The "14th Five-Year" National Eye Health Plan was issued to focus on the prevention and treatment of eye diseases and the rehabilitation of low vision

On January 11, the National Health and Medical Commission issued the "14th Five-Year" National Eye Health Plan (2021-2025), focusing on the prevention and treatment of eye diseases such as trachoma, cataract, myopia in children and adolescents, and the rehabilitation of low vision, and strives to improve the eye health of the people
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The original text is as follows: Health and Health Committees of all provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps: In order to effectively do a good job in China's eye health work during the "14th Five-Year Plan" period, further improve the people's eye health level, and continue to promote the high-quality development of China's eye health cause, Based on the current work situation, our commission has formulated the "14th Five-Year Plan for National Eye Health (2021-2025)" (downloadable from the website of the National Health Commission)
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It is hereby printed and distributed to you, and all localities are requested to implement it conscientiously
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National Health Commission January 4, 2022 (form of information disclosure: active disclosure) Eye health is an important part of national health, involving people of all ages and the entire life cycle
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Visual impairment, including blindness, seriously affects people's physical and mental health and quality of life, and increases the burden on families and society.
It is a public health and social problem involving people's well-being
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This plan is formulated in order to continue to promote the high-quality development of China's eye health cause during the "14th Five-Year Plan" period and further improve the people's eye health level
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I.
Planning background The Party Central Committee and the State Council attach great importance to eye health work
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Since the 1980s, the national level has successively issued plans and policies related to blindness prevention, blindness treatment and eye health, strengthened top-level design, defined tasks and objectives, proposed specific measures, and continued to improve the eye health management system, technical guidance system and medical service system
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Focus on the prevention and treatment of eye diseases such as trachoma, cataract, myopia in children and adolescents, and the rehabilitation of low vision, and strive to improve the eye health of the people
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During the "Thirteenth Five-Year Plan" period, the prevention and control of myopia in children and adolescents was included in the government performance assessment, forming a good atmosphere of "government leadership, department cooperation, expert guidance, school education, and family attention", and ophthalmic medical and health services developed rapidly.

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The service capacity of ophthalmology continued to improve, and cataract surgery was widely carried out in the county
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The team of ophthalmologists has been continuously improved, and the number of ophthalmologists has increased to 47,000
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Medical staff actively participate in eye health science education
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People's awareness of eye care and eye care has been significantly improved
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At the end of the 13th Five-Year Plan, the age-standardized prevalence of blindness in China was lower than the global average
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The World Health Organization officially certified that China has eliminated the public health problem of blinding trachoma
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The cataract surgery rate (CSR) for one million people in China exceeded 3,000, doubling from the end of the "Twelfth Five-Year Plan" period
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However, China is still one of the countries with the largest number of blind and visually impaired patients in the world
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The major blinding eye diseases in China have changed from infectious eye diseases to eye diseases such as cataract, myopic retinopathy, glaucoma, corneal disease, and diabetic retinopathy
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With economic and social development and the intensification of population aging, the people have higher demands on eye health
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The total amount of high-quality medical resources for ophthalmology in China is relatively insufficient and the problem of unbalanced distribution still exists, the grass-roots eye health service capacity still needs to be strengthened, and the task of eye health work is still arduous
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II.
Guiding ideology and basic principles (1) Guiding ideology
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Guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully implement the spirit of the 19th National Congress of the Communist Party of China and all the 19th Plenary Sessions, focus on the health of the people, and promote high-quality development as the theme, so as to meet the people's multi-level and diverse vision.
With health needs as the starting point and end point, we will implement the Healthy China strategic deployment, further build a high-quality and efficient eye health service system, and strive to provide the people with eye health services covering the entire life cycle
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(2) Basic principles
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1.
Adhere to overall planning and resource integration
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Adhere to eye health work to serve people's health
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Adhere to the government-led, multi-departmental collaboration, and the whole society's participation in eye disease prevention and control work mode
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According to the people's eye disease medical needs, eye disease spectrum, and population distribution, scientifically formulate regional eye health plans, clarify work objectives and task division, adapt measures to local conditions, provide classified guidance, coordinate medical resources in the region, and ensure that specific work measures are effective
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2.
Adhere to the improvement of quality and efficiency, and high-quality development
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Adhere to the new development concept, take improving the quality and level of eye health services as the core task, promote the high-quality development of the eye health management system, technical guidance system and medical service system, accelerate the expansion of high-quality medical resources and regional balanced layout, and continue to improve the quality of eye health services.
Equity and Accessibility
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3.
Adhere to prevention first and combine prevention and treatment
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Pay attention to the intervention of early-stage factors of eye diseases, pay attention to the coordination of medical treatment and prevention, and separate and treat acute and chronic diseases, and promote the transformation of the development of eye health from focusing on disease treatment to focusing on people's health
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Strengthen the publicity and education of eye health science, strengthen that everyone is the first person responsible for their own eye health, and promote the formation of an atmosphere where everyone participates, everyone is responsible, and everyone shares
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4.
Focus on key groups and key eye diseases
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Focus on the two key groups of children, adolescents and the elderly, focus on key eye diseases such as myopia and other refractive errors, cataracts, fundus diseases, glaucoma, and corneal blindness, promote appropriate technologies and diagnosis and treatment models for the prevention and treatment of eye diseases, and improve the eye health of key populations
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3.
Main goals During the "14th Five-Year Plan" period, focus on strengthening the construction of ophthalmic medical service system, capacity building and talent team, continue to improve the ophthalmic medical quality control system, and promote the expansion and extension of high-quality ophthalmic medical resources
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Effectively promote the prevention and control and scientific correction of myopia in children and adolescents, further improve the ability of cataract recovery, gradually improve the screening ability of primary medical and health institutions for diabetic retinopathy and other fundus diseases, and promote the orderly development of corneal donation
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By 2025, strive to achieve the following goals: 1.
The annual coverage rate of eye care and vision examinations for children aged 0-6 will reach more than 90%, and the overall level of children and adolescents' eye health will continue to improve
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2.
The effective refractive error correction coverage (referred to as eREC, see attachment) has been continuously improved, and the number of people with visual impairment caused by high myopia has gradually decreased
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3.
