  Huehuetenango Regional Coordinator Teodolinda Herrera (better known as “Teo”) had recently completing her SVOne training, and this was the first campaign she would lead. Teo attended to 13 people over the course of a few morning hours with her SVOne. 16-year-old Allan Estwaldo Suarez was one of her clients. His case is a prime example of the incredible impact that a pair of glasses can have on someone who has never previously had access.

Allan, who was accompanied by his mother Maria, shared with Teo that he had been having difficulties with his vision since as long as he could remember. In fact, in no small part due to this, he dropped out of school a few years ago and was now working as the janitor in his church. Allan was doing well in his job when Teo met him but he aspired to more. The problem was not that Maria didn’t want to help her son with his vision challenges—she simply couldn’t afford to do so.  “Maybe if Allan continues to work it is something that he could save up for in the future,” Maria shared with Teo. 

Maria had never been able to get glasses for Allan because the income she earned at her local taco stand made it impossible to pay the $25 for an exam and over $100 for glasses that the local optometrist charged in the nearest big town. This amounts to over a month’s earnings and makes it prohibitive for the vast majority of families in the area to get the glasses and/or overall vision care that they need. In response to this problem Teo was going village to village giving free screenings and selling glasses from Smart Vision Labs partner, VisionSpring, for $6.50. She was referring people with obvious eye health issues to the nearest low-cost clinic a few hours away by bus. 

According to protocol designed with the advice of US optometrists, Teo started the process with a visual acuity exam. Not surprisingly, Allan could not make out the direction of the “E” once he got to the 20/60 line. Upon finishing the visual acuity exam, Teo shared with him her conclusion that it indeed made perfect sense why he was having trouble seeing. At this point Allan, who seemed to have a great rapport with his mother, turned to her and said, “I told you so Mom.” Next, Teo used the SVOne to capture his sphere, cylinder and axis. He had very slight astigmatism bur really just needed the spherical equivalent glasses that Teo had to offer. As Soluciones Comunitarias has found, so many other Guatemalans in his area are hyperopic just like Allan.

Following the diagnosis, Teo had Allan try on a pair of glasses based on the SVOne results. They then used the Snellen chart to check his visual acuity again, this time while wearing glasses. He could now see well at 20/30. After walking around a bit with the glasses to make sure he was “20/Happy,” Allan came back to Teo with a big smile and said that he wanted to buy the glasses. Without hesitation his mother took the Q50 ($6.50) from her purse and paid Teo for Allan’s glasses. In casual conversation after the event Allan shared with Teo that he will now enroll in school again and give it another try. 

Teo and the Soluciones Comunitarias team will stay in contact with Allan periodically. This ability to follow-up is one of the most powerful value-adds of having a local leader such as Teo doing this work in communities. Thanks to the SVOne in the hands of a dedicated team working to solve the challenges of rural poverty, Allan has another shot at getting an education and a better opportunity to pursue his dreams. Go get ‘em Allan!

           Friends getting glasses for the first time in the Dominican Republic

Please read our previous post “The Concept: The SVOne: Empowering Access to Glasses through Social Enterprise” to learn how this model can be put into action.

Smart Vision Labs launch partner Community Enterprise Solutions and its social enterprise field partner Soluciones Comunitarias are proving the success and impact of the social enterprise model in both Guatemala and the Dominican Republic.

The Guatemala Case: 16 people screened, 11 purchased glasses

Recently Soluciones Communitarias held a campaign in Magdelena Milpas Altas, Guatemala. Maria, a new Vision Advisor (VA), organized this campaign in her hometown pharmacy. She made an investment of approximately $6 for marketing and advertising. Sixteen people arrived at the campaign between 9 am and noon. Adults were charged $1.25 for the SVOne exam; the exam was free for children and youth. Out of these 16 people, 12 were diagnosed as needing the SVOne exam. Of those 12, eight needed glasses for distance vision and two were referred to a nearby vision clinic. Five people purchased glasses. In addition, two people bought reading glasses and four people purchased “protectors” (glasses with no prescription but with UV protection to prevent pterygium). Three people also purchased basic eye drops.

