Project Vision: A Program for Sustainable Eye Care in China

Nathan G. Congdon, MD, MPH

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Medscape Ophthalmology 

In This Article

Cataracts in China

Why the need for Project Vision in China? We are accustomed to hearing stories of the Chinese economic miracle, and indeed, there are some 23,000 ophthalmologists in China, with the best eye hospitals, such as Guangzhou's Zhongshan Ophthalmic Center, equipped to a standard that rivals America's finest institutions. However, only half of China's ophthalmologists perform surgery, and many of their practices are clustered in the cities. Some 70% to 80% of Chinese citizens still dwell in the countryside, where government investment in healthcare has been limited, leaving a legacy of poorly equipped facilities, high prices, and an inadequate healthcare safety net for the vast bulk of rural residents. Patients who do receive cataract surgery in rural areas all too often wind up with poor results, attributable in part to the use of intracapsular cataract extraction without provision of aphakic spectacles, or significant posterior capsular opacification after conventional extracapsular cataract extraction with polymethylmethacrylate (PMMA) intraocular lens implanted at the sulcus. Separate studies in 2 rural areas of China, Doumen in the South[2] and Shunyi in the North,[3] reported that 40% to 55% of patients were still blind in the operated eye after surgery.

The combined result of poor outcomes, high prices, and poor availability of cataract services for the majority of Chinese citizens is captured in a single picture (Figure 2).

China's cataract surgery rate is among the lowest in Asia, and is comparable to that of West African countries with far less ophthalmic manpower.

Data from the World Health Organization (WHO) show that China's rate of cataract surgery, at 300-400 per million people per year, is barely one tenth that of India's (3600 per million per year), and is comparable to countries in Western Africa with far lower standards of living and a fraction of the number of ophthalmologists.[4] In fact, some 4-5 million of the world's cataract-blind reside in China, which is estimated to have the largest number of blind people in the world.[5] Without major efforts, this number will only increase dramatically. Again, a picture tells the story most eloquently: The ballooning at the top of the population pyramid in the lower half of Figure 3 shows a striking increase in the number of China's oldest citizens over the coming decades, as estimated by WHO. In fact, the number of persons over the age of 80 years is expected to increase 6-fold by 2050 to 50 million, leading to a commensurate increase in cataract blindness if nothing is done.

China's aging population.

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