The national CSR has reached more than 3500, and the coverage rate of effective cataract surgery (referred to as eCSC, see attachment) has been continuously improved
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4.
Promote the high-quality development of the ophthalmic medical service system (1) Strengthen the construction of the ophthalmic medical service system
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1.
Strengthen the construction of ophthalmology and ophthalmology specialized hospitals in general hospitals
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According to the needs of patients for medical treatment and the distribution of medical resources, the construction of the ophthalmic medical service system will be incorporated into the “14th Five-Year Plan” regional medical institution setting plan and other overall construction, and promote the expansion and extension of high-quality medical resources related to ophthalmology
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Gradually establish and improve the national-regional-provincial-city-county five-level ophthalmic medical service system, and optimize the layout of medical resources
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Strengthen the establishment and construction of ophthalmology in general hospitals above the second level, and make up for the shortcomings of ophthalmology and its supporting disciplines
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Each prefecture-level city has at least one general hospital above the second level to independently set up an ophthalmology department
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Encourage qualified county-level general hospitals to independently set up ophthalmology departments and provide outpatient services
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2.
Build a highland for ophthalmology
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In accordance with the construction planning requirements of the National Medical Center and the National Regional Medical Center, coordinate the construction of the National Medical Center for Ophthalmology and the National Regional Medical Center, and build a national and regional ophthalmology highland
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Give full play to the technical leadership and radiation driving role of each center, improve the overall service capacity of ophthalmology, gradually narrow the difference in ophthalmology medical service capacity between regions and between urban and rural areas, and reduce the number of patients seeking medical treatment across regions
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3.
Build an ophthalmic medical service network
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Build an eye health service network suitable for China's national conditions and provide comprehensive, fair and accessible eye health services
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Encourage strong ophthalmology specialized hospitals and general hospitals to take the lead in building specialized alliances, integrate specialized medical resources, and drive the improvement of the overall service capabilities of ophthalmology
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Promote the construction of urban medical groups and county-level medical communities, fully absorb the participation of ophthalmic medical resources, establish a division and cooperation mechanism between ophthalmic medical resources and other medical resources in the region, and improve the two eye health work networks in cities and counties
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Strengthen the construction of telemedicine collaboration network, and use information technology to promote the extension of high-quality ophthalmic medical resources to the grassroots
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(2) Strengthen the capacity building of ophthalmic medical services
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1.
Improve the capacity of ophthalmic medical services
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In accordance with the "14th Five-Year Plan for National Clinical Specialty Capacity Building", support the construction of key ophthalmic clinical specialties at the national, provincial and city (county) levels, improve the relevant ophthalmic sub-specialty system, and further enhance the service capabilities of ophthalmic clinical specialties
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At the same time, focus on children and elderly patients, and focus on improving the ability of scientific correction of myopia, cataract surgery, and common eye disease screening
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Strengthen the construction of supporting disciplines such as pathology, and improve the ability of ocular pathology diagnosis
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2.
Improve the efficiency of ophthalmic medical services
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Build a "slow and slow separation" pattern
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Improve the work system and workflow related to day surgery in ophthalmology, and gradually expand the scope of diseases on the basis of day surgery for patients with cataract and refractive errors, and continue to increase the proportion of day surgery in elective surgery
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At the end of the "14th Five-Year Plan", the proportion of day surgery in tertiary ophthalmology specialist hospitals accounts for 60% of elective surgery
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Strengthen the collaboration between the ophthalmology department and rehabilitation institutions and primary medical institutions, improve the two-way diagnosis and referral mechanism, and transfer the postoperative rehabilitation period and patients with chronic eye diseases with a clear diagnosis and stable condition to the grass-roots follow-up
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Promote the implementation of the appointment diagnosis and treatment system for ophthalmic outpatient clinics and day surgery services, and use information technology to continuously optimize the medical service model and process, further improve the efficiency of medical services, and effectively improve the patient's medical experience
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3.
Strengthen the construction of grass-roots service capacity
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In accordance with the basic standards of community hospitals, encourage qualified community hospitals to gradually provide ophthalmic medical services
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Relying on urban medical groups and county medical associations, guide the extension of appropriate medical technologies for eye disease prevention and treatment to the grassroots level, promote the application of effective vision screening and fundus screening technologies at the grassroots level, and implement eye disease prevention and control measures
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Improve the two-way referral and upper-lower linkage mechanism to provide reasonable diagnosis and treatment and upward-referral services for patients with eye diseases
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4.
Strengthen the implementation of the combination of prevention and control requirements
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Strengthen the cooperation between medical institutions and disease prevention and control institutions, maternal and child health care institutions, and rehabilitation institutions, carry out inter-institutional and interdisciplinary cooperation, establish a working mechanism that combines medical treatment, prevention, and rehabilitation of ophthalmic diseases, and provide patients with continuous screening-diagnosis-treatment-follow-up type medical services
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Strengthen the prevention and control of myopia in children and adolescents, eye care for children aged 0-6, and rehabilitation of low vision, and promote the improvement of the integration model of medical treatment and prevention
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Promote the organic combination of traditional Chinese medicine ophthalmology and modern ophthalmology new technologies and methods, and give play to the unique role of traditional Chinese medicine ophthalmology in the prevention and treatment of eye diseases
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(3) Strengthen the construction of ophthalmology professionals
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1.
Optimize the team of professional and technical personnel in ophthalmology
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Strengthen the training and training of ophthalmic medical staff to form a stable and reasonable team of ophthalmic professionals
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At the end of the "14th Five-Year Plan", the total number of ophthalmologists will exceed 50,000, and the number of ophthalmologists per 100,000 population will exceed 3.
6
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Strengthen the introduction and training of leaders and key physicians in the ophthalmology department, focus on cultivating high-level compound ophthalmic medical talents, form a group of high-level leading talents and innovative teams, and promote the high-quality development of the ophthalmologist team
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2.
Strengthen the standardized training of ophthalmology residents
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With the cultivation of clinical diagnosis and treatment capabilities as the core, the standardized training of resident physicians is further promoted, so that clinicians have good professional ethics, solid medical theoretical knowledge and clinical skills, and standardize the diagnosis and treatment of ophthalmic diseases
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Further improve the linkage mechanism between standardized training and professional title promotion for ophthalmologists
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3.
