VisionSpring: Jordan Kassalow

Eyeglasses are a powerful tool for social and economic development, as well as personal wellbeing. Yet, 2.7 billion people around the world lack access to this 700-year-old technology. Jordan Kassalow shares how VisionSpring expands the optical market, using innovative distribution and service models to sell radically affordable, durable, and attractive eyeglasses to people living on less than $4/day.

To learn more about this work visit www.visionspring.org.

Talia: So your story begins in a rather unexpected place, in the Yucatan Peninsula. You were a first year student studying to be an optometrist. What were you doing there?

Jordan: Well, I had joined an organization that brought eye-care to underserved populations in Latin America. This was my very first international trip, I was only a first year student, so I can't say I knew too much. But I was there to learn and to help as much as I could. When we arrived at the clinic, there was a line of several thousand people around the health clinic. This was the first time that most of them had ever had an opportunity to have their eyes examined. And I met my first patient who was a seven year old boy, and what made him unique was that he was blind. Or at least he thought he was — he was attending the School for the Blind, and according to his parents had not really seen since he was a little child. And we examined his eyes, and we realized that he wasn't blind, he just needed a very, very strong pair of eyeglasses. So for your listeners who might know their eyeglass, or contact lens prescriptions is minus two or four, or even eight, this boy was a minus 20. And I was the person who got to put the first pair of glasses on his face. And when the lenses lined up with his eyes, and he saw for the first time, it was a miracle. It was something that changed both of our lives. I gave him his vision. And he gave me mine. I knew at that moment that that's what I wanted to keep doing in my life.

Talia: This was obviously a very important moment for you. What did you do when you got back from that trip?

Jordan: Well, I went back to the States, and I analyzed the statistics — we as a group saw 2,000 patients in a week, and of those 2,000 people, 1,400 of them, or 70%, were there because they needed a pair of eyeglasses and the other 30% were there for a whole host of reasons from needing cataract surgery to needing medicines for the eye. And then I broke down the eyeglass number even further and realized that half of the people who needed glasses, which made up about 700 people or a full third of the people we were seeing, just needed the simple pair of glasses that we could buy in the drugstore, what we call cheaters or readers, these are for people over the age of 35 or 40, who lose their ability to focus up close. And so I realized that a third of our effort went to provide a product that was so simple that it became a consumer product in America. And it made me think for the first time that that's kind of a waste to send a bunch of highly trained eye doctors and students to spend a third of their time prescribing something that was really a consumer product — were there ways that we could de-medicalize that aspect of the work. tThat was sort of my first aha moment.

As I continued in that work, I kept seeing the same pattern over and over again, the need for those plus one, plus two, plus three pair of eyeglasses. It's like if we were dentists, we would be needing to sell floss and toothpaste. That's what most people just needed. The base of the eye-care pyramid are just these simple ready made reading glasses.

Talia: So at this point, you're still a student, and I know that you travel at some point to South America in South India, and these experiences reinforce for you the need to disseminate affordable eyeglasses.

Jordan: Yes, so still working with the same student organization, and this time we were in Columbia, South America working with the Chocó Indians. Through the week, I met a 40 plus year old woman, her name was Noca and she was Chocó Indian and she had canoed down river a full day to see me. She was known as the blind lady in her village, but she wasn't blind she was just profoundly nearsighted. Her prescription was a minus eight with a lot of astigmatism, so she couldn't really ever see properly, and after examining her we found a pair of glasses that matched her prescription perfectly and she put them on and she saw 2020 for the first time in her life, it was an amazing moment again. A few days later Noca showed back up the clinic and through translation from her India tongue to Spanish to English, we found out that when she got back to her community, people laughed at her because they thought her eyeglasses looked so ridiculous, and she came back to see if there was a different pair of glasses that would work for her. And we told her, we're so sorry that she had such an unusual prescription. And it was sort of a miracle that we had one that matched her prescription in the first place. And we told her that was all we had. And then she did something that sort of blew our minds, she took the glasses off her face, she put them on a wooden table, went back to her canoe, and went up river without her glasses. And it just stopped me in my tracks — It was a moment where this woman just chose blindness over what we were providing. And I said, okay, we must be doing something fundamentally wrong. And what we were doing wrong was that we weren't taking into consideration their cultural context and her personal dignity. These glasses are right on your face, and to tell you the truth, the pair of glasses that we gave her did look ridiculous, because the only pair that matched her prescription, were these 1950 cat eyeglasses with rhinestones all over them. So you know, maybe they look hip in the East Village of New York, but they didn't work in Chocó, Colombia. It started to make me think, how could we take into consideration the local context, maybe, rather than giving people things that we wanted to give them, we should be providing products and services that they wanted themselves, and that maybe if we charge them some money for the products, even though it might be a low amount, the market is a very powerful feedback mechanism, and if a person value something, they'll pay for it; most everyone has at least a little money to buy products. So if we could provide glasses for $1, or two or three, then I posited that most people would not only buy them, but they would choose the products that they liked, and that they felt good about.

