Uncorrected refractive errors (myopia, hyperopia and astigmatism) have substantial effect on the individual but also the community. The condition is linked with reduced employment opportunities, social isolation and reduced independence and mobility. In children, the condition impacts on education performance. The economic cost to society in lost productivity was estimated to be I$269 billion per year.1
Data from WHO suggest that in 2004, there were 12.8 million children visually impaired by uncorrected refractive errors worldwide and nearly half of them live in China.2 Although refractive errors can be easily corrected with spectacles, 30-40% of children with refractive errors in southern rural China do not own a pair of spectacles, and 60-70% of children needing spectacles do not benefit from appropriate correction.3 It remains a challenge to eliminate uncorrected refractive errors in school-aged children in rural China before 2020.
Several reasons contribute to this public health issue in rural China.3 First, government hospitals in rural China that can provide quality optical service are scarce. Rural families often seek spectacles from refractionists in private stores, where dilating eyedrops, necessary for children to obtain accurate refraction results, are uncommon. Consequently, poor refraction commonly leads to poor visual outcomes.3 Second, many Chinese parents and teachers wrongly believe that wearing spectacles harms children's eyes. Children also concern over appearance after wearing spectacles being teased by schoolmates. Although intervention on children in rural China to promote spectacle use has shown imperfect compliance,4 but did improve children’ educational outcomes.5 Third, cost of spectacles is still a barrier in rural China. Acceptance of spectacles could be improved by reducing the cost or making them available free of charge.3
Our aim needs to be the provision of refractive and optical services that are affordable and of good quality to everyone, regardless of where they live or whether there are rich or poor. To build a sustainable, cost-effective program with high coverage of children in rural China, several measures are suggested to be executed. A data pooling from the existing surveys in different areas of China on the national prevalence of refractive errors in school-aged children is urgent. This will provide evidence for the communication with the Ministry of Health and the Ministry of Education in China. With policy support from the government and technical support from the Chinese Ophthalmology Society, different strategies to improve spectacles acceptance could be evaluated and should be integrated into the NCMS. Additionally, the study on the interventions to prevent the onset and development of myopia in school-aged children should also be enhanced.
There are some argument on the effect of uncorrected refractive error on education6 because Ma et al.5 only find an improvement in mathematics after providing free spectacles to children. Further analysis based on the data of our cohort study, the Anyang Childhood Eye Study,7 will explore whether uncorrected refractive error will affect the education performance of children in other subjects such as language, biology, geography and history lessons.
We declare that we have no competing interests.
Shi-Ming Li, *Ningli Wang, Andreas Muller
Correspondence to: Ningli Wang wningli@vip.163.com
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China (SML, NLW); and Technical Officer, Prevention of Blindness, World Health Organization, Western Pacific Regional Office (AM)
Reference
1. Smith TS, Frick KD, Holden BA, Fricke TR, Naidoo KS. Potential lost productivity resulting from the global burden of uncorrected refractive error. Bull World Health Organ 2009; 87(6): 431-7.
2. Resnikoff S, Pascolini D, Mariotti SP, Pokharel GP. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ 2008; 86(1): 63-70.
3. Sharma A, Congdon N, Patel M, Gilbert C. School-based approaches to the correction of refractive error in children. Surv Ophthalmol 2012; 57(3): 272-83.
4. Congdon N, Li L, Zhang M, et al. Randomized, controlled trial of an educational intervention to promote spectacle use in rural China: the see well to learn well study. Ophthalmology 2011; 118(12): 2343-50.
5. Ma X, Zhou Z, Yi H, et al. Effect of providing free glasses on children's educational outcomes in China: cluster randomized controlled trial. BMJ 2014; 349: g5740.
6. Rahi JS, Solebo AL, Cumberland PM. Uncorrected refractive error and education. BMJ 2014; 349: g5991.
7. Li SM, Liu LR, Li SY, et al. Design, methodology and baseline data of a school-based cohort study in central China: the Anyang Childhood Eye Study. Ophthalmic Epidemiol 2013; 20(6): 348-59.