Strengthen continuing medical education and training
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Give full play to the technical advantages of national and provincial blind prevention technical steering groups and ophthalmology professional associations, and conduct training for eye disease prevention and control managers and professional technicians
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Establish a high-quality teaching team, carry out different forms of continuing education through online and offline, and improve the clinical technical ability and level of ophthalmologists
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(4) Strengthen the quality management of ophthalmic medical care
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1.
Standardize clinical diagnosis and treatment behavior
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Strengthen the awareness of ophthalmologists to practice in accordance with the law, strictly implement the core system of medical quality and safety, and ensure the quality and safety of medical care
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Further improve the technical documents such as ophthalmology-related diagnosis and treatment specifications, clinical pathways and diagnosis and treatment guidelines, strengthen the management of ophthalmic drugs and clinical diagnosis and treatment technology applications, and standardize the clinical diagnosis and treatment behavior of ophthalmologists
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2.
Strengthen the construction of ophthalmic medical quality management and control system
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With the construction of quality control centers at all levels as the core, improve the quality control organization system of ophthalmic professional medical care
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With key ophthalmic diseases and key technologies as the main line, improve the quality control index system of ophthalmic diseases
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With the goal of improving the quality level and technical capabilities of ophthalmic medical care, strengthen the application of quality control indicators, strengthen the collection, analysis and feedback of medical quality and safety data, and carry out quality improvement work
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V.
Strengthen the prevention and treatment of key eye diseases in key populations (1) Improve the level of myopia prevention and treatment
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1.
Promote the prevention and control of myopia in children and adolescents
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Fully implement the requirements of the "Implementation Plan for Comprehensive Prevention and Control of Myopia in Children and Adolescents" and "Guidelines for Appropriate Technical Guidelines for the Prevention and Control of Myopia in Children and Adolescents"
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Formulate and revise relevant standards for the prevention and control of myopia, and form a standard system for children and adolescents' vision health
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Strengthen eye care and vision examination services for children aged 0-6
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Promote the monitoring and intervention of myopia and risk factors in children and adolescents, carry out special monitoring of myopia through the national monitoring system for common diseases and health influencing factors of students, and strive to achieve 100% coverage of myopia monitoring in counties (districts) throughout the country during the "14th Five-Year Plan" period, and dynamically grasp the whole country.
Changes in myopia rate and risk factors in children and adolescents
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Gradually expand the population of primary and secondary school students for vision screening, strengthen the construction of a vision monitoring network, and carry out targeted interventions such as experts entering the campus and health month activities for primary and secondary school students
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2.
Promote the scientific correction of myopia
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Guide medical institutions to implement the "Guidelines for the Prevention and Treatment of Myopia" and other requirements, carry out optometry and other inspections scientifically, strengthen early warning and intervention for patients with high myopia, improve the ability of early diagnosis and early control of myopia, and reduce visual damage caused by high myopia
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Guide medical institutions to standardize the development of myopia correction services, formulate and improve clinical application specifications such as orthokeratology lenses, strengthen the supervision of myopia-related surgical operations, and continue to improve eREC
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(2) Improve the level of cataract recovery
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Promote the implementation of the rural revitalization strategy, solidly promote the "Thousand Counties Project", deepen the tertiary hospitals to help the county hospitals, continue to carry out activities such as the Bright Project and Bright Walk, promote the sinking of cataract surgery technology, and improve the capacity of county hospitals for cataract surgery
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At the end of the "14th Five-Year Plan", more than 90% of county hospitals that have reached the recommended standards for comprehensive service capabilities of county-level hospitals will carry out cataract restoration surgery, and the national CSR will reach more than 3,500 (provinces with a CSR that has not reached 3,000 at the end of the "13th Five-Year Plan" period) strive to increase every year.
5%)
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Guide medical institutions to standardize cataract restoration surgery, promote the clinical application of small incision extracapsular cataract extraction or phacoemulsification, strengthen surgical quality management, establish and improve postoperative follow-up systems, and improve eCSC
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(3) Improve the ability of early diagnosis and treatment of eye diseases such as fundus diseases and glaucoma
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Promote the early detection, early diagnosis, and early treatment of glaucoma, as well as diabetic retinopathy, myopic retinopathy, macular degeneration, retinal vascular occlusion, hypertensive fundus disease and other fundus diseases, formulate diagnosis and treatment standards for key diseases, and improve the management model for chronic eye disease patients.
Reduce disease burden and blindness
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Continue to promote the construction of ophthalmology-related medical alliances, promote the gradual coverage of fundus photography screening technology in primary medical and health institutions, explore the establishment of a service model of "primary inspection and higher-level diagnosis", and improve the diagnosis and treatment capabilities of fundus diseases, glaucoma and other eye diseases
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Implement technical plans for hierarchical diagnosis and treatment of ophthalmic diseases such as diabetic retinopathy, promote the implementation of the "Thousand-County Project", build a chronic disease management center in county-level general hospitals, steadily promote the contracted service of family doctors, and build a chronic eye disease management system
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(4) Improve the ability to treat corneal blindness
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Relying on existing medical resources, rationally plan and standardize the construction of eye banks
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Implement the requirements of "Eye Bank Management Standards" and "Eye Bank Operation Technical Guidelines", standardize the acquisition, processing, preservation and use of donor corneas, and ensure the traceability of donor corneas
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Strengthen the clinical application management of corneal transplantation technology, and implement quality control of the whole process of corneal transplantation
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Establish a corneal donation model in line with China's national conditions, increase publicity efforts, encourage social participation, advocate corneal donation, and expand the source of corneal donors
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Attach importance to talent team building and related technical training, improve the level of corneal transplantation, and achieve 100% coverage of corneal transplantation technology in all provinces across the country
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(5) Improve the level of prevention and treatment of other eye diseases
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Monitor the prevalence of trachoma and consolidate the achievements in eliminating blinding trachoma
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Strengthen the screening and treatment of neonatal eye diseases, especially retinopathy of prematurity, standardize the treatment of premature infants, and reduce the incidence and blindness of retinopathy of prematurity
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Further improve the treatment level of strabismus amblyopia, ocular surface diseases, orbital diseases, ocular trauma and other eye diseases
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Strengthen the diagnosis and treatment services of hereditary eye diseases
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VI.
