ReSpectacle: Helping People See

I recently saw a patient in clinic who has been through a tough stretch in life. He has exotropia, which means his eyes drift apart, and this causes him constant double vision, which is why he came to see me. I have also seen his children as patients, and I know his is a family that tries hard, but has many challenges.

During my clinic visit with him, he decided he wanted to have surgery to fix his exotropia, and so we picked a date. I explained that I would need to see him again in clinic once more prior to surgery to remeasure his strabismus to help me with surgical planning, and that for best accuracy, he needed to be wearing glasses; he is significantly nearsighted, and didn't have glasses, so I prescribed him a new pair.

The day of the pre-operative visit arrived, and I entered the room, eager to see him again. Timidly, he let me know that he hadn't been able to get the eyeglasses I had prescribed, because he couldn't afford them. He went on to say that because he couldn't see well without glasses, he wasn't able to drive a car.

Fortunately, most people in the United States are not in the situation where they must choose between being able to see and being able to eat, but many are. This man needed more than just surgery to realign his eyes, and I realized that getting him glasses would likely have an even larger impact than fixing his double vision.

Thinking quickly, I remembered my friend and colleague Dr. Jeffrey Lynch, whom I met while we were both training in ophthalmology at the University of Iowa. Dr. Lynch, recognizing this same issue that faced my patient, started a 501(c)3 nonprofit organization known as ReSpectacle, which, via volunteers, collects high-quality used eyeglasses, cleans them, photographs them, and categorizes them into an online database which patients and providers domestically and internationally can access.

On ReSpectacle's website, the patient or eye doctor enters the patient's glasses prescription, and instantly, the screen displays a number of different possible "matches," complete with a photograph, a description of the glasses, including the prescription, and a color-coded numerical score that describes how well each option matches the patient's own prescription. The user selects the desired glasses, enters a small amount of basic demographic information, and the glasses are shipped for free to the address desired. Amazing!

I recently posed a few questions to Dr. Lynch, who kindly agreed to be interviewed for this story.

MW: What prompted you to start ReSpectacle?

JL: A decade ago on an ophthalmic mission trip...I was disappointed with the haphazard organization and poor quality of the used glasses we had available to us using a traditional eyeglass recycling model. There are many people eager to donate their used glasses and there are many people eager to accept them, the challenge lies in effectively transferring the resource.

As I saw it, the problem was two-fold: 1) A glasses prescription is highly specific to an individual (there are over 10 million possible eyeglass prescriptions) 2) An acceptable style frame is often as critical as (or in some cultures more critical than) the accuracy of the prescription.  

A website seemed like an ideal location to store large volumes of donations yet keep them highly searchable and accessible. The inclusion of photographs & other descriptors gives our users the dignity of choosing a preferred style among available options.  

MW: What has been the biggest challenge in starting or running ReSpectacle?

JL: Finding the time to give the organization the attention it deserves, among competing responsibilities and interests as a young physician and parent. 

MW: How do you envision ReSpectacle growing in the future?

JL:  We expect it to continue growing small chapters organically at academic medical centers, taking advantage of the natural migration patterns of our medical student volunteers as they 'match' to different residency programs across the country. Simultaneously, we will be collaborating and developing our own chapters that can accommodate larger volumes of glasses and offer quicker turnaround times on orders. At some point we expect to grow our network to include international locations as good opportunities arise.

MW: How many pairs of eyeglasses has ReSpectacle recycled?

JL: We recently processed our 10,000th order here in the United States, and have recycled a similar number internationally.

A woman in Nepal with her glasses prescription, which ReSpectacle was able to match and provide. Used with permission.

MW: Is the process for obtaining glasses internationally any different from doing so within the United States?

JL: Yes, currently we do not support shipping of individual orders internationally, as the cost is prohibitive. Instead, we partner with mission groups or established eye care providers in underserved areas abroad and supply glasses to them in batches. They will typically send us 'mugshots' of patients holding their prescriptions, which are then matched to the best pair of glasses in our database taking into account the prescription power and gender/style. We have worked with over 30 mission groups and offer significant flexibility depending on their needs.

