'Middle generation' may be key to resolving cataract blindness, low vision rates in rural China

NUSA DUA, Indonesia — A family-based, unified approach to cataract surgical rates and refractive errors reveals what is working and what still needs to be done in rural China to improve blindness and low vision rates, according to one researcher here.

Nathan G. Congdon

In the Holmes Lecture during the joint meeting of the Asia-Pacific Academy of Ophthalmology and the American Academy of Ophthalmology, Nathan G. Congdon, MD, MPH, said that despite having positive attributes toward raising cataract surgical rates, such as a high number of ophthalmologists, high population density and a growing middle class, the rates are still the lowest in Asia, and the situation is only going to get worse.

Studies among schoolchildren in rural China show low vision from uncorrected refractive error is also highly prevalent, Dr. Congdon said.

"A knowledge gap more than an income gap is preventing children from getting glasses," he said.

Dr. Congdon and his colleagues have found that those in the middle generation are the key decision makers in the family. They are responsible for getting spectacles for their children and cataract surgery for their parents, he said. This group has largely been overlooked until now in the uptake of services for both cataract in the elderly and refractive error in children.

"The household sale of presbyopic spectacles by micro-entrepreneurs could serve as the entry point to contact that middle generation," he said.

Dr. Congdon also said to improve cataract surgical rates, China needs to improve its residency training programs, new pricing models are needed to make services more affordable, and central health care reform is needed as well.