Build an eye health service support platform (1) Strengthen the construction of an eye health service platform for children aged 0-6
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Combined with national basic public health services, eye care and vision examinations for children aged 0-6 are implemented to ensure that the coverage rate of examinations reaches more than 90%
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Implement the "0-6-year-old Children's Eye Care and Vision Examination Service Specifications (Trial)", give full play to the linkage role of primary medical and health institutions, maternal and child health care institutions, and ophthalmology departments in general hospitals, and build children's eye care with division of labor, different priorities, and close cooperation.
Service network, early screening of common eye diseases in children and correction of poor vision
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Promote the establishment of electronic files for children and adolescents' vision health, update the refractive development health data in a timely manner, and transfer them in real time with children and adolescents entering school
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(2) Strengthen the construction of low vision diagnosis and treatment and rehabilitation platform
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Continue to improve the low vision outpatient setting rate of ophthalmology departments of tertiary general hospitals and ophthalmology specialty hospitals
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Encourage qualified tertiary general hospitals and ophthalmology hospitals to carry out low vision rehabilitation work such as visual function assessment, rehabilitation needs assessment, formulation and implementation of rehabilitation plans
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Improve the referral mechanism of ophthalmic medical institutions and low vision rehabilitation institutions, and smooth the two-way referral channel
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Strengthen the construction of low vision rehabilitation talent team, strengthen the standardized training of low vision rehabilitation technology, and improve the low vision rehabilitation ability of ophthalmic medical staff
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(3) Strengthen the construction of eye health information platform
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Actively promote the application of the "Internet +" medical service model in the field of ophthalmology, and use Internet diagnosis and treatment, telemedicine and other information technologies to improve the accessibility of ophthalmic medical services
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Promote the deep integration of emerging technologies such as big data, artificial intelligence, and 5G with ophthalmic services, and carry out the application of artificial intelligence in the prevention, diagnosis and follow-up of eye diseases, and improve the ability of early screening of eye diseases
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Establish an ophthalmology case database, strengthen the collection and statistical analysis of ophthalmology case data, and provide data support for clinical scientific research
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(4) Strengthen the construction of eye health science popularization platform
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Establish and improve the public welfare eye health science knowledge base and popular science publicity platform
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Give full play to the technical advantages of ophthalmology professionals, use new mainstream media to strengthen eye health education, enhance public awareness of eye disease prevention, and create a good social atmosphere
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Focusing on "focusing on universal eye health" as the main line, focusing on time nodes such as National Eye Care Day and World Vision Day, strengthen the publicity of eye health science
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Guide ophthalmic medical institutions to organize public welfare activities such as free eye disease diagnosis and popular science education during winter and summer vacations and other peak periods for children and adolescents
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(5) Strengthen the construction of eye health scientific research platform
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Adhere to the development ideas of technological innovation, strengthen clinical diagnosis and treatment technology innovation and application research, and promote the transfer, transformation and popularization of research results
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Give full play to the role of the National Ophthalmology Clinical Research Center and its collaborative research network to carry out collaborative research in clinical, public health, and health economics
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Strengthen epidemiological research on key eye diseases, monitor the prevalence, incidence, and changes of disease spectrum of major blinding eye diseases in China, and grasp the situation of eye diseases and their social and economic burdens in China
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7.
Organization and implementation (1) Strengthen organizational leadership
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Health administrative departments at all levels should attach great importance to eye health and blindness prevention and cure, strengthen the implementation of responsibilities, and make it a priority for the construction of a healthy China
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Strengthen communication and coordination with the Disabled Persons' Federation, education, civil affairs, finance and other departments to form policy synergy
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Pay attention to the construction and evaluation of blindness prevention technical steering groups at all levels to ensure that the work has achieved practical results
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(2) Responsibility for implementing goals
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All provincial health administrative departments should formulate regional work plans before the end of March 2022, formulate timetables and roadmaps, clarify the division of labor, and implement responsibilities based on this plan and the actual situation in the region
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Where conditions permit, special work on eye health can be carried out to promote the development of eye health work
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(3) Strengthen monitoring and evaluation
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All provincial health administrative departments should formulate a monitoring and evaluation plan for the development of eye health in their respective regions during the "14th Five-Year Plan" period, and do a good job in dynamic monitoring and evaluation of the implementation of the plan
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Regularly monitor and evaluate the progress of the work, find problems in a timely manner and study and solve them
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The National Health and Health Commission will evaluate and report the implementation of the plans by the provincial health and health administrative departments in due course
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(4) Strengthen publicity and guidance
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Health administrative departments at all levels should attach importance to eye health-related publicity work and strengthen personnel policy training
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It is necessary to give full play to the role of the media, improve social recognition and support, and create a good social atmosphere for the implementation of various policies and measures
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Annex: Interpretation of indicators 1.
Effective Refractive Error Correction Coverage (eREC) Definition: The number of people who have received refractive error correction (such as spectacles, contact lenses or refractive surgery) and obtained high-quality results ratio of people
.
Taking into account the impact of near vision impairment on quality of life and productivity, both distance and near vision effective refractive error correction coverage need to be included in the global monitoring of eREC
.
Recommended calculation method for effective refractive error correction coverage for distance vision: ((a+b)/(a+b+c+d))×100
.
a: Wearing spectacles or contact lenses due to distance vision impairment; UCVA <6/12 and PVA ≥ 6/12 in the eye with better vision (meeting the needs of eye health services); b: eye with a history of refractive surgery and better vision UCVA ≥ 6/12 (meeting the need for eye health services); c wear glasses or contact lenses or have a history of refractive surgery due to distance vision impairment, UCVA < 6/12 and PVA < 6/12 in eyes with better vision , but can be improved to ≥6/12 through pinhole lenses or refractive correction (not fully meeting the needs of eye health services); d is no vision correction, the UCVA of the eye with better vision is less than 6/12, and the eye can pass through the pinhole Mirror or refractive correction improved to ≥6/12 (unmet need for eye health services)
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Recommended calculation method for effective refractive error correction coverage for near vision: (a/(a+b+c))×100
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a: Wearing spectacles due to near vision impairment, UCVA <N6 at 40 cm of the eye with better vision, and PVA ≥ N6 in the eye with better vision (meeting the needs of eye health services); b Wearing spectacles due to near vision impairment , the distance BCVA of at least one eye is greater than or equal to 6/12, and the PVA of the eye with better vision is <N6 (the needs of eye health services are not fully met); c means there is uncorrected near vision impairment, and the distance of at least one eye is BCVA ≥ 6/12, and UCVA < N6 in eyes with better vision (unmet need for eye health services)
.
