The EARN Trial
Background
Presbyopia, the age-related loss of near vision, affects over 1 billion people worldwide, typically beginning around age 40. It results from the eye’s lens losing flexibility, making it difficult to focus on close objects. Left uncorrected, presbyopia can hinder daily tasks such as reading, using digital devices, and performing work that requires precision, which impacts quality of life and productivity.
The burden of presbyopia is particularly severe in low- and middle-income countries (LMICs), where access to affordable corrective solutions is limited. Many individuals cannot afford or access simple reading glasses, leaving them unable to work or engage fully in their communities. This exacerbates social and economic inequalities.
Globally, an estimated 800 million people need reading glasses but do not have them.
The Trial
A $4.8m grant, contributed by GiveWell and the Livelihood Impact Fund, will be used to assess the impact of providing eyeglasses for people with near-vision impairments in India and Kenya.
The randomised controlled trial of the Economic Advantages of Readers for Near vision in Kenya (EARN), will test the effect on income, household consumption and expenditure, and vision-related quality of life for adults 35-65, before and after being provided with glasses.
The trial will also look at other economic and quality-of-life metrics for participants, such as self-reported productivity and general health-related quality of life.
Our partners for the project are Dr Shroff’s Charity Eye Hospital in India, and Kenya Medical Research Institute in Kenya, who are both long-term collaborators with ICEH.
Starting in 2024 and running for five years, it’s hoped that the trial results will provide evidence that supplying people with near-vision spectacles is a cost-effective mechanism for development, improving lives and livelihoods for individuals, families and communities.
Long term, this could potentially lead to more funding for the provision of reading glasses, using eye health to unlock progress in low and middle-income countries globally.
Details
Location: India & Kenya
Design: Prospective, single-masked, parallel group, two-arm individually randomised controlled trial (RCT)
Primary objectives: To determine if the provision of near vision glasses to people of working age with presbyopia leads to increased household consumption and/or vision related quality of life.
Secondary objectives: To determine if the provision of near vision glasses to people of working age with presbyopia leads to: (i) increased individual income; (ii) increased household consumption, individual income, and/or workplace productivity in those who work in near vision intense/dependent occupations (occupational sub-group analysis).
Co-primary outcomes:
• Household consumption at 12 months and vision related quality of life at 12 months
Secondary outcomes:
• Employment status and characteristics
• Self-reported productivity (presenteeism and absenteeism)
• Self-reported income sufficiency
• Self-reported individual income
• Health Related Quality of Life: EQ5D with vision bolt-on question.
Participants: Individuals with presbyopia (<N8) identified through established screening programmes, who meet the trial inclusion criteria.
Intervention: Trial participants will be randomised to one of the following arms:
• Intervention arm: individuals will be given free near vision glasses (spherical, non-astigmatic correction), appropriate for their degree of presbyopia. As they are given glasses they will be counselled about the use and care of the glasses.
• Control arm: individuals will not be given free near vision glasses at baseline. They will be given free near vision glasses (spherical, non-astigmatic correction), appropriate for their degree of presbyopia at the end of the trial follow-up period (2 years). However, they will be informed that they have presbyopia at baseline, so it is possible that some may choose to independently purchase glasses themselves.
For more information on the trial please contact us.