And so I started to research organizations that sort of took this more market based approach, more entrepreneurial approach, more capitalistic approach, and I found out about an Eye Hospital in South India called the Aravind Eye Hospital, which has now become the largest Eye Hospital in the world. And it was started by a man named Dr. Venkataswamy, who was all about dignity of choice and compassionate capitalism. And he had a paying hospital and a free hospital. And anybody could walk into either one, and it was sort of a sliding fee scale. It was a beautiful, compassionate capitalist kind of model, and that's where I learned the idea that you could both do good and do well, at the same time.

We were there in these villages trying to find people who had blinding cataracts, but in doing so, we were seeing the same thing — that for every person who needed cataract surgery, there were 10 people who needed eyeglasses. For every person who had a terrible infection, there were 30 people who needed eyeglasses. And so it just sort of reconfirmed what we saw in Latin America. Then I started to not only work in India, but afterwards also Africa, saw the same thing in Africa, and started to realize that it wasn't just about vision, it was about productivity — it was about opportunity.

Talia: So you identified this problem. What was your plan to get these glasses in the hands of those who need them?

Jordan: So when we started VisionSpring, we had a few key assumptions. One was that people would buy eyeglasses if they were attractive, and affordable and accessible. Second hypothesis was that people would buy glasses from someone in their neighborhood, rather than a health professional or a doctor. And so we had a test those kinds of concepts. And if you take the pie chart of people in the world who need eyeglasses, and again, it's several billion people, and you draw a line smack through the middle of that circle, half of the people need glasses are there's just these simple ready made reading glasses, and the other half need more advanced prescription eyeglasses. So VisionSpring said, we're going to start with the first half, if we can figure that out, then we'll get to the second half. So when we started with the first half, we just focused on adults who needed eyeglasses to continue their livelihoods. This was also an observation I first made in Mexico and then saw again throughout the world: there were a lot of individuals in those same communities who are unemployed or underemployed, so we thought, well, why couldn't we just train local women in particular who were most stricken by under employment, give them a small "business in a bag,” a little opportunity to sell simple eyeglasses to their neighbors, and train them to screen for presbyopia, which is the ability to see up close, and then provide the glasses to their neighbors. And we started that idea in India — we got funding to start a small pilot of about eighteen women, this was in 2002 or so; and then we provided them with the inventory of glasses with different powers and different styles for men and women, different plastic, metal styles — and they had a little optical shop that they could transport around their community and sell the glasses. People are willing to pay around two days of wages for a pair of glasses, and our average customer makes between one and $4 a day. And so are glasses, we price at around two or $3, for the simple ready made reading glasses.

Talia: So you actually found that people were buying these glasses. I wonder then why you chose to become a nonprofit rather than a for profit company…

Jordan: So if you look at the market, it's very segmented. And you're absolutely right, there are segments of the market that you could make a for profit business thrive. But what VisionSpring was really meant to do was to try to get to people who were so far downstream that it was going to take decades for the market to catch up to them. So even to this day, we are not fully cost recovered, only about a third of our fully loaded costs of operating are covered by the sales of our product, the other two thirds still come from philanthropy. Now we could say rather than focusing on the folks who earn one to $3 a day, we could say, well, let's focus on people earn 7,8, or 9 dollars a day. And then we could probably get rid of that subsidy. But we feel that there are other players for profit players who are going to be coming down market who don't really need us. And this group, this billion plus people who earn only one, two, or $3 a day — who don't have eyeglasses are going to need us for the foreseeable future. And then if we are successful in getting them glasses, and their productivity increases by 20, or 30%, then they can go and buy glasses in the private sector and in those models that start to exploit the demand. So what we're really all about is creating demand early on, and seeding the marketplace for long term for-profit players to take over in the years to come. But because we realized it was going to take maybe decades for those markets to evolve, and we wanted to make sure that those people had access to glasses, we went to the part of the market that really wasn't amenable to a for-profit model.