Remarks: UCVA is uncorrected visual acuity, and uncorrected visual acuity is measured for those who wear glasses (frame glasses or contact lenses).

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PVA is daily life visual acuity, which is measured by spectacle wearers (glasses or contact lenses)
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BCVA is best corrected visual acuity obtained by pinhole lens or optometry
.
When calculating the eREC for near vision, only individuals with a distance BCVA ≥ 6/12 were included in order to exclude other causes of near vision impairment
.
2.
Effective cataract surgery coverage (eCSC) Definition: The proportion of people aged 50 years and older who have undergone cataract surgery and who have good distance vision after surgery to those who need cataract surgery
.
Recommended calculation method: ((a+b)/(c+d+e))×100
.
a is unilateral cataract surgery, the PVA of the operated eye is ≥6/12, the BCVA of the contralateral eye is less than 6/12, and the main cause of visual impairment or blindness in the contralateral eye is cataract; b is bilateral cataract surgery, at least one eye is operated on Posterior PVA ≥ 6/12; c is unilateral cataract surgery (regardless of the visual acuity of the eye), BCVA of the contralateral eye is <6/12, and the main cause of visual impairment or blindness in the contralateral eye is cataract; d is bilateral cataract surgery (regardless of the visual acuity of the operating eye); e is BCVA < 6/12, and the main cause of visual impairment or blindness in both eyes is cataract
.
Remarks: The above measurements are for distance vision
.
PVA is daily life visual acuity, which is measured by spectacle wearers (glasses or contact lenses)
.
BCVA is best corrected visual acuity obtained by pinhole lens or optometry
.
Policy Interpretation: 1.
Why is the "Plan" issued? The Party Central Committee and the State Council attach great importance to eye health work.
Since the 1980s, the national level has successively issued plans for blindness prevention, blindness treatment and eye health, clarifying the main tasks and measures at different stages, and continuously improving the eye health management system, technical guidance system and service system.

.
During the "13th Five-Year Plan" period, my country has made remarkable achievements in the field of eye health, and the age-standardized prevalence of blindness is lower than the global average.

.
General Secretary Xi Jinping has made important instructions on the problem of myopia in children and adolescents six times, calling on "the whole society to take action to jointly care for children's eyes and let them have a bright future"
.
The "Healthy China 2030" Planning Outline clearly requires that we continue to carry out blindness prevention and cure
.
However, the problem of insufficient total and uneven distribution of ophthalmic medical resources in China still exists, and the work of eye health has a long way to go
.
The promulgation of the "Plan" will help promote the high-quality development of eye health in China during the "14th Five-Year Plan" period
.
2.
What are the guiding ideology and basic principles of the Plan? Guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully implement the spirit of the 19th National Congress of the Communist Party of China and all the 19th Plenary Sessions, focus on the health of the people, and promote high-quality development as the theme, so as to meet the people's multi-level and diverse vision.
With health needs as the starting point and end point, we will implement the Healthy China strategic deployment, further build a high-quality and efficient eye health service system, and strive to provide the people with eye health services covering the entire life cycle
.
During the "14th Five-Year Plan" period, to promote the high-quality development of eye health business, we must follow the basic principles of "three adherences and two key points", that is, adhere to overall planning and resource integration, adhere to improving quality and efficiency, and adhere to high-quality development, adhere to the combination of prevention and prevention, Focus on key populations and key eye diseases
.
3.
During the "14th Five-Year Plan" period, what are the tasks and specific goals for the development of my country's eye health work? During the "14th Five-Year Plan" period, efforts will be made to strengthen the construction of the ophthalmic medical service system, capacity building, and talent team, continue to improve the ophthalmic medical quality control system, and promote the expansion and extension of high-quality ophthalmic medical resources
.
Effectively promote the prevention and control and scientific correction of myopia in children and adolescents, further improve the ability of cataract recovery, gradually improve the screening ability of primary medical and health institutions for diabetic retinopathy and other fundus diseases, and promote the orderly development of corneal donation
.
By 2025, strive to achieve the following goals: First, the annual coverage rate of eye care and vision examinations for children aged 0-6 will reach more than 90%, and the overall level of children and adolescents' eye health will continue to improve
.
Second, the coverage rate of effective refractive error correction continues to increase, and the number of people with visual impairment caused by high myopia is gradually decreasing
.
The third is that the cataract surgery rate for the country's population of one million has reached more than 3,500, and the coverage rate of effective cataract surgery has continued to increase
.
4.
During the "14th Five-Year Plan" period, how to further promote the development of my country's ophthalmic medical service system? During the "14th Five-Year Plan" period, in order to promote the high-quality development of China's ophthalmic medical service system, we must focus on the following aspects: First, strengthen the construction of ophthalmology and ophthalmology specialized hospitals in general hospitals, and gradually establish and improve the national-regional-provincial-city - The county-level five-level ophthalmic medical service system optimizes the layout of medical resources
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Build an ophthalmology highland, give play to the technical leadership and radiation driving role of each center, and improve the overall service capability of ophthalmology
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Build an eye health service network suitable for China's national conditions, provide comprehensive, fair and accessible eye health services, and strengthen the construction of an eye medical service system
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The second is to improve the ability of ophthalmic medical services, focusing on children and elderly patients, focusing on improving the ability of scientific correction of myopia, cataract surgery, and common eye disease screening
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Improve the efficiency of ophthalmic medical services and build a "separation of rapid and slow" model
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Strengthen the construction of grass-roots service capacity, and promote the application of effective vision screening and fundus screening technologies at the grass-roots level
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Strengthen the implementation of the requirements for the combination of prevention and treatment, establish a working mechanism that combines medical treatment, prevention and rehabilitation of ophthalmic diseases, and provide patients with continuous diagnosis and treatment services of screening-diagnosis-treatment-follow-up
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The third is to optimize the team of ophthalmic professional and technical personnel, strengthen the training and training of ophthalmic medical personnel, and form a stable and reasonable team of ophthalmic professionals
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Strengthen the standardized training of ophthalmologists, and further improve the connection mechanism between the standardized training of ophthalmologists and the promotion of professional titles
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Strengthen continuing medical education and training, and improve the clinical technical ability and level of ophthalmologists
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The fourth is to standardize the behavior of clinical diagnosis and treatment, strengthen the awareness of ophthalmologists to practice in accordance with the law, strictly implement the core system of medical quality and safety, and ensure the quality and safety of medical care
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Strengthen the construction of ophthalmic medical quality management and control system, and improve the quality of ophthalmic medical care
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5.
