Illustration: Simon Davies
Over tea and dim sum in a rain-lashed tower in his native Hong Kong, James Chen rattles through a list of the 21st century’s buzziest tech obsessions: machine learning, big data, drones, 3D printing. He has just met with Google’s DeepMind, the artificial intelligence business that wrote the code that mastered the impossibly complex board game, Go, beating the human champion in March.
Chen, a self-described “venture philanthropist”, hopes that a new prize and campaign – called Clearly – will enthuse people working on technology’s bleeding edge to apply their minds to solve a global health problem that has preoccupied him for more than a decade.
“They’re working on things that aren’t to do with solving the vision issue, but you make them think about it and they realise they could,” he says.
This is the problem the world forgot. It’s the largest unaddressed disability in the world today
“The vision issue” is the 2.5 billion people worldwide who suffer from poor eyesight, 80 per cent of whom are in the developing world. According to a 2016 study by the World Economic Forum, that equates to $227 billion each year in lost productivity; in 2015 only $37 million was spent on trying to address the challenge.
“This is the problem the world forgot,” Chen says. “It’s the largest unaddressed disability in the world today.”
Chen started working on vision 12 years ago, launching a venture with the Oxford professor Joshua Silver. Silver had invented a type of fluid-filled lens that can be mass-produced, then quickly adjusted in the field, making it ideal for use in the developing world, where the infrastructure and healthcare systems do not exist to make bespoke traditional lenses cost-effective.
The two created a commercial enterprise – Adlens – and a non-profit, Vision for a Nation. The latter was responsible for an ambitious programme in Rwanda, which will, by the time it wraps up at the end of 2017, have conducted 1.5 million eye exams and dispensed hundreds of thousands of pairs of glasses.
When they launched, Chen says, there was a lot of cynicism in the aid world that they could achieve systemic change, even in a relatively well-managed country like Rwanda. Vision is understandably low down on the priority list of global health institutions, which are overstretched, underfunded and focused on more immediate, life-threatening concerns.
“The assumption was it couldn’t be done,” he says. “Rather than give up, or try to do these little pilots, or to push a rock up a mountain with institutions like the World Bank… we said, ‘let’s see if we can figure it out ourselves. Let’s take one country, solve this issue. And if we can’t, we’ll learn why we can’t’.”
It was, he acknowledges, naive – but it worked. The programme’s success hinged on rethinking the diagnostic process. The lack of trained professionals and healthcare centres in Rwanda was a huge bottleneck – people simply were not able to reach one of the country’s few university-trained ophthalmologists; nor could they justify the cost of doing so if they were close enough.
Instead, Vision for a Nation created a training protocol for nurses that took just three days, massively scaling up the available personnel, who could head out to the field and provide diagnoses in situ. People who need glasses can buy them for $1.50; anyone with more serious conditions can be referred onwards. When they leave, Chen says, Rwanda will be one of the few developing countries with a comprehensive primary eye-care system.
Scaling up
Buoyed by the success in Rwanda, Chen wants to go far further, but the programme that they have built is hugely complex and not easily replicable. As he says: “We figured, if you do it one country at a time, it might take us 1,000 years.”
Fresh inspiration came in the form of a 2014 talk at the high temple of the techno-fix, TED, by Andrew Bastawrous, an eye surgeon and technologist who had set up a series of clinics in Kenya’s Rift Valley. During that talk, Bastawrous demonstrated a deceptively simple piece of kit: a 3D-printed clip for a smartphone, costing less than $5, which enabled it to take a photo of the back of the eye. Combined with an app, it allowed a relative amateur to rapidly and accurately test a patient’s vision, and send the data on to specialists.
“There are other things that are technological, there are things that aren’t technological, that are needed to solve this problem,” Chen says. “But this is the backbone, a smartphone app.”
Using mobile phones for healthcare projects is hardly new, and so-called “m-health” initiatives have been circulating for the past decade. The platform is particularly relevant in the developing world, where mobile phone penetration has surged in recent years. However, many projects floated perpetually at the pilot stage, and never quite broke out.
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As Jeanine Vos, who works on m-health projects at the mobile telecoms trade association, the GSMA, says: “A couple of years back… it was a big puzzle as to how it would really happen. Over the last two years we’ve really seen more momentum gather.”
Even so, she says: “There are many cases where this technology exists, but it’s just not reaching the people that need it.”
Quite often, this is because the technology is really only a fraction of the solution to problems of immeasurable complexity, which require co-ordination between government ministries, local charities and communities to solve.
Bastawrous, who inspired Chen’s new venture, has continued his work since that 2014 TED talk. His social enterprise, Peek, is now working in Kenya, Botswana and India, and is conducting field research in several other countries. Although his approach has been defined by its gadgetry, he says: “The technology is a small component, in reality, of the actual delivery.”
In Botswana, Peek is piggybacking on a national cervical cancer vaccination drive in schools to provide eye tests for children. Teachers have been trained to use the system, which identifies defects in vision and automatically informs parents and headteachers and links back into the hospital system. Bastawrous demonstrates a dashboard, which shows in real time how patients are moving through consultation and treatment. Its implications, not just for vision, but for the entire health system, are profound.
But, he cautions, while the potential is enormous, “All of our work is only possible because there are a lot of good people on the ground. We’re only extending what they’re doing, as opposed to doing it all ourselves.”
The deadline
After years of fieldwork, Chen says he understands the limitations of technology – “I’ve got people who are battle hardened,” he says.
The Clearly Vision Prize, which “casts a wide net” for ideas will be supplemented by “labs”, will incubate experts from a variety of fields, he says. Events have already been held in San Francisco and Hong Kong; others will follow in London, New York, Nairobi and Bangalore. Rwanda will, most likely, be the test bed for emerging ideas.
Chen has high hopes for AI. DeepMind is already working with the Moorfields Eye Hospital; its technology could, ultimately, be used to rapidly diagnose complex eye conditions using the scans taken on a smartphone. Drones, too, are already being trialled in Rwanda, delivering medical supplies.
The ultimate goal is universal access to vision correction within 20 years. The deadline has become something of a mantra: “when they put the first man on Mars, we want to make sure that everyone on Earth can see it happen,” Chen says.
“People like Elon Musk and NASA have said we’re going to be able to put man on Mars by 2035. The way I look at it, they’re not making these statements out of thin air. They’re able to do it because they think the core technologies exist, but there’s a lot of things that need to be answered before they can actually get there. Similarly, we think the core to solving this vision correction problem globally is here now.”
