Seventy-five year-old Huang Guoyi lived with cataracts for five years until ophthalmologists from Wuzhishan Eye Hospital in Hainan province went to his village and removed them. The surgery took just 20 minutes and Huang was charged US$4 for drugs during his recovery period.
“For almost a year I couldn’t go outside and it used to be difficult to live alone, but now I can see,” he said.
Huang is just one of the approximately 600,000 cataracts sufferers who receive surgery in China every year, or 300 to 400 surgeries per million people, according to the World Health Organization. Each year, an additional 400,000 people become cataract-blind.
Lost in the clouds
Cataract-blindness happens when sufficient clouding builds up in the eye to the extent that all the light is blocked out. The condition tends to afflict people aged 45 or over and is the leading cause of blindness in China. Rural populations in the west of the country and those living in remote areas are most susceptible to cataracts during their elder years due to constant exposure to ultraviolet light from the sun and high altitudes.
China has some 23,000 ophthalmologists able to perform phacoemulsification (phaco surgery), whereby ultrasonic energy is used to remove cataracts. But most of these specialists live in urban areas and, even if they didn’t, the average cost for the phaco surgery is US$400-500 for each eye. This is twice the average annual incomes of the country’s rural residents most afflicted by the disease.
On top of that, phaco surgey is not suitable for rural patients who have had cataracts for many years, said ophthalmologist Dr Jeanne Xi at Beijing United Family Health hospital.
Currently, there are about a dozen NGOs providing preventative outreach and cataract surgeries across China. Some organizations, such as Hong Kong-funded “Health Express,” send medical teams out into remote, underserved areas to perform cataract surgeries for free.
But the goals of nonprofit organization Orbis International, which has been combating avoidable blindness in the country since 1982, are different. Their principle is to train local doctors so they are able to remove cataracts themselves in the long-run.
Orbis offers one-week courses to skilled ophthalmologists during which they are taught extracapsular cataract extraction (ECCE). This process involves inserting an artificial lens into the eye once the cataracts have been removed manually.
Rural patients are charged approximately US$50-100 for each eye, less than half the rates typically charged at county-level hospitals.
“Age-related cataracts, [can be postponed if] farmers wear hats and goggles while working in the fields and have less direct contact with sunlight,” said Dr Wang Jianguo, director of the Wuzhishan Eye Hospital.
But Leshan Tan, the country director of Orbis believes the best way to prevent cataracts is more government spending on rural health care. “China’s major problem in combating cataracts is affordability. Cataracts is a public health issue, not simply a disease,” he said.
Until health care becomes affordable for China’s rural population, the problem will persist.