During the "14th Five-Year Plan" period, how to strengthen the prevention and treatment of eye diseases? During the "14th Five-Year Plan" period, the prevention and control of eye diseases should be strengthened from the following aspects: First, the comprehensive implementation of the "Implementation Plan for the Comprehensive Prevention and Control of Myopia in Children and Adolescents" and the "Guidelines for Appropriate Techniques for the Prevention and Control of Myopia in Children and Adolescents" and other requirements, promote the prevention and control of myopia in children and adolescents
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Guide medical institutions to implement the "Guidelines for the Prevention and Treatment of Myopia" and other requirements, promote scientific myopia correction, and improve the level of myopia prevention and correction
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The second is to promote the decline of cataract restoration surgery technology and improve the capacity of county hospitals for cataract restoration surgery
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Guide medical institutions to carry out cataract restoration surgery in a standardized manner, strengthen surgical quality management, establish and improve postoperative follow-up systems, and improve the coverage of effective cataract surgery
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The third is to promote the early detection, early diagnosis and early treatment of fundus diseases, glaucoma and other eye diseases, and improve the management model of chronic eye disease patients
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Promote the construction of ophthalmology-related medical alliances, and promote the gradual coverage of fundus photography screening technology
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Promote the implementation of the "Thousand-County Project", build a chronic disease management center in county-level general hospitals, build a chronic disease management system, and improve the ability of early diagnosis and early treatment of eye diseases such as fundus diseases and glaucoma
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Fourth, rationally plan and standardize the construction of eye banks, and standardize the acquisition, processing, preservation and use of donor corneas
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Attach importance to talent team building and related technical training, strengthen the management of the clinical application of corneal transplantation technology, implement quality control of the whole process of corneal transplantation, and improve the ability to treat corneal blindness
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The fifth is to consolidate the achievements in eliminating blinding trachoma, improve the treatment level of eye diseases such as neonatal eye diseases, strabismus amblyopia, ocular surface diseases, orbital diseases, and ocular trauma, and strengthen the diagnosis and treatment services for hereditary eye diseases
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6.
During the "14th Five-Year Plan" period, which eye health support platforms should be strengthened? In order to provide high-quality eye health services, the following five supporting platforms must be built: First, strengthen the construction of eye health service platforms for children aged 0-6, and implement eye care and vision examinations for children aged 0-6 in combination with national basic public health services , to build a children's eye care service network with division of labor, different priorities, and close cooperation, early screening of common eye diseases in children and correction of poor vision
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The second is to strengthen the construction of low vision diagnosis and treatment and rehabilitation platforms, continue to increase the low vision outpatient setting rate in ophthalmology departments of tertiary general hospitals and ophthalmology specialist hospitals, and improve the referral mechanism for ophthalmic medical institutions and low vision rehabilitation institutions
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The third is to strengthen the construction of an eye health information platform, actively promote the application of the "Internet +" medical service model in the field of ophthalmology, and use Internet diagnosis and treatment, telemedicine and other information technologies to improve the accessibility of ophthalmic medical services
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The fourth is to strengthen the construction of eye health science popularization platform, establish and improve the public eye health science knowledge base and science popularization platform, with the main line of "focusing on universal eye health", and the national eye love day, the world vision day and other time nodes as the focus.
Strengthen the publicity of eye health science
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The fifth is to strengthen the construction of eye health scientific research platforms, strengthen the innovation and application of clinical diagnosis and treatment technology, promote the transfer, transformation and application of research results, strengthen epidemiological research on key eye diseases, and monitor the prevalence of major blinding eye diseases in China.
Incidence and disease spectrum changes
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Expert Interpretation 1 Eye health is an important part of physical and mental health, involving the entire life cycle of people of all ages, and is a major public health and social problem involving people's livelihood
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The introduction of the "14th Five-Year Plan for National Eye Health" (hereinafter referred to as the "Plan") is an important reality for promoting the high-quality development of China's eye health cause during the "14th Five-Year Plan" period and improving the people's eye health level.
meaning
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1.
Focus on the two key populations of children, adolescents and the elderly.
The research shows that uncorrected refractive errors and cataracts are the top two blinding eye diseases in China.
Children, adolescents and the elderly are the most vulnerable to these two eye diseases in all age groups.
people
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During the "14th Five-Year Plan" period, China's eye health work focused on these two groups of people, which played a vital role in improving the level of eye disease prevention and treatment in China
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In terms of myopia prevention and control, during the "13th Five-Year Plan" period, myopia prevention and control was included in the government performance assessment, forming a good atmosphere of "government leadership, department cooperation, expert guidance, school education, and family attention"
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The establishment of ophthalmology-related courses, the training of ophthalmologists and optometrists and other measures have helped the construction of professional talent teams
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During the "14th Five-Year Plan" period, based on the improvement of service availability, further attention was paid to the improvement of service quality
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The concept of effective refractive error correction coverage (eREC) is explicitly used to measure the coverage and quality of refractive error correction services
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In terms of cataract prevention and treatment, by 2020, the cataract surgery rate (CSR) for one million people in China has exceeded 3,000, an increase of nearly 38 times in the past 30 years
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During the "14th Five-Year Plan" period, the measures for improving the ability of cataract restoration surgery in the "Plan" will effectively ensure that the capacity of county hospitals in China to carry out cataract restoration surgery is greatly improved, and at the same time, the CSR will reach 3500 or more
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And the "Plan" emphasizes the need to strengthen the management of surgical quality and postoperative follow-up, and continuously improve the effective cataract surgery coverage (referred to as eCSC)
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2.