Talia: Oh, interesting. So are there for-profit companies that you are partnering with?

Jordan: Well, our number one partner in terms of support for our work and length of relationship is with Warby Parker. Many people know Warby Parker is a eyeglass company that sells radically affordable, very stylish eyeglasses online first, and now they have stores. For every pair of glasses that people buy, they support someone around the world getting a pair of glasses themselves. We've been working with them on that 1-for-1 product since really they started their business. The story is very organic. As I was starting VisionSpring many years ago, my second employee was a man named Neil Blumenthal, who spent five years with us helping me launch VisionSpring, and after five years, Neil went to Wharton Business School and founded Warby Parker with three of his classmates at Wharton. And as they were starting the organization, I was working with them to sort of envision this 1-for-1 concept. And when they launched the business, we got that going, and what was amazing was how they grew. I remember originally we thought maybe we'd get a few hundred bucks or a few $1,000 from Warby Parker, but now they are our largest donor and have been for for many years. And as they grow, we're able to grow. So it's a it's been a wonderful partnership.

Talia: So I want to pivot back to VisionSpring’s activities. You started with the “business in a bag” approach. How has the organization's activities evolved since those early days?

Jordan: The good news is that it worked in many ways. We proved that people would buy glasses, assuming they were, again, the right style and appropriate for the culture — as long as they were priced properly — and as long as the women were well trained and portrayed a certain sense of trust and confidence, and we also proved that they could also make a little bit of money while they did it. What we did when we first started was we sort of were identifying and training our own salesforce. So we had this what we call an independent salesforce, our own salesforce selling the glasses, and that became very expensive and hard to scale. So we started to think of where there are better ways to scale this model.

In the first few years, I met one of the head executives at an organization called BRAC, which is the largest non-profit entity in the world, based in Bangladesh. And they had created an army of community health workers. They're called shasthya shebikas, these are women in almost every community in Bangladesh who had already built the trust in those communities. They were already providing simple and important health services, like clean birthing kits, sanitary napkins, aspirin and nutritional products. And so we said to BRAC, would you be interested in adding eyeglasses into your basket of goods. And they said, we'd be glad to give it a go. And the trial went very well. So then they expanded up to 500 women, and then went to 5,000 women, and now we've trained over 25,000 women in Bangladesh. About two years ago expanded that program into Uganda with BRAC. And they work in over 10 countries, so we're hoping to expand with BRAC. So the idea here is to take our original secret sauce, and rather than scaling it ourselves, finding other organizations, whether it's NGOs or private sector organizations, or governments, and enabling them to own the program, and we can continue to provide the technical assistance and the products to make sure that they source the best highest quality products.

Talia: And a large component of your work today is these major partnerships that you've developed with multinational companies across the world.

Jordan: Yes. So we started to see that once people got classes, as we had postulated, that they would be better at their jobs, they would be able to be more productive, they would be able to last in their jobs longer. So we set out to work with a number of our colleagues to create a very robust randomized control trial to show that when people got classes, their productivity was improved. And we did this study in a large tea plantation in Assam, India. We took 800 women and provided them with glasses, and then 800 women as a control group who didn't get glasses, and we followed those tea pickers for six months. We found that overall that the people who got glasses had a 21% improvement in productivity. More striking for the group of women over the age of 50, those who needed stronger reading glasses, their productivity increased by 32%. So it became a very compelling argument for going into companies and engaging their workforce. So we are working with groups like Levi Strauss and West Elm and Target and many others, where we go into their factories, and we ensure that everyone who's on that factory floor working with their eyes and hands can get a vision screening, and for those who needed to, get a pair of eyeglasses.