Rapid Response:
Uncorrected refractive errors (myopia, hyperopia and astigmatism) have substantial effect on the individual but also the community. The condition is linked with reduced employment opportunities, social isolation and reduced independence and mobility. In children, the condition impacts on education performance. The economic cost to society in lost productivity was estimated to be I$269 billion per year.1
Data from WHO suggest that in 2004, there were 12.8 million children visually impaired by uncorrected refractive errors worldwide and nearly half of them live in China.2 Although refractive errors can be easily corrected with spectacles, 30-40% of children with refractive errors in southern rural China do not own a pair of spectacles, and 60-70% of children needing spectacles do not benefit from appropriate correction.3 It remains a challenge to eliminate uncorrected refractive errors in school-aged children in rural China before 2020.
Several reasons contribute to this public health issue in rural China.3 First, government hospitals in rural China that can provide quality optical service are scarce. Rural families often seek spectacles from refractionists in private stores, where dilating eyedrops, necessary for children to obtain accurate refraction results, are uncommon. Consequently, poor refraction commonly leads to poor visual outcomes.3 Second, many Chinese parents and teachers wrongly believe that wearing spectacles harms children's eyes. Children also concern over appearance after wearing spectacles being teased by schoolmates. Although intervention on children in rural China to promote spectacle use has shown imperfect compliance,4 but did improve children’ educational outcomes.5 Third, cost of spectacles is still a barrier in rural China. Acceptance of spectacles could be improved by reducing the cost or making them available free of charge.3
Our aim needs to be the provision of refractive and optical services that are affordable and of good quality to everyone, regardless of where they live or whether there are rich or poor. To build a sustainable, cost-effective program with high coverage of children in rural China, several measures are suggested to be executed. A data pooling from the existing surveys in different areas of China on the national prevalence of refractive errors in school-aged children is urgent. This will provide evidence for the communication with the Ministry of Health and the Ministry of Education in China. With policy support from the government and technical support from the Chinese Ophthalmology Society, different strategies to improve spectacles acceptance could be evaluated and should be integrated into the NCMS. Additionally, the study on the interventions to prevent the onset and development of myopia in school-aged children should also be enhanced.
There are some argument on the effect of uncorrected refractive error on education6 because Ma et al.5 only find an improvement in mathematics after providing free spectacles to children. Further analysis based on the data of our cohort study, the Anyang Childhood Eye Study,7 will explore whether uncorrected refractive error will affect the education performance of children in other subjects such as language, biology, geography and history lessons.
We declare that we have no competing interests.
Shi-Ming Li, *Ningli Wang, Andreas Muller
Correspondence to: Ningli Wang wningli@vip.163.com
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China (SML, NLW); and Technical Officer, Prevention of Blindness, World Health Organization, Western Pacific Regional Office (AM)
Reference
1. Smith TS, Frick KD, Holden BA, Fricke TR, Naidoo KS. Potential lost productivity resulting from the global burden of uncorrected refractive error. Bull World Health Organ 2009; 87(6): 431-7.
2. Resnikoff S, Pascolini D, Mariotti SP, Pokharel GP. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ 2008; 86(1): 63-70.
3. Sharma A, Congdon N, Patel M, Gilbert C. School-based approaches to the correction of refractive error in children. Surv Ophthalmol 2012; 57(3): 272-83.
4. Congdon N, Li L, Zhang M, et al. Randomized, controlled trial of an educational intervention to promote spectacle use in rural China: the see well to learn well study. Ophthalmology 2011; 118(12): 2343-50.
5. Ma X, Zhou Z, Yi H, et al. Effect of providing free glasses on children's educational outcomes in China: cluster randomized controlled trial. BMJ 2014; 349: g5740.
6. Rahi JS, Solebo AL, Cumberland PM. Uncorrected refractive error and education. BMJ 2014; 349: g5991.
7. Li SM, Liu LR, Li SY, et al. Design, methodology and baseline data of a school-based cohort study in central China: the Anyang Childhood Eye Study. Ophthalmic Epidemiol 2013; 20(6): 348-59.
Competing interests: No competing interests