During this three-hour campaign, seven people got prescription glasses for the first time in their lives. Maria was able to effectively serve her community and for her effort she earned $20. (On a good day a person in Maria’s community will typically earn $6 per day.) After netting out costs, Soluciones Comunitarias earned approximately $30. If we could repeat these campaign results 20 times in a month, 140 people would have prescription glasses for the first time, Vision Advisors like Maria would earn $400, and the local social enterprise would earn $600 to help pay for its leadership team, office expenses, transportation, growth, and other priority programming.

The Dominican Republic:  28 glasses and one huge 10 year old grin

The Soluciones Comunitarias team in the Dominican Republic held a two-day campaign in El Palmar, a community in the southwest of the country with a local population of approximately 1,400 people. Over the course of the two days 80 clients got free visual acuity screenings and 35 needed to get diagnosed with the SVOne. In total 28 people of all ages found the right solution and purchased glasses. During this campaign the local entrepreneur earned $49 and the social enterprise netted approximately $50. These quantitative results are very much in line with what we have been seeing in Guatemala. However, it is the qualitative results that demonstrate the true impact of this work.

Adriana Isabel Reyes is 10 years old. When it was Adriana's turn for her visual acuity screening she initially struggled to understand how to interpret the "tumbling E" on the charts. The team could see that she was getting frustrated, so after several minutes of trying to explain how to do it, the local social enterprise team had her move right to the SVOne diagnosis. The results indicated that she needed glasses, and the Vision Advisors found the right pair of glasses for her. After her parents bought her glasses, Adriana walked away not only with a chance for a better quality of life, but with a huge grin on her face as well.

                             Adriana with her new pair of glasses

Smart Vision Labs will continue to test and develop its social enterprise model in the field with partners such Community Enterprise Solutions and Soluciones Comunitarias. We are currently contacting other organizations that want to build on these efforts. If you work for, lead, or know of a social enterprise that is looking to sustainably scale vision solutions for girls like Adriana, please contact us. We want to work with you.

The Problem of Access

There are hundreds of millions of children, youth, and adults throughout the developing world who suffer from refractive errors. Although the ideal solution to this problem would be to have optometrists and ophthalmologists with a presence in every low income community, as we know, this isn’t the reality and is unlikely to be so anytime soon. As such, how can we reach these people in need of a high-quality and economically sustainable way whereby they can access vision solutions that they so desperately need? Certainly mission trips by good-willed optometrists play an important role. However, in addition to this, we believe that local social enterprises should and must play a key role in this effort. They act as the essential “bridge to the last mile” and are commonly the only organizations reaching populations in need in the most marginalized corners of the world. 

                                  Typical rural community in Latin America

The Social Enterprise Solution

The social enterprise movement has been gaining steam for the past decade or so and there are now hundreds, if not thousands, of great organizations (for profit and non profit) in the developing world who define themselves as social enterprises. These entrepreneurial organizations are intelligently solving the health, education, energy, agricultural and economic needs (amongst others) of marginalized communities at scale. They do this by empowering local (typically women) entrepreneurs/community health workers to serve their neighbors by creating awareness, educating, promoting and selling “livelihood” solutions. To date, social enterprises have proven successful in creating first-time access to myriad solutions such as improved cook stoves, solar lamps, water filters, oral rehydration salts, and the like. And in no small part, as a result of the initiative of our good friends at VisionSpring, a growing number of these organizations are successfully getting people 35 years old and over reading glasses for the first time throughout the world. The impact of this work cannot be overstated. However, how can we address the refractive errors of people younger than 35 years old? How do we help the ten year old girl who drops out of school and becomes “stuck” in the vicious cycle of poverty simply because she can’t see the white board? To date it has been exceedingly difficult for social enterprises to solve this problem. The missing element to getting this girl the glasses she needs is that an appropriate, low-cost technology for diagnosing refractive error that is portable, easy to use and accurate simply hasn’t existed.  Smart Vision Labs has now solved this problem and is proving that social enterprises, equipped with the SVOne, a backpack of glasses and training in basic vision problems and solutions, can efficiently get glasses to people for the first time in their lives. How do we know this? We know this because we have been proving it in the field in the Dominican Republic, Haiti, Nicaragua, Ecuador and Guatemala working with the professionals at Community Enterprise Solutions and the locally-owned social enterprise they founded and support called Soluciones Comunitarias. We share in our next post some recent examples of success that demonstrate the power of the SVOne as a social enterprise solution. However, let us first a bit how a Smart Vision Labs social enterprise model can work.  