Talia: And then you also conducted a similar study on the impact of vision on education.

Jordan: Yes, the study on the education front led to our work in school eye health. The study is simple, it posits that if a child needs glasses, they will learn better when they get them versus when they have blurry vision. And again, it's one of those “duh” moments where like, okay, do you really need to study to show that a kid who can't see is not going to learn as well. The study in China was a landmark study, it showed that once a child gets a pair of glasses, their learning improves by what would be equivalent to about a half a year of learning. And it turned out that the impact of learning from a pair of glasses was greater than any other health intervention ever studied. It was 10x more powerful than any nutritional supplementation study had shown. And 3x more powerful than worming the gut, which is a very well known intervention to help learning outcomes in children — when you're hungry, and calorically challenge, u=you're not going to learn as well. But even that wasn't as powerful as the link between vision and learning. So we go into schools, we train teachers how to screen their kids for glasses, and then we go in with a team of optometrists and do large scale vision exams and provide glasses either on the spot for those who have certain prescriptions, or we make customized glasses for those who need customized ones.

Talia: So you're working in factories and in classrooms. Where else do you hope to be in the next five years?

Jordan: Well, we are a growing organization. We've been growing every year since we started. We want the folks who we work with in the supply chain from the big international companies like Gap and Levi Strauss to be meeting in five years and saying, remember those crazy times that half of our workforce didn't see, wasn't that ridiculous. We want to bring about a similar thing with kids in school: remember, those days where 10% of kids were in the classroom, and they weren't seeing because they just needed a pair of eyeglasses — and now it's normalized, that if you're in school, you get a pair of glasses if you need a pair of glasses. And then likewise with commercial drivers: remember that day when 10-15% of the commercial driving workforce in a country like Ghana, were visually impaired, and wouldn't be able to pass a vision test — wasn't that ridiculous? So we want to normalize the provision of this product and service to make people safer, make kids learn better, and make people more productive across the world.

Talia: And among those efforts that you've made to normalize the need for eyeglasses, was the recent creation of the Eye-Alliance coalition. Can you tell our listeners a little bit about what that is?

Jordan: Well, you know, when we started VisionSpring, that first year with those 18 women, we sold 800 pair of glasses the first year, and then it went to 1,000 years later, and then 80,000 years later, and then 800,000 years later, and last year, we sold 1.4 million pair of glasses in 23 countries. So we're very pleased with those kinds of results, but we realized that held against a problem that impacts billions of people, it was gonna be a long road to getting to a place where we made a real significant dent in the problem. And so I started to think with some of my colleagues, and one of my co-workers at VisionSpring, her name is Liz Smith, she and I are the co-founders of Eye-Alliance, a membership of organizations from which we learn and take their solutions, and help them scale those solutions through governments and the private sector.

Talia: Before we end, I understand that you've written a new book called Dare to Matter. Can you tell us a little bit about why you wrote that book?

Jordan: Well, I wrote the book, because as a social entrepreneur, I've had the opportunity to speak at a lot of universities. And as I was going around the country, and the world, speaking to student organizations and student conferences, almost invariably, the following question would arise: is there a way to both do well and do good at the same time? And I kept hearing that question, no matter where I went. In terms of VisionSpring, if I was the eye doctor, sitting in the chair, doing all the exams, I was never going to scale up the business. And so I thought maybe rather than having to go from stage to stage and telling 20 people, 80 people, 100 people at a time, my story and my message, it might be better to write a book. And the central theme of the book is that it's normal and natural to have two forces in one's life. And that is wanting to live a nice life and provide for your family, but at the same time, living your life for something bigger than yourself, so that you leave the world a better place because you were in it. And how do you integrate those two drives into one life? So that's really what the book is about. You know, unfortunately, it's very challenging to move from the first to the second. In other words, most people get sort of stuck on living a nice life and providing for their family, which is wonderful — we all need to do that — But as we say in the book, it's like filling up your tank only halfway with gas, because you might run out if you're not working for something that's beyond yourself, something bigger than yourself, something that's gonna really give back to the world and to help your legacy.

As Mark Twain says, The two most important days of your life are the day that you're born. And the day that you find out why — and for me VisionSpring was the why.