MW: My patient was in disbelief that something like this was even possible, and he was the happiest I have seen him, thanking me with a big smile over and over again. Thanks, Dr. Lynch, for helping him, and thousands of others, enjoy life more fully with better vision.

To learn more about ReSpectacle, including how you can support the cause, click here.

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Will wearing glasses fix it?

Wearing glasses helps fix some eye problems, but certainly not all of them.

There is a common misconception that any eye problem can be fixed by wearing the proper glasses. This, unfortunately, is not true. Glasses and contact lenses help correct eye problems related to focus, and that's it.

Think of the eye as a camera. If the camera is out of focus, then it won't take a good picture. Focus the camera (or wear glasses, in our analogy), and you'll have a clear image.

Extending the analogy, here are a few categories of eye problems that cannot be fixed by wearing glasses:

Cataract (lens smudged)
Corneal disease (cloudy screen)
Optic nerve disease (dead battery)
Retinal disease (bad film)

What is astigmatism?

Astigmatism occurs when the focusing structures of the eye -- the cornea and lens -- are not perfectly round.

I get this question a lot, and since it's often misunderstood, I thought it would be a great topic to discuss.

Astigmatism, along with the previously-discussed entities of hyperopia (farsightedness) and myopia (nearsightedness), is one of three common types of refractive error. Refractive errors are problems with the focusing system of the eyes.

A normal eye is round, like the baseball you see here. An eye with astigmatism, by contrast, has a cornea -- the clear, front part of the eye that focuses light -- that is steeper/more curved in one axis and flatter in the axis 90 degrees away, like a football. This means that light in an eye with astigmatism is focused at two different points on the retina, creating a blurry image.

Astigmatism, like all refractive errors, can be corrected with glasses, contact lenses, or laser surgery (e.g. LASIK). It is easy to identify in a routine eye examination.

What does it mean to be "farsighted?"

The anatomy of hyperopia, or farsightedness

In the simplest of terms, people who are farsighted have an easier time seeing far away than up close.

Why is this? Well, a farsighted eye is an eye that is either too short or too weak. Take a look at this picture. The image is focused behind the retina, not right on the retina where it will be sharpest. You can imagine that this could happen either because the eye is too small, or the focusing power is too weak.

Now, here is where hyperopia is a bit different from simply the opposite of myopia. Young people have the ability to accommodate -- to increase the power of their lens focus -- and this can neutralize farsightedness. Hence, a young person who is farsighted may have no trouble at all seeing far away or up close, even if their prescription is high, because there lens can change shape and focus the image. The natural decline of this ability with age is called presbyopia, and is the reason why many people need reading glasses beginning in their 40s and 50s.

If a person's hyperopia is significant enough to warrant correction, the available options are the same as those we discussed last time, for myopia, namely: glasses, contact lenses, and corrective surgery.

What does it mean to be "nearsighted?"

Anatomical diagram illustrating myopia, or nearsightedness

First of all, myopia, or nearsightedness, means that relatively speaking, you see things better up close than far away. This is easy to remember, because the term "nearsightedness" suggests that you are best "sighted" at "near."

Take a look at the drawing here, of a myopic eye. Ideally, the cornea and lens at the front of the eye (left side of the drawing) should focus the light rays, from the image the eye is trying to see, right on the retina, at the back of the eye (right side). But look at this eye -- the image is focused in front of the retina. Nearsightedness! The eye is either too strong in its focusing ability or too long for its focal power.

So how can this be corrected? One way is by moving the object you look at closer to your eye. Why does this work? Simple optics. As the distance from the object to your eye decreases, the distance from the front of the eye to the image created by the eye increases -- the focal plane "moves backward." This means that instead of being focused in front of the retina, the image will be in focus farther back -- ideally, right on the retina. The more nearsighted you are, the closer this distance between the object you are looking at and your eye will need to be for you to see best.

OK, Dr. Weed, holding things close might work for books and whatnot, but it's not so great for sporting events, oncoming cars, other humans, etc. How else can nearsightedness be corrected? There are a variety of medical and surgical options. By wearing corrective lenses -- eyeglasses or contact lenses -- that "push the image back," so to speak, the eye can then focus images on its retina. Alternatively, a variety of surgical options, most commonly laser vision correction (e.g. LASIK), can be pursued.