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How a medical necessity became a luxury item

A medical necessity is becoming an aggressively marketed, value-added luxury, amid soaring rates of myopia – and a simple prevention.

I was startled by my first view of the real world – a hard-edged, saturated, hyper-real world – when I was 10 and started wearing glasses. I could see blades of grass! The sky looked so blue! The clouds so puffy!

But I soon “lost” my glasses.

If you have read William Golding’s Lord of the Flies, you will know the kid with glasses was called “Piggy” and (spoiler alert) came to a sticky end courtesy of his peer group.

My peer group called me Specky Four Eyes and Mr Magoo (also Sheriff Nicholls, for some reason), and so I biffed the miraculous goggles – until even a seat at the front of the class wasn’t close enough to make out the blurry marks on the blackboard. “If you can’t see THIS, you must be REALLY BLIND,” roared my teacher. I squinted as hard as I could, and knew I must be.

Today, I’m as resigned to forking out eye-watering sums for new lenses as I am about selecting face furniture when I can’t see my face.

On my last account-draining visit to an (admittedly trendy) inner-city Auckland optometrist, I bought a new pair of Oliver Peoples frames for – are you sitting down – $525, and plain, non-progressive prescription lenses (described on the bill as “premium single vision lens with multicoating) for $220.

Am I insane? Yes, I checked out the cheaper options. But those designer brands – gorgeous, gleaming frames by Miu Miu, Alain Mikli, Persol, Ray-Ban and Oliver Peoples – were cool. They oozed quality. They were not, simply, a means to an end. And they were all made, I was amazed to learn later, by one company, Luxottica, which has around one quarter of the global frames market.

Frames need lenses, and mine came from Essilor, which isn’t surprising – they make 45% of the world’s prescription lenses.

“The profit margins within the optical business are a closely guarded secret,” wrote investigative journalist Sam Knight in the Guardian in May. “But insiders explained to me that while opticians might sell frames for two or two-and-a-half times their wholesale price, it is the lenses where they make the most money, charging mark-ups of 700% or 800% to their customers.” One former marketing manager told Knight: “Nobody knows how much lenses cost. The consumers don’t know. Nobody knows.”

In March, the Italian frame maker and the French lens maker quietly merged.

Left: Hugh Edwards as the bespectacled Piggy in Lord of the Flies, a 1963 film based on the classic book by William Golding. Right: Justin Bieber, in 2010, wearing “fashion glasses” with non-prescription lenses.

Luxottica earned its vast market share by turning the nerdy goggles of my 70s teens into a fashion statement. From the late 80s, they “added value” with the most potent labels in fashion. Giorgio Armani, Bulgari, Burberry, Chanel, Coach, Dolce & Gabbana, DKNY, Michael Kors, Miu Miu, Polo Ralph Lauren, Paul Smith, Prada, Ralph Lauren, Valentino and Versace all sell frames made by Luxottica. The company owns other names outright: Alain Mikli, Oakley, Oliver Peoples, Persol and Ray-Ban.

The symbol of Piggy, social dweeb, has been transformed into a sign of sexy intelligence – nerd power. When Justin Bieber was photographed posing in “fashion glasses” with non-prescription lenses, the cultural make-over of spectacles, from Piggy to Prada reached a ludicrous and lucrative peak.

In September 2017, the New Zealand Commerce Commission allowed Essilor International and Luxottica Group to merge their business activities here. A few months later, regulators in the EU and the US followed.

In New Zealand, the major players in optometry are OPSM, British chain Specsavers, and Visique. OPSM is owned by Luxottica, while Visique, a co-operative of locally owned optometrists, gets most of its lenses from Essilor.

“The creation of EssilorLuxottica,” says the Guardian’s Sam Knight, “is a big deal. It will have knock-on consequences for opticians and eyewear manufacturers from Hong Kong to Peru. But it is also a response to an unprecedented moment in the story of human vision – namely, the accelerating degradation of our eyes.”

It is safe to say the international eyewear industry, today worth around US$100 billion, will soon be worth much more. Rates of myopia are climbing so rapidly that a child with spectacles is no longer an outlier. Specs, once the writer’s go-to symbol of freakish unathleticism (like Piggy) or genius (like Brains from Thunderbirds) are becoming so common that in many countries today a school teacher will face a sea of tiny lenses.

In New Zealand, recent reports put skyrocketing eye problems and clogged ophthalmology wards down to diabetes and an ageing population. But if overseas trends are any guide, growing levels of myopia are complicating this picture and adding to the national burden of eye care.

In 2013, the journal Ophthalmology published an influential paper that predicted soaring rates of myopia. It forecast that by 2050, half the world’s population – around five billion people – would need glasses. In the past decade, it has become obvious that genes, long considered the main cause of myopia, aren’t the whole story.

“Currently, 30-50% of adults in the United States and Europe are myopic,” says a British Medical Journal paper, published in June, “with levels of 80-90% reported in school leavers aged 17 or 18 years in Singapore, South Korea and China.” Sixty years ago, China’s myopia rate was between 10% and 20%.

The BMJ study concluded that education was, somehow, to blame for myopia. The cumulative effect means the difference between 12 years of education and 17 years of education, the researchers say, would be at least -1 dioptre. (A dioptre is a unit of refractive power; a typical short-sighted person is -4.5 dioptres.) “A difference of this magnitude would affect the ability to drive without glasses.”

The study, by researchers from the Universities of Cardiff and Bristol, is making headlines partly because of the large number of subjects – 67, 798 – and also because of the way DNA was used to help randomise the survey, and untangle cause and effect. There was little evidence that myopia led people to study for longer, for example, but strong evidence that more years of study led to myopia.

This may sound like a small effect, but the younger a child becomes short-sighted, the more time they have to become severely myopic, which increases the risk of retinal detachment, myopic maculopathy and resulting blindness.

The intuitive explanation is that close reading and glare from a computer or cellphone screen is to blame. This seems, er, blindingly obvious. But research doesn’t back that up. Scientists have found what matters is the eye’s exposure to bright light – the kind you get outdoors.

Kathryn Rose, head of orthoptics at the University of Technology, Sydney, led a study of more than 4000 schoolchildren that showed they were less likely to become short-sighted the more time they spent outside every day. Physical activity, she found, was not the answer; in fact, indoor sport offered less protection than lying on the beach reading a cellphone! So, it isn’t education itself which damages children’s eyes – it is the time spent indoors while they learn.

Blame dopamine, which appears to be released in the retina by light, and regulates the elongation of the eye when it is growing. (Near-sightedness is caused by light focusing in front of, instead of on, the retina at the back of an eye. It is like moving the screen back too far when you are setting up a projector.)

“Large differences in ambient light exist between well-lit classrooms (500 lux) and bright sunlight (up to 120,000 lux) and, very simply, those who spend more time in education might have less exposure to natural light,” writes Bristol University’s Denize Atan, one of the authors of the BMJ study.

The theory is supported by myopia researcher Ian Morgan, at the Australian National University in Canberra, who says children should spend at least three hours outside every day.

Meanwhile, in 2012, Essilor announced that an estimated 2.5 billion people, mostly in India, Africa and China, now need spectacles.

“It is,” says Knight, “a staggering business opportunity.”

This was published in the August 2018 issue of North & South.