Project vision: a new and sustainable model for eliminating cataract blindness in China.

Cataract is by far the most common cause of major vision loss, accounting for approximately half of all global blindness. According to the World Health Organization (WHO), roughly 18 million people worldwide are bilaterally blind from cataract. These sobering statistics have a profound societal economic impact through the combined loss of productivity of both the blind and those who must care for them. This, and the significant reduction of life expectancy for the blind, makes sight restoring cataract surgery one of society’s most cost-effective medical interventions. It is estimated that increased economic productivity during the first postoperative year alone exceeds the cost of the surgery by a factor of 15. The costly societal burden of cataract blindness is not for lack of an effective treatment, as residents of all developed countries enjoy the hi-tech miracle of modern cataract surgery. Instead, cataract blindness results from the sizable gap in health-care delivery between affluent and poor societies. Cataract remains the leading cause of blindness in developing countries where the significant shortage of ophthalmologists and eye surgical services is the chief, but not sole cause. Yorston highlighted four additional major obstacles that deter people from receiving cataract surgery in developing countries. These barriers are (i) a lack of awareness about cataract and its treatment, (ii) a negative perception of the quality of locally available health services, (iii) problems with transportation to health-care facilities, and (iv) the inability to afford the direct and indirect costs arising from surgery. During the past three decades, China’s explosive economic growth and development have been apparent and impressive to all. However, the benefits of this extraordinary economic transformation have been largely reaped in China’s urban centres, and have not been shared by the rural population. Perhaps in no area is this gap in living standard more apparent than in health care. An important public health statistic is the so-called, cataract surgical rate (CSR), which represents the number of cataract operations annually performed per one million of population. As would be expected, the highest rates are seen in those countries with the highest gross domestic product (GDP) (Table 1). Astonishingly, however, China’s CSR is among the lowest in the world, and on a par with African countries with extremely low GDPs. This glaring discrepancy is all the more disappointing considering that economic reforms have resulted in a 10-fold rise in China’s GDP since 1978. An epidemiological survey in the late 1980s estimated that at least 5 million people suffered from bilateral blindness in China, and that cataract was responsible for 50% of these cases. According to the WHO, in developing countries a CSR of 1000 is necessary simply to treat the new cases of cataract blindness arising every year. For China, the current population of 1.3 billion, translates into 1.3 million new cases of cataract blindness per year. With such a deficient CSR, China’s burden of cataract blindness will continue to grow at an epidemic rate until access to surgery can be increased. To underscore the severity of the problem, even a tripling of China’s current CSR would barely make a dent in the country’s huge backlog of cataract blindness.