Currently available data on myopia and spectacle wear are drawn largely from China’s richer and middle-income areas, and little is known about refractive error and spectacle wear in the lowest income provinces. Studies from China and elsewhere suggest that large differences in myopia prevalence may exist between areas of different socioeconomic status within countries, but reasons for these differences are not well understood. The current report details the prevalence and predictors of myopia measured using the identical protocols and equipment in adjoining provinces of western China, middle-income Shaanxi and low-income Gansu. Study methods including institutional review board approvals and consent have been described elsewhere.

This paper examines the prevalence of vision problems and accessibility to and quality of vision care in rural China. We obtained data from 4 sources: 1) the National Rural Vision Care Survey; 2) the Private Optometrists Survey; 3) the County Hospital Eye Care Survey; and 4) the Rural School Vision Care Survey. The data from each of the surveys were collected by the authors during 2012. Thirty-three percent of the rural population surveyed self-reported vision problems. Twenty-two percent of subjects surveryed had ever had a vision exam. Among those who self-reported vision problems, 34% did not wear eyeglasses. Fifty-four percent of those with vision problems who had eyeglasses did not have a vision exam prior to receiving glasses. However, having a vision exam did not always guarantee access to quality vision care. Four channels of vision care service were assessed. The school vision examination program did not increase the usage rate of eyeglasses. Each county-hospital was staffed with three eye-doctors having one year of education beyond high school, serving more than 400,000 residents. Private optometrists often had low levels of education and professional certification. In conclusion, our findings shows that the vision care system in rural China is inadequate and ineffective in meeting the needs of the rural population sampled.

We respond to Anning Hu's commentary on our report “College is a rich, Han, urban, male club: Research notes from a census survey of four tier one colleges in China.” The topic of assessing disparities in college access in China (and other developing countries undergoing major transitions in their higher education systems) is an important one. We hope that our China Quarterly article, Hu’s commentary and our response will stimulate more research and dialogue on this topic in China and elsewhere.