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Lily Canter

The introduction of glaucoma screening in China could save people over the age of 50 from nearly three million years of blindness, according to new research published in The Lancet Global Health.
Glaucoma is a condition that damages the optic nerve, usually by causing increased pressure within the eyeball leading to gradual loss of sight. It is the leading cause of irreversible blindness globally, affecting 64.3 million people worldwide in 2013, with one-sixth of them living in China, according to the research.
The eye disease is associated with ageing, meaning global numbers are rising rapidly as populations grow older.
When vision is lost from glaucoma, it cannot be recovered through surgery or other treatments – unlike cataracts, for example.
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Currently only 10 per cent of people living with glaucoma in middle-income countries such as China are diagnosed and treated, compared to 50 per cent in richer countries such as the UK and US.
Introducing a national screening programme would be cost-effective and improve the lives of millions of people in China, say the researchers from Wenzhou Medical University, Renmin University of China, Orbis International and Queen’s University Belfast.
“The research findings suggest that a national glaucoma screening programme in China could save the government money in the long term, as it would reduce the demands on resources for the large population who would otherwise suffer completely avoidable loss of sight,” says Dr Tang Jianjun from the Centre of Public Health at Queen’s University Belfast.
Highly effective treatments including eye drops, laser and incisional surgery are proven to greatly reduce the risk of blindness for glaucoma patients. However, glaucoma is nearly always asymptomatic in its early stages, when treatment is most effective. That means patients are unaware of having the disease unless screening is carried out.
“In the UK and US, a higher proportion of people with glaucoma end up getting picked up in day-to-day life from going to the ophthalmologist for something else,” says Professor Nathan Congdon, director of research at Orbis International, an NGO dedicated to eliminating preventable blindness. “But this doesn’t happen in China, particularly in rural areas. It is not getting picked up until it is too late.”

Congdon says a lot of damage occurs before people are aware of the problem.
“Damage occurs to the peripheral vision, which you might not notice. You can see faces, read, watch TV. It is only when [damage] gets to the middle that people notice and it can be too late to treat then.”
There are two forms of glaucoma: primary angle closure glaucoma (PACG) and open angle glaucoma (POAG).
PACG is highly prevalent in China due to the anatomical shape of people’s eyes. Nearly half of all people in the world with PACG are of Chinese descent. People with PACG are four to five times more likely be blind when they are diagnosed.
“People with smaller eyes are more likely to get angle-closure glaucoma,” Congdon explains. “Older Chinese people have eyes that are shortened and the front part of the eye is crowded.”

Previous studies in countries such as the UK and Finland have not considered glaucoma screening to be cost effective because of the greater expense of outreach efforts and lower risk of eventual blindness thanks to better early detection and treatment.
However, given the disproportionate number of people affected by PACG in China – one third of those with glaucoma blindness worldwide – the researchers set out to assess the cost-effectiveness of glaucoma screening programmes there.
The research concludes that glaucoma screening in both rural and urban settings in China can save money while preventing blindness. The screening cost per person would be US$3.2.
“This paper has the potential to be a game-changer for Orbis and our partners and beneficiaries worldwide,” Congdon says. “It fundamentally alters the way we all think about this disease, from a passive approach of waiting for patients to seek care, often too late, to actively reaching out into the community, catching glaucoma before blindness occurs.”
The regional economies in China vary widely. A screening programme can be more cost-effective in some cities than others
Professor Christopher Leung, ophthalmologist, the Chinese University of Hong Kong
The research concluded that the costs of increasing screening for both types of glaucoma in China were far below the World Health Organisation cost-effectiveness threshold of one to three times rural gross domestic product. For the urban China setting, combined screening was predicted to result in fewer net costs and greater gain in health benefits than no screening at all.
“Our research illustrates that a national screening programme in China is a win-win scenario for both patients and the government, and we hope that this research will inform future health-care policies,” Tang says.
China’s national health insurance system, despite its split operation in rural and urban China and its large geographical variations, manages to cover more than 95 per cent of the Chinese population, according to government statistics.
Including glaucoma screening as a part of the routine annual check-up and allowing it to be reimbursed through the health insurance scheme will improve the accessibility and sustainability of the programme, says the Lancet study.
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Commenting on the study, ophthalmologist Professor Christopher Leung of the Chinese University of Hong Kong says he would support a national screening programme in China for glaucoma and other common conditions that cause blindness. He adds, though, that while such a programme is likely to be cost-effective in China where the screening and treatment costs are relatively low, it is uncertain whether screening for glaucoma alone would be cost-effective in other nations.
“It is feasible, however, to apply a screening test to screen for multiple eye diseases, including age-related macular degeneration and diabetic retinopathy, in addition to glaucoma, to increase the cost-effectiveness of a screening programme,” he adds. “The regional economies in China vary widely. A screening programme can be more cost-effective in some cities than others.”


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Glaucoma screening in China would be cost-effective and improve lives of millions: report

Introducing a national glaucoma screening programme in China would be cost-effective and improve the lives of millions of people, say the researchers of a new study.

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Glaucoma is the leading cause of irreversible blindness globally, and few in China are diagnosed and treated in time
A new report concludes that glaucoma screening in China can save money while preventing blindness. The screening cost per person would be US$3.2


Initiative would be cost-effective at just US$3.2 per person and improve the lives of millions of people in China, where few are diagnosed and treated in time, according to a new report.


Health in China

World Health Organization (WHO)

Glaucoma screening in China would be cost-effective and improve lives of millions: report

Glaucoma is the leading cause of irreversible blindness globally, and few in China are diagnosed and treated in time A new report concludes that glaucoma screening in China can save money while preventing blindness. The screening cost per person would be US$3.2

Glaucoma is the leading cause of irreversible blindness globally, and few in China are diagnosed and treated in time

A new report concludes that glaucoma screening in China can save money while preventing blindness. The screening cost per person would be US$3.2