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The development of Eye Health Services in China, 1949 – 2020

1949 to 1978: From Liberation to Opening Up

Major eye problems facing the People’s Republic of China in 1949 included high rates of vitamin A deficiency and the trachoma.1,2 The government tackled these with national campaigns and its new Urban and Rural Medical Security Systems.1,3 Educators targeted severely limited capacity, and the number of ophthalmologists nationwide grew from 100 in 1950 to 1000 a decade later.4 The first successful isolation of Chlamydia trachomatis, the cause of trachoma, occurred in China in 1955, which together with the National Patriotic Health Campaign, helped to spur a decline in national prevalence from 50% to 40% by the early 1960s.5-7


1978 to 1998: 1st Round of Healthcare Reform

The new policies of “Reform and Opening Up” catalyzed a more entrepreneurial approach to healthcare, which drove a further expansion in ophthalmologists to 22,000 by 1998.8 The introduction of new equipment, devices and techniques led to improved diagnosis, treatment and outcomes.9 A limited number of private eye care facilities began to emerge, and ophthalmology departments at many university hospitals were established as independent eye centres.8 In the mid-1980s, the National Committee for the Prevention of Blindness was established, with provincial and city-level offices,9 and cataract was found responsible for half of China’s blindness in the first national survey.10 To boost public understanding of eye health, in 1996 the Ministry of Health designated June 6 as National Eye Care Day.11


1998 to present: National Health Insurance and 2nd Round of Healthcare Reform

The government established three basic medical insurance systems to ensure basic medical security for all, including the New Rural Cooperative Medical Care System in 2003. By 2018, over 95% of the population was covered by national basic insurance.12 In 2009, a new round of medical reform began, aiming to improve equity and accessibility of services. These general reforms were supplemented by eye health campaigns, including the Chinese launch in 1999 of Vision 2020,13 and cataract surgical programmes such as “The Million Poor Cataract Patient” project.2,14 Such campaigns, together with capacity building at China’s 2800 rural county-level hospitals, brought the national Cataract Surgical Rate from 277/million population/year in 1998 to 2205/million population/year in 2018.2,15 The “Sight First China Action” project in collaboration with Lions Clubs International officially verified eradication of trachoma in China in 2014.16,17

Between 1990 and 2015, refractive error became the most common eye disorder in China, and by 2018 the national prevalence of myopia in children and adolescents reached 53.6%.18,19 In view of this health threat, eight ministries under the direction of the Ministry of Education began a comprehensive national plan of management for children’s myopia in August 2018.

With changes in lifestyle, diabetic retinopathy has become a major cause of vision impairment. Given that 87% of diabetic retinopathy patients are treated at county or lower level facilities, protocols and guidelines for diagnosis, treatment and referral at this level have been issued.20,21 In addition to the government-led efforts, non-governmental organizations have also played an important role in eye health promotion in China, such as the Lions Clubs International, Lifeline Express, ORBIS International and The Fred Hollows Foundation. Thanks to these combined efforts, the prevalence of blindness and vision impairment among those aged ≥ 50 years fell by 27% and 16% respectively in the decade between 2006 and 2014.22


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