Clearly improve the level of prevention and treatment of myopia during the "13th Five-Year Plan" period, General Secretary Xi Jinping has made important instructions and instructions on the problem of myopia in children and adolescents many times, requiring the whole society to take action and jointly take good care of children's eyes
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The state has successively formulated and issued the "Implementation Plan for Comprehensive Prevention and Control of Myopia in Children and Adolescents", "Guidelines for Myopia Prevention and Control", and "Guidelines for Appropriate Techniques for Myopia Prevention and Control in Children and Adolescents" to guide the prevention and control of myopia in various places
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The prevention and control of myopia must move forward
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The "Plan" emphasizes the need to strengthen the eye care and vision examination services for preschool children aged 0-6, advocates prevention and physical fitness to prevent myopia, encourages ophthalmologists to enter the campus for popular science publicity, and carry out health month activities for primary and secondary school students
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Adhere to government leadership, multi-department cooperation, and the participation of the whole society, strive to achieve 100% coverage of myopia monitoring in counties (districts) nationwide, and form a vision health standard system for children and adolescents
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For children and adolescents who have been shortsighted, it is emphasized to carry out scientific optometry
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Improve the ability of early diagnosis and prevention of myopia, strengthen the scientific correction of myopia, so as to delay the progress of myopia and avoid secondary injuries caused by improper use of products; those who have developed high myopia should implement intervention measures as soon as possible to reduce disability and blindness
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In the process of carrying out myopia correction services for children and adolescents and myopia surgery for adults, medical institutions at all levels must strictly abide by the clinical application specifications to ensure the quality and safety of medical care
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3.
Clarify the meaning of two new indicators eREC and eCSC In 2020, the World Health Organization proposed the 2030 global eye health goals
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It is proposed that countries with a 40% increase in eREC and a baseline effective coverage rate of 60% or higher by 2030 should strive to achieve universal coverage; countries with a 30% increase in eCSC and a baseline effective coverage rate of 70% or higher should strive to achieve universal coverage
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These two indicators, eREC and eCSC, can monitor the scope and quality of eye health services around the world.
They can not only reflect the availability of cataract surgery and refractive correction services in a certain population, but also reflect the quality of services
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With the development of China's economy and the improvement of national health awareness, the public's requirements for the quality of eye health services are also gradually increasing.
The focus of China's eye health work has entered the stage of high-quality development of the ophthalmic medical service system
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Therefore, during the "14th Five-Year Plan" period, these two indicators are included in the "Plan" and used as indicators in the evaluation system of eye health services in China, which will help patients to "see clearly" under the premise of "seeing".
, to achieve high-quality development of eye health services in China
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4.
Efforts to strengthen the construction of information platform The "Plan" emphasizes the construction of an eye health service platform
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China's large population base, vast territory, and rapid population aging process have led to the rapid growth of demand for ophthalmic services and the relative lack of ophthalmic resources in remote areas.
The eye health information platform is of great significance to solve this problem
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Compared with traditional diagnosis and treatment, Internet diagnosis and treatment, telemedicine and other information technologies are conducive to the effective downward movement of high-quality ophthalmic medical resources, and can effectively improve the accessibility and affordability of ophthalmic medical services
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At the same time, promoting the deep integration of emerging technologies such as big data, artificial intelligence, and 5G with ophthalmic services is conducive to consultation, referral and follow-up, and greatly facilitates the treatment of common eye diseases, especially chronic disease-related fundus diseases (such as diabetic retinopathy, macular disease, etc.
), diagnosis and treatment in stable period, screening for complications, and regular follow-up
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Informatization construction helps improve the efficiency of ophthalmic diagnosis and treatment services, the effective integration and rational application of ophthalmic resources, and is conducive to the precise prevention and treatment of ophthalmic diseases and slowing down the process of blindness
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The establishment of an ophthalmology case database helps to accumulate a large amount of ophthalmology data.
On the one hand, it can provide data support for clinical scientific research, and on the other hand, it is conducive to the real-time optimization and iteration of artificial intelligence model algorithms, providing high-quality data support for eye disease diagnosis models, and realizing a virtuous circle
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5.
Pay attention to the early prevention of eye diseases The "Plan" emphasizes "prevention first, combined with prevention and treatment", so as to achieve "move forward", in addition to continuing to strengthen the capacity building of grass-roots ophthalmology services, the construction of eye health science popularization platform also plays an important role
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Popular science propaganda and health education are "social vaccines" for disease prevention and control
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In the work of eye health science, we need to highlight the key concept of "everyone is the first responsible person for their own eye health", and transform the knowledge of eye care and eye care into good eye health behaviors
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In addition, to run through the concept of both scientific and popular science, it is necessary not only to rely on the technical advantages of ophthalmology professionals to transmit correct scientific knowledge, but also to convey eye health knowledge in an easy-to-understand and simple-to-understand way, so as to do To effective popular science, improve the awareness of eye care and eye care, and help prevent eye diseases
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Promoting children's vision health has become the top priority of China's eye health work.
0-6 years old is a critical period for the development of children's eye structure and visual function.
The visual development before the age of 6 affects children's lifelong visual quality.
Early monitoring, early detection, early warning and early intervention are crucial
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To carry out eye care and vision examinations for children aged 0-6 and establish vision files, it is necessary to give full play to the role of primary medical and health institutions, and at the same time, strengthen cooperation with maternal and child health care institutions, and build a children's eye care service network with clear division of labor, different priorities, and close cooperation.

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In short, with the continuous advancement of blindness prevention and blindness and eye health work in China, the development of China's eye health career has gradually changed from disease treatment to people's health.
Improve and build the eye health system, and promote the high-quality development of China's eye health cause
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Expert Interpretation 2 Entering the new journey of the "14th Five-Year Plan", with the continuous change of life>
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In this context, the "14th Five-Year Plan for National Eye Health (2021-2025)" (hereinafter referred to as the "Plan") was officially released, marking that China's eye health work has entered a new stage of high-quality development.
