We Have Been Counting Glasses. We Should Be Counting Years.

By Matt Gianino, GVUSA Executive Director

Not long ago, in my early days at GoodVision , I was in a meeting with a group of impact investors genuinely interested in global vision care. One of them asked a question I wasn’t fully prepared for: “How do I compare one vision program’s impact against another?”

I gave her the standard answer. Glasses distributed. Patients screened. Communities reached. She nodded and moved on. But I knew it hadn’t landed. Because the honest answer is: under the metrics most vision organizations use today, you can’t meaningfully compare them.

Think about three people.

David is in his late 40s and already owns two pairs of functional glasses. He stops by an outreach booth and picks up a third pair as a backup. Glasses distributed: 1.

Amara is nine years old and has been sitting in the back of her classroom squinting at the board for two years. Her teacher thinks she’s a slow learner. She receives glasses for the first time and can suddenly read every word from her seat. Glasses distributed: also 1.

Joseph is in his mid 60s and undergoes a cataract surgery that takes about four minutes and restores his functional sight for the remaining 20 years of his life. Procedures completed: 1.

Under traditional impact measurement, the first two count the same. The third often doesn’t make it onto the same scorecard at all.

If you’re an impact investor trying to allocate capital in the vision care space, this should bother you. It bothers me.

The sector has been measuring outputs, glasses distributed and patients seen, rather than outcomes, which are meaningful and lasting improvements in people’s ability to function. Not because organizations don’t care about outcomes. Most of them do. We just haven’t had a shared tool to measure them, which means capital has been flowing without a reliable map.

GoodVision is working to change that with the VALY: Vision Adjusted Life Year.

The formula is straightforward: VALY = Degree of Disability Reduction × Duration. The Degree of Disability Reduction captures how much someone’s functional vision actually improved, using the WHO’s globally recognized visual impairment classification, the same framework that underpins every major global eye health study and World Health Assembly target. Duration accounts for how long that improvement realistically holds, roughly three years for prescription glasses (based on field replacement rate data), and potentially decades for a successful surgery.

To make it concrete: before her glasses, Suzanna could barely function visually. After, she could. We measure that shift using visual acuity, the clinical measure of how clearly a person sees, converted into a degree-of-disability score on a 0-to-1 scale. Suzanna’s improvement was close to 0.9. Multiply that by a three-year expected lifespan for her frames and her impact registers as roughly 2.7 VALYs. Joseph’s cataract surgery improved his visual acuity enough to reduce his disability score by 0.75, and with 15 years of remaining life, that multiplies out to around 11.25 VALYs. David, who already had functioning glasses? The difference in his visual acuity before and after: zero. Zero VALYs because nothing changed functionally.

This isn’t about penalizing programs that serve less severe need. It’s about being honest with ourselves, and with the people funding us, about where the real impact is.

Anyone working in health economics will recognize the logic here. QALYs, Quality-Adjusted Life Years, have been used for decades by governments, payers, and investors to evaluate whether medical interventions are actually worth funding. The VALY is a purpose-built equivalent for a sector that has, until now, lacked one.

With VALYs, real comparisons become possible: a school-based program reaching urban students versus an eye camp serving rural communities with zero prior access; a campaign distributing low-prescription glasses to people who function fine without them versus targeted work with people facing severe, life-limiting vision loss; a single surgery generating 15 VALYs versus 10 pairs of glasses generating nothing measurable. These comparisons change how programs are designed. They redirect resources toward the populations carrying the greatest functional burden.

GoodVision developed this metric and we’re sharing it openly. We want other organizations to adopt it. The vision care sector already makes one of the strongest ROI arguments in global health, around $28 in economic return for every dollar invested. Investors who understand the VALY can now start identifying which programs are driving that return and which ones using dated metrics and rudimentary output numbers.

We’re holding ourselves to this standard and inviting others to do the same.

If you would like to learn more about how GoodVision USA is using VALY to better measure impact and help the entire sector allocate resources more effectively, please let me know. It’s another example of the kind of innovation GoodVision focuses on and I enjoy talking about.

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#glasseschangetheworld

#GlobalHealth #ImpactInvesting #VisionCare #SocialImpact #eyehealth #global development