Eyewear and Mental Health: Why Education Isn't the Only Thing Rural China Lacks

From Ortho-k contacts to Apple's newest AR Glasses, eyewear is just about everywhere in the world around us.

In the average American classroom, teachers will immediately notice if we have to squint to look at the whiteboard and likely ask for us to either move to the front of the class or get our eyes checked out.

Sadly, this is far from the case in rural China.

In an estimate by the World Health Organization, up to 20% of school-aged children in developing regions have vision impairment issues. But this fact by itself isn't shocking, nor does it elicit a response.

I'll break you into the issue slowly.

Primarily, empirical data and research amount to the conclusion that about half of the world's school-aged students with vision issues occur in China.

Examining closely the portion of rural students in that percentage, up to 85% of students in the rustic regions of China are not equipped with appropriate eyewear.

Maybe the percentages and numbers have confused you. But you don't have to be a statistician to understand that an unignorable majority of the students in rural China do not have the proper eyewear for school.

Case Studies

Let's look at some case studies regarding vision impairment in children across rural China.

YongShuo County

The first case study that we will be looking at was conducted across elementary schools in Yongshuo County of Northwest China.

Researchers in this study found that less than 1/3 of children in the rural primary schools who were found with poor vision wore eyeglasses appropriate for their situation. The issue, they concluded, did not fall to the fact that families could not afford the monetary price, but that there were limiting access to eyewear.

One reason is that there were too few clinics scattered across large patches of area. Nevertheless, numerous other studies have shown that while distance may be a factor in demotivating families from participating in health check-ups, a larger issue is a lack of incentives.

Through this experiment specifically, researchers found that many parents whose children have expressed difficulties seeing rarely connected it the need to be fitted for proper eyewear. Instead, some parents believed eyeglasses were a novelty that helped their kids fit in with their peers. Or, quite bluntly, that their children were watching too much television.

Gansu

Next is a large scale study consisting of 20,000 students between grades 4 to 5 across 253 elementary schools in the Gansu Province of China. (And if you haven't taken a look at the Rainbow Mountains in the Gansu, or any other attractions there, you're missing out.)

While such large phenomenons of mother nature are rather easy to spot, for children with vision impairment, the colors and shapes may still appear blurred. Taking that to the white, chalky math equations and China poems written on a blackboard 45 feet in front of you, the viewing experience for many is an absolute nightmare.

What the researchers ended up discovering through this study was a series of correlations connecting high levels of vision impairment and the environment around them. Such conclusions were largely in line with those found in the Yangshuo County, proving indirectly that observations in a much smaller scope holds true even when applied to the larger regions around it.

Results

First, there is an inverse correlation between a child's vision and his or her anxiety. In other words, the worse a child's vision became, the greater risk they were at for anxiety attacks. Unsurprisingly, if a student is unable to see what the teacher is writing on the board in front of them, they can very easily become nervous about what they are possibly missing. A subsequent effect of this is low academic performances and high dropout rates, which will be described in greater detail later.

Next, this study also concluded a positive correlation between vision and parent education. Students in rural China whose parents had a high level of education were found to be more likely to have vision impairment issues. At the same time, there seems to be a negative correlation between vision and parent migration. That is, students living in households with higher levels of parent migration were likely to receive lower marks on vision tests.

Of course, it is important to note that such relationships do not signify causation, nor are they meant to discriminate against a specific group of children. Instead, it merely specifies subjects who were more likely to have vision issues such that doctors could better diagnose them.

Ultimately, of all the students who were samples, about 25% of them needed eyewear. However, out of this quarter of the students, a mere 3% wore eyewear daily, with the rest either not being aware of the issue, or not finding the motivation to wear prescribed glasses.

Conclusion

These case studies enumerate the importance of proper eyewear for children in rural China. With such a large portion of students having vision issues as early as elementary school and such a small portion of them being adequately fitted with prescription glasses, the ramifications have and will continue to be huge if we do nothing about them.

Primarily, students unable to see the front of the board during daily lectures will undoubtedly feel left behind or see no motivation in learning something that they can't even see. Both large and small scale studies have illustrated the tight association between a lack of proper vision diagnosis with higher anxiety, lower test scores, and higher dropout rates.

Additionally, the nearly negligible amounts of government funding and attention leads to scattered clinics which largely disincentives parents from taking the time to bring their children quarterly or annually for a checkup. At the same time, for those who do have the ability to access such facilities, the lack of education and awareness pervasive among guardians of these children leads to minimal attempts towards solving even an identified problem.

Luckily, there is a very simple solution to all of this: train teachers for teacher-led clinics. Estimates have shown that currently, the cost to train a sufficient amount of teachers and provide necessary equipment costs roughly 200 RMB (or around 32 USD depending on the exchange rate and adjusting for inflation) per school. As empirical research across rural China supports, funding such facilities not only allow medical check-ups to be readily accessible but also largely boosts participation rates among families since the cost is also low.

The bottom line is that in the face of this largely unknown crisis influencing education in rural China, funds need to be directed towards an effort to prescribe students with the appropriate glasses as early as possible.

Regardless of how engaging the curriculum is and how well-nourished the student is, none of that matters when he or she goes into every class practically blind.

---

Poor Vision among China’s Rural Primary School Students: Prevalence, Correlates and Consequences

An Investigation of Vision Problems and the Vision Care System in Rural China

Impact of a Local Vision Care Center on Glasses Ownership and Wearing Behavior in

Northwestern Rural China: A Cluster-Randomized Controlled Trial

Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China