Andrew Bastawrous could have had a comfortable career as an NHS consultant eye surgeon. Instead, he moved with his family to rural Kenya, spending two years setting up temporary eye clinics — before concluding that direct service would never be enough. The result is Peek Vision, a platform that has screened 21 million people across 12 countries, connecting more than 2 million to treatment they would otherwise never have received. He spoke with fellow UK-based social entrepreneur Andrea Coleman about what it takes to build a system that works — and what still needs to change.
Andrea Coleman: Let’s start at the beginning, Andrew. What first drew you to vision — and to making it your life’s work?
Andrew Bastawrous: I grew up vision impaired and didn’t know it — getting poor grades, people laughing at how clumsy I was. When told I might need glasses, I avoided it for almost two years. I was already the only non-Caucasian in my school, and the idea of looking more different wasn’t something I wanted. When I eventually had the test, the moment the lenses dropped in was completely transformative — looking at trees and seeing leaves on them for the first time, I was floored. Soon after, while visiting a poor area of Cairo, a child my age who looked a lot like me ran past, and we just stopped and locked eyes with each other. The conversation in my head — which I felt was the conversation in his — was: how come you got your life and I got this one? It broke me, the idea that where you live dictates your opportunities, and it set a fire in me that years later translated into wanting to spend my life helping people see.
Coleman: You were about to take a consultant post in the NHS. What did you find in Kenya that changed everything?
Bastawrous: My wife and I quit our jobs and moved with our one-year-old son to Kenya. We spent two years there establishing 100 temporary eye clinics, seeing patients every day who were blind or severely vision impaired from completely treatable things. Many had cataracts, which can be treated in 5–10 minutes for $50 to $100. People who’d been blind for ten years, accompanied by a grandchild who had left school to be their eyes. People in midlife no longer able to work because they couldn’t access a $1 pair of reading glasses. The UK has about 3,500 eye surgeons — and Kenya at the time had 80, for a population of similar size. We were treating the people in front of us, but felt that it would never be enough.
Coleman: What was the breakthrough that led you to start Peek Vision?
Bastawrous: I was at a clinic with no road access, no electricity, no running water — and an older man came out of the pit latrine chatting away on a Nokia with perfect mobile signal. It just struck me: almost no infrastructure, but still connectivity. Over a billion people living with vision loss are disconnected from services, yet we’re more connected than we’ve ever been. Surely I could use technology to close that gap. We were carefully moving £120,000 worth of eye equipment with us, which also gave us the chance to reverse-engineer key elements from first principles to work on a smartphone — so that anyone with basic training could find people who’d lost their vision and connect them to services. The vision test we built means the examiner doesn’t need to know anything about eyes — they just mimic the patient. It tells them the result and what to do next. We iterated this until we had a closed-loop system tracking every person from community screening through to treatment.
Coleman: What does the impact look like today?
Bastawrous: Now, across our partner network, 150,000 people are reached with screening every week, and over 21 million have been reached cumulatively — most of that in the last three years. It took us ten years to cumulatively reach one million people; we’re now seeing that every ten weeks or less. The approach reaches twice as many people, connects 16x more people to the treatment they need, and cuts cost per referral by six times. And every $1 invested in eye care generates $28 in economic value. The aim is, within three years, to be reaching a million people per week — the point at which the curve starts to tip.
Coleman: Early on, did you ever come close to giving up?
Bastawrous: In Kenya, when it was all going wrong — team members lost, money taken, equipment missing — I thought, I’ve deluded not just everyone else but myself. It’s a fine line between delusional and visionary, and you can never be sure which side of that line you’re on. I told a friend on a run that I was done, I had to quit. He put his hands on my shoulders and said: “You know when an airplane goes down the runway? It only takes off after it’s hit its maximum resistance. You’re at that point now — don’t stop.” I’ve come to think of problems as following the laws of physics — they aren’t created or destroyed, they just change form. There’s no such thing as making it. If you’re moving forward, you’re blessed with new problems; if you’re not making progress, it’s the same problem you’ve always had — at which point it’s worth recognizing that I am the problem.
Coleman: You’ve also reimagined how eye care gets funded. Tell us about See Now Pay Later.
Bastawrous: When someone in a household gets their sight back, household income goes up — when tracked over a year, it’s more than the treatment cost. But people were often saving for 18 to 24 months to pay for treatment, and then something in life would happen and that money would get diverted. So we partnered with an eye hospital in Uganda and a microfinance institution to create “See Now Pay Later” — you’re seen one day, treated the next, and repay it over 12 to 18 months, while the hospital gets paid immediately. Suddenly the hospital is earning income treating the lowest-income patients, so it’s not choosing between doing well and doing good. The person who found the patient gets paid for finding them. The household’s income rises. The bank carries the risk but profits from acquiring new customers. Everyone wins. We’re still testing — early results are promising — and we’re trialing variations of the model in India and Kenya too.
Coleman: What would you tell someone wanting to enter this space?
Bastawrous: Be less wedded to the solution and more wedded to the problem. Get proximal to it — spend time in the communities you want to serve and understand it from the perspective of the people you want to impact. And get clear on what drives you. A decision I had to make was: did it matter more to me to be doing eye surgeries, or that eye surgeries were being done? That distinction mattered. For me, what mattered more was that treatment was happening — not that I was the one providing it.
___
Andrew Bastawrous is the founder of Peek Vision and an Ashoka Fellow since 2017. Andrea Coleman is the founder of Riders for Health and an Ashoka Fellow since 2014. This interview has been condensed for length and clarity by Ashoka.
