Some 30% of Shanghai’s 18.9 million citizens (2008) are migrants. Children aged 17 years and younger account for 10.5% of the total population, and 600,000 of these are migrant children without medical insurance. According to a pediatric eye health survey conducted by Shanghai Eye Diseases Prevention & Treatment Center in 2009, 35% of school-aged children in Shanghai had visual acuity < 6/9, indicating over 660,000 children with visual impairment. Migrant children and those dwelling in the city’s poorer districts are without access to affordable, high-quality eye care.
Uncorrected refractive error accounts for over 90% of visual disability among children in urban China. It has been demonstrated that in many areas half of secondary school children require glasses, and yet some two-thirds of these either do not have or wear them, or have spectacles of such poor quality that they do not improve the vision adequately. Failure to provide children with a simple pair of accurate glasses can inhibit their ability to function well in the classroom. Though strabismus (squint) and amblyopia (lazy eye) typically do not cause bilateral blindness, they are very common among Chinese children, in part because of high rates of uncorrected refractive error. These conditions, which are typically not covered by Chinese health insurance, often go untreated, and may be associated with significant social stigma and reduced future work opportunities. Although an eye disease prevention network exists in Shanghai, pediatric eye services are rarely available at the district or community level, where they are most critically needed for early detection and referral. The high price of medical treatment in Shanghai makes eye care service unaffordable for migrant families lacking health insurance coverage, and for poor patients native to the city.