It is of great guiding significance for health workers to strengthen their confidence, build consensus, and promote the sustainable development of eye health work
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The "Plan" closely focuses on "high-quality development", and has made a comprehensive and systematic plan for the construction of the medical service system, the prevention and treatment of key eye diseases in key groups, and the construction of service support platforms
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Starting from the four dimensions of ophthalmic medical service system construction, service capacity building, professional talent team construction, and medical quality management, the path and measures to strengthen the construction of the ophthalmic medical service system are expounded incisively.
direction
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1.
Emphasizing "making up for shortcomings" and "strengthening advantages", it is necessary to grasp the overall layout of the ophthalmic medical service system with both hands.
The "Plan" proposes a "national-regional-provincial-city-county" five-level ophthalmic medical service system.
Emphasis is placed on promoting the expansion and extension of high-quality resources
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The "Plan" proposes important measures to "make up for shortcomings and strengthen the grassroots", such as setting up ophthalmology departments in general hospitals above the second level, and encouraging qualified county-level hospitals to independently set up ophthalmology departments and provide outpatient services
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The overall improvement of ophthalmic medical service capabilities also needs to strengthen the leading role of the "national team" in the entire system, so it is necessary to pay attention to "strong advantages" while "making up for shortcomings"
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The "Planning" especially emphasizes the importance of building an ophthalmology highland.
It is necessary to take the construction of national medical centers and national regional medical centers as the starting point, and give full play to the leading role of the center's technology and radiation
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During the operation of the five-level ophthalmic medical service system, each link can perform its own duties and operate collaboratively.
Conducive to the promotion and implementation of hierarchical diagnosis and treatment
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2.
Using information technology to provide comprehensive, fair and accessible eye health services The fairness and accessibility of medical resources has always been a concern of the people.
In order to solve this problem, the "Planning" encourages strong ophthalmology specialists The ophthalmology department of the hospital and the general hospital took the lead in establishing a specialist alliance to integrate resources to drive the improvement of overall service capabilities.
On the basis of building two eye health work networks in cities and counties, the telemedicine collaboration network allows high-quality ophthalmology medical resources to be extended to the grassroots more efficiently
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In order to achieve this goal, we can make full use of the advantages of remote diagnosis and treatment and Internet hospitals in terms of efficiency, convenience, and personalization, open up online and offline services, and form an Internet-based professional alliance medical service network, which will effectively promote the scale and development of eye health medical services.
Normalization and accessibility play an important role in sinking medical resources, especially during the normalization of epidemic prevention and control to facilitate people to seek medical treatment nearby
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On this basis, the integration and development of digital technology and medical services can be further deepened, and new-generation information and communication technologies such as 5G, big data, cloud technology, and artificial intelligence technology can be integrated and deeply applied in actual ophthalmic medical service scenarios, allowing remote eye care.
Health services are smarter, more efficient, more accurate and safer
.
3.
Emphasize the combination of prevention and treatment, and provide continuous eye health services throughout the life cycle.
With the development of the times, more and more people realize that the development of eye health has changed from focusing on disease treatment to focusing on people's eye health
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The "Plan" has repeatedly mentioned the importance of the combination of prevention and treatment and life-cycle services, established the basic principle of "prevention first and combined prevention and treatment", and encouraged the multi-dimensional integration of medical institutions, disease prevention and control institutions, maternal and child health care institutions, and rehabilitation institutions.
Combined, build a screening-diagnosis-treatment-follow-up continuous diagnosis and treatment life-cycle service system
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Taking the prevention and control of myopia as an example, the prevention and control of myopia in children and adolescents is currently included in the government performance assessment.
The "Plan" not only emphasizes relevant content in many places, but also puts forward clear and specific goals for relevant indicators
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In fact, the prevention and treatment of myopia is a task that is the priority of prevention and runs through the whole life cycle.
Before the age of 3, a file of refractive development should be established as soon as possible, and precise intervention should be carried out in combination with family history and other circumstances
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After the establishment of refractive development files, continuous tracking, observation, and classification interventions should be carried out at different ages to ensure the accuracy of popular science, standardization of screening, and standardization of diagnosis and treatment in the whole process
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At present, some areas have already tried to build cloud-based refractive files based on the Internet, and actively build a benign "prevention-control-treatment" system of "school-community-medical institution-family", which effectively ensures the prevention and control of myopia throughout the life cycle.
It is worthy of further improvement and promotion
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4.
Promote day surgery and appointment diagnosis and treatment to improve the efficiency of medical services.
Day surgery is a rapidly developing surgical medical service model.
Ophthalmology is more suitable for day surgery or even outpatient clinics due to the characteristics of disease diagnosis and treatment under the premise of ensuring the quality of medical care.
Surgery is very beneficial to improve service efficiency
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The "Planning" clearly proposes to expand the scope of ambulatory surgeries, and to continuously increase the proportion of ambulatory surgeries in elective surgeries.
The third-level ophthalmology hospital specifically requires it to reach more than 60%, which will greatly promote the efficiency of ophthalmic medical services
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In addition, the "Planning" also emphasizes the establishment of a "separation of acute and slow" mode, and promotes an information-based ophthalmology clinic and day surgery service appointment diagnosis and treatment system, which will help further improve the efficiency of medical services and improve the patient experience
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5.
Pay attention to the construction of talent team and focus on the cultivation of high-level compound talents.
"The strength of a country is due to people, and the success of talents is due to learning.
" The high-quality development of the eye health medical service system depends on the construction of a high-quality talent team and high-quality Talent training system
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The "Plan" proposes that by the end of the "14th Five-Year Plan", the total number of ophthalmologists will exceed 50,000, and the number of ophthalmologists will exceed 3.
6 per 100,000 population.

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On the basis of quantitative goals, the "Plan" especially emphasizes "focusing on cultivating high-level compound ophthalmic medical talents" and focusing on "high-level leading talents and innovative teams", which is consistent with the general idea of ​​high-quality development of eye health medical services.
It is to ensure that the team of ophthalmologists develops in a stable, reasonable and high-quality direction with the continuous increase of the base
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In terms of the training system, the "Planning" focuses on the two major points of standardized training for residents and continuing medical education, emphasizing the training orientation of "clinical diagnosis and treatment ability as the core", and guides the transformation of ophthalmology education to the improvement of clinical technical ability level, so that ophthalmologists are more Standardized and homogenized diagnosis and treatment work
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