November 19, 2013
Author: Tan Jingjing
Xiaoning Yan, a student at Balasu Central Primary School in Yulin, Shaanxi Province, has a pair of big beautiful eyes. She can hardly remember when her eyesight became so poor that she could not see the blackboard and fell behind her classmates. It was not until an optometrist fitted her with a pair of eyeglasses to correct her 20/225 vision that the world came into focus. At first she froze, and then she laughed with delight. “I never knew I could see so clearly,” marveled Xiaoning. “I’m thrilled!”
The Rural Education Action Program (REAP), a collaboration between Stanford University, the Chinese Academy of Sciences and Northwest University, launched the “Seeing is Learning” project in 2012 in rural China. Most recently, a reporter from Xinhua News accompanied REAP on a field visit to several rural schools in Yulin, Shaanxi Province, where the surveys are taking place. The trip revealed the severity of the myopia problem and the negative impact on rural children’s school performance and mental health. Unfortunately, nearsightedness has largely been ignored. Even when teachers and parents notice the problem, there are many misconceptions around treating nearsightedness.
Nearsightedness is Being Ignored
Twelve-year-old Zexiong Kang is a 5th grade student at Hengshan County’s Longkaijing School in Yulin, Shaanxi Province. Both of his parents are migrant workers in cities a long distance from home. His grandmother takes care of him and his 18-year-old brother. Zexiong Kang is severely nearsighted, which prevents him from seeing the blackboard clearly. He is easily distracted in class and his poor vision makes it difficult for him to pass his school exams.
There are 52 students in Zexiong’s class and none of them wear glasses. The class monitor, Huiling Chen, estimated that four or five students in the class had vision problems. Unfortunately, her estimate was far from the truth. Vision screenings conducted by REAP revealed 24 out of 52 students tested below 0.5 logMAR or myopic, while two students were diagnosed with amblyopia.
“Among the myopia cases we found, 24% are severely nearsighted. What’s more concerning is that only 14% of nearsighted students are wearing glasses, and when they do, the glasses are often of very low quality. Some are even wearing the wrong prescription eyeglasses. The vision care in rural China is far from adequate,” says Professor Nan Kang from Zhongshan University Ophthalmic Center.
Yongsheng Liu, Principal of Balasu Central Primary School, admitted that if students at her school were not given free vision screenings and free fitted glasses by REAP, parents would most likely not be willing to purchase glasses for their children even if they were nearsighted.
Tingting Luo was one of twelve students at Zhongshanjian Central School in Jingbian County, Shaanxi Province to receive free fitted glasses from REAP. She was shy when she first put on her glasses, but her face broke into a sweet smile when a reporter told her she looked cool. “My mom did not let me wear glasses because she thought my classmates might make fun of me, but I feel great wearing them today!”
Resolving Misconceptions About Nearsightedness
During our trip, we found there was skepticism and misunderstandings among many teachers and parents towards nearsightedness. Ophthalmologists from Zhongshan University list the following as common misconceptions:
Misconception #1: On average, rural children have good vision.
“Rural children can look at blue sky, white clouds and green trees every day, so they have good vision and few are myopic,” said Dong Wang, Principal of Longyang Kaijing School. His view was echoed by many parents who attended a community meeting organized by REAP.
Boxiang Xiao, one of the ophthalmologists from Zhongshan University admits that on average, rural children are less likely to be nearsighted compared to urban children. “However, this does not mean the myopia problem in rural China is not serious. The trend has been that more and more rural children are nearsighted, and if our society does not address this problem, rural children will have the same rate of nearsightedness as urban children by the time they reach middle school.”
Misconception #2: Wearing eyeglasses makes your vision worse.
During our interviews, several parents said that they would not let their children wear glasses even being nearsighted was affecting their children’s grades. They thought that if children wore glasses, they would never be able to take them off, and that wearing glasses would actually hurt their eyesight.
“Children’s eyes are still developing, so if poor vision causes them to strain their eyes, it could lead to more serious consequences such as amblyopia,” said Boxiang Xiao. “In fact, the best way to ensure good vision is by wearing eyeglasses.”
Misconception #3: Eye exercises can treat nearsightedness.
When a reporter asked the question, “What would you do if you were nearsighted?” many children replied, “More eye exercises!”
Boxiang Xiao explained that in fact, there is no scientific proof that eye exercises can treat nearsightedness. It may be beneficial for relieving eye fatigue and preventing nearsightedness, but not for treating the condition.
Protecting Rural Children’s Eyes
Hu Xia, a volunteer from Shaanxi Normal University, used a video and comic book to show children at Zhongshanjian Central School in Jingbian County, Shaanxi Province how they can protect their eyesight and what to do if they are nearsighted.
Getting a proper vision screening is one of the most basic and important steps. However, many rural areas in China lack vision care services and even if they are available, they are often of low quality.
Studies have shown that in Shaanxi and Gansu Province, there is on average only one ophthalmologist per county hospital, and only four private optical shops. Furthermore, many village clinics and township hospitals have no vision screening services.
"Identifying an effective way to address rural students’ vision health problems is an urgent issue from a societal perspective," said Qu Xiaobo, Research Associate at Chinese Academy of Science’s Institute of Population and Labor Economics.
Experts suggest that the Government should increase financial investments and merge vision care, health care and nutritional care for rural students into a new rural cooperative medical system. In addition, vision screenings should be incorporated into a variety of educational vision monitoring and evaluation polices. Lastly, scientific evidence of how poor vision can be properly treated should be promoted at the school level, completing a comprehensive 3-prong solution: prevention, screening, and treatment.
The Yulin government has been an important collaborator, assisting with project implementation and fully aware of the importance of vision health. The government’s next step is to promote visual health education activities among the city's primary and secondary schools to enhance the students' understanding of nearsightedness, and ensure all schools, teachers and parents are concerned about children’s vision health. The government is also planning for each student to undergo a vision screening every semester as part of a long-term approach to protecting the eyesight of students in rural areas.