Who stole our eye health

"There is nothing more (frightening) than loss of sight, except loss of life." Recently, at this year's "National Eye Care Day" press conference, Wang Ningli, member of the National Committee of the Chinese people's Political Consultative Conference and head of the national anti blindness technical guidance group, once again called on everyone to take care of their eyes and pay attention to their health. In 1999, the World Health Organization and the International Association for the prevention of blindness launched the global initiative "Vision 2020", which proposes to eliminate avoidable blindness (cataract, trachoma, river blindness, child blindness, low vision and ametropia) globally by 2020, and reverse the trend that avoidable visual impairment may double between 1990 and 2020. China is the first country in the Western Pacific region to launch the Vision 2020 initiative. In 2016, the 13th five year plan for national eye health was formulated and implemented. This year is the target year of Vision 2020, the end of the 13th five year plan for national eye health, and the decisive year of health poverty alleviation. "Without eye health, there will be no great health. Only by promoting great health can eye health be promoted. Without great health, there will be no healthy China." Wang Ningli said. Myopia is not just wearing glasses. According to the survey, in 2018, the overall myopia rate of children and adolescents in China was 53.6%. Among them, 36% are primary school students, 71.6% are junior high school students and 81% are senior high school students. Myopia in ametropia is the highest incidence rate and the biggest eye health problem in the world. Among them, retinopathy of high myopia accounts for a high proportion in the causes of blindness. A lot of young people have a mistake - isn't nearsightedness just wearing glasses? Actually not. Once myopia occurs, it can't be reversed. Especially in children who have myopia at a low age, they are more likely to become high myopia, resulting in vision damage, and even blindness in old age. Xu Xun, executive director of the Shanghai eye disease prevention and control center, said that the complications of the fundus of the patients (high myopia) mostly occurred after the age of 40 or 50. At that time, their work and later life of the elderly may be greatly affected. "With the development of myopia, the axial length of the eye becomes longer and longer. The eyeball is like a balloon blowing larger and larger. The weakest place is at the fundus of the eye, which will shrink, thin and even rupture. For the patients with high myopia, the current treatment is limited, and some people will be blind. Xu Xun said that the prevention and control of young people's myopia is very difficult. It has been late since school. It is hoped that the whole cycle of high myopia and high quality visual health service will be started at the age of 0, and medical coordination will be achieved, so that the incidence rate of myopia and the decline of morbidity will be seen. According to Xu Xun, prevention and control of myopia should be a three-level task in the shape of "pyramid": the first level is "tower bottom", which needs to control the risk factors of the population generally, screen out the high-risk population, and prevent the occurrence of myopia; the second level is "Tower Center", which needs to actively respond to the people who have myopia, delay their progress, and prevent them from becoming high myopia or even pathological myopia; the third level is "tower top" For the existing high myopia patients, it is necessary to treat complications to prevent blindness. "For patients with high myopia, at present, only a few tertiary hospitals of Ophthalmology and specialized hospitals can treat it, the main purpose is to reduce visual impairment and blindness rate.". According to Xu Xun, "once and for all, laser surgery can correct myopia and help people remove their glasses, but it can't change the enlarged and deformed eyeball, change the existing fundus problems, or reduce the risk of blindness and vision damage.". From this point of view, it is of great significance to prevent the occurrence of myopia and the rapid growth of myopia degree. Everyone can have cataracts. "If you live to be 100 years old, everyone can have cataracts, which is age-related blindness. But as long as the operation can be restored Wang Ningli said. By 2019, China's population over 60 years old has reached 254 million, accounting for 18.1% of the country's total population, and the aging population is still increasing. The increasing number of the elderly means that the number of patients with age-related ophthalmopathy will continue to increase, including ametropia and cataract, which are the main burden of ophthalmopathy in China. In addition, the common main blinding eye diseases, including glaucoma, macular disease and other fundus diseases, are also age-related eye diseases. The prevalence of the elderly is much higher than that of the young. In recent years, the state has promulgated a series of policies on promoting the construction and development of medical consortia, promoting the construction of hierarchical diagnosis and treatment system, and comprehensively improving the comprehensive diagnosis and treatment capacity of county-level hospitals, and further improving the ophthalmic service capacity of county-level hospitals. At present, about 90% of the counties in China have eye medical institutions, of which about 90% can independently carry out cataract surgery. In 2018, the number of doctors with cataract surgery capacity in China was 13835, 2.33 times higher than that in 2000 (5939). "In 1999, there were more than 300 cataract surgeries in 1 million people in China. After 21 years of development, in 2020, there are nearly 3000 cataract surgeries. More important than that is how many cataracts are treated in time. In 2014, it was more than 60%, and now it's estimated that it's more than 70%, so this is a progress in the treatment of blindness. " Wang Ningli said. Wang Ningli said that at present, the main blinding ophthalmopathy in China has changed from trachoma as the representative infectious ophthalmopathy to metabolic ophthalmopathy such as diabetic retinopathy and age-related ophthalmopathy such as senile cataract. The great change of ophthalmic disease spectrum in China has also led to the transformation of blinding ophthalmopathy from treatment to prevention and control. "We will continue to promote the training and promotion of appropriate technologies for preventing and controlling blindness, and pay attention to the prevention and treatment of major blindness, and reduce the incidence rate of blindness, increase the effectiveness of prevention and treatment, and strive for the realization of a bright China." We should not only see, but also see clearly that since the launch of Vision 2020, the blindness rate in China has been further reduced. According to the results of two epidemiological surveys of blindness and visual impairment in nine provinces and cities in 2006 and 2014, the prevalence rate of blind and moderate weight visual impairment patients in China has decreased by 37.8% and 15.4% respectively according to the daily life vision assessment. It is estimated that the number of blind people in China has been reduced by more than 700000 and the number of patients with severe visual impairment has been reduced by more than 500000. Zhang Luo, executive vice president of Beijing Tongren Hospital, said: "our goal is to improve the medical service capacity of Ophthalmology, especially county Ophthalmology, focus on blindness prevention, and gradually turn to promote the high-quality development of Ophthalmology and optometry services. Our goal is not only for the people to see, but also for them to see clearly. " It is understood that from 2003 to 2018, the number of ophthalmologists in China increased from 19100 to 44800, and the number of full-time ophthalmic nurses increased from 16100 to about 50000. The proportion of middle and senior ophthalmologists and the proportion of ophthalmologists to doctors and nurses are also gradually becoming reasonable. The number of optometrists increased from 1487 in 2006 to 6218 in 2018. The number of eye beds has increased three times from more than 40000 in 2000 to more than 130000 in 2018. In 2015, more than 80% of county-level hospitals were equipped with non-contact tonometer, operating microscope, direct ophthalmoscope, indirect ophthalmoscope and other basic ophthalmic equipment. In addition, China has also established the national, provincial (district city), municipal level management system for blindness prevention and treatment and the county, township, village eye disease prevention and control network to ensure the fairness and accessibility of eye resources. "Eye health needs group prevention, group control and comprehensive measures. It needs not only the promotion of professional departments, but also the participation of all sectors of society, including individuals and families." Zhou Changqiang, deputy director of the medical administration bureau of the national health and Health Commission, said. Zhou Changqiang said that in the next step, according to the requirements of healthy China, in combination with China's national conditions and changes in the spectrum of blinding eye diseases, the national eye health plan of the 14th five year plan will be formulated, the three-level service system for blindness prevention and treatment and eye health will be further improved, the construction of professional ophthalmic teams at the grassroots level will be strengthened, the quality control system for ophthalmic medical treatment will be established, and the high-quality development of ophthalmic medical services will be promoted To meet people's increasing eye health needs.