The Smart Vision Labs Social Enterprise Field Methodology

Within the model that Smart Vision Labs is developing, the local social enterprise and its trained entrepreneurs (“Vision Advisors” (VA’s)) promote a “vision campaign” with local community leaders and/or organizations who set up a space at a school, in someone’s home, or in the town hall (really anywhere central where people convene).  Here is how a typical vision campaign works. On the designated day the fully-equipped VA’s arrive in the community (assuming they don’t live there) where they have been promoted and are greeted by a line of people who have self-identified as having vision problems. The VA’s set up their work area and then begin by gathering client information and providing visual acuity exams for free (teachers can play a preliminary screening role as well). If someone can see clearly to 20/40 they “pass”. If not, assuming they don’t simply need reading glasses, they are offered the opportunity to be diagnosed with the SVOne. In some cases the social enterprise may charge a reasonable amount for the SVOne diagnosis and in other cases it may not. This is up to the social enterprise and we are testing both models. (Critical note - If at any time in the process it appears that a client has other visual health issues they are referred to the nearest vision professional.) For those who choose to get the SVOne service, both eyes are then tested to ascertain the sphere, cylinder, axis and, as a result, spherical equivalent. If the client is diagnosed as having a need that can be solved with between +3.00 and -4.00 lenses, the VA then uses this SVOne produced data and the client tries on the appropriate pair of glasses from the VA’s backpack. Next, with the glasses on, the client is asked to repeat the visual acuity exam. The goal is that this person can now reach 20/40 at worst, 20/20 ideally and most certainly, 20/Happy. If this is not achieved, the VA iterates to get the right pair of glasses. If for some reason this result cannot be achieved, the client’s information is noted and he or she is referred to the nearest vision professional.  

                                Rosa, a Vision Advisor in Guatemala

Assuming the client achieves the desired result, he or she is then offered the opportunity to try on different styles, walk around a bit and, if all goes well, buy what is likely his or her first pair of glasses. Different prices are charged depending on the age of the client and style of the glasses. Through this process people are able to get the glasses that they need and/or are referred whilst an income generating opportunity is created for the both local VA and social enterprise. Ideally everyone wins. But there is one more key element here that speaks to the power of social enterprise. Because the VA’s are from the community they are serving or one in close proximity, they speak the local language of their clients and can follow-up periodically to ensure that the glasses are actually solving the problem. This is of critical importance. The goal is that people can use the SVOne as a catalyzing tool to obtain glasses that they like, that serve their needs and that they actually use. This is the kind of “sustainability” that really matters.

Finally, to be clear, this approach is in no way obviates the need for an eye health check by a professional. As noted above, at times there may be a vision clinic within a few hours. However, often times this isn’t the case. Ideally the social enterprise and VA’s are able to work with clinics somewhere in country and/or with groups such as VOSH, OneSight and the like to schedule comprehensive vision exam visits on a periodic basis.

So, that is how it works. Now stay tuned for our next blog post to see how this social enterprise concept has been turned into reality in Guatemala and the Dominican Republic!