On January 4th, 2022, in order to effectively carry out eye health work during the "14th Five-Year Plan" period in China, further improve the eye health level of the people, and continuously promote the high-quality development of China's eye health cause, the National Health Commission issued a notice on the "14th Five-Year Plan National Visual Health Plan (2021-2025)", which pointed out that by 2025, efforts will be made to achieve an annual coverage rate of 90% or more for eye health and vision examinations for children aged 0-6 years, and the overall level of visual health of children and adolescents will continue to improve. The effective coverage rate of refractive error correction will continue to increase, and the number of people with visual impairment caused by high myopia will gradually decrease. The following is the content of the document:

"National Plan for Vision Health during the 14th Five-Year Plan Period (2021-2025)"

Eye health is an important component of national health, involving people of all ages throughout their lifespan. Visual impairments, including blindness, seriously affect the physical and mental health and quality of life of the population, increase the burden on families and society, and are a public health and social issue affecting the wellbeing of the people. To continue promoting the high-quality development of China's eye health during the "14th Five-Year Plan" period and further improve the eye health level of the people, this plan has been developed.

I. Background of the Plan

The CPC Central Committee and the State Council attach great importance to eye health work. Since the 1980s, the state has continuously introduced blindness prevention and eye health-related plans and policies, strengthened top-level design, clarified task objectives, proposed specific measures, and continuously improved the eye health management system, technical guidance system, and medical service system. Focusing on the prevention and treatment of eye diseases such as trachoma, cataracts, and myopia in children and adolescents, and low vision rehabilitation, efforts have been made to improve the eye health level of the people.

During the "13th Five-Year Plan" period, local governments included the prevention and control of myopia in children and adolescents in the government's performance evaluation, creating a good atmosphere of "government-led, departmental coordination, expert guidance, school education, and family attention," and the eye medical and health services industry developed rapidly. The ophthalmic service capabilities continued to improve, and cataract surgery was widely carried out in counties. The ophthalmic medical staff team was continuously improved, and the number of ophthalmologists increased to 47,000. Medical personnel actively participated in eye health popularization and education, and people's awareness of eye care and protection significantly increased. At the end of the "13th Five-Year Plan," China's standardized age-specific prevalence of blindness was lower than the global average. The World Health Organization formally certified that China had eliminated trachoma, a public health problem that caused blindness. China's cataract surgery rate per million population (CSR) exceeded 3,000, doubling that at the end of the "12th Five-Year Plan."

However, China is still one of the countries with the largest number of blind and visually impaired patients in the world. The main causes of blindness in China have changed from infectious eye diseases to eye diseases such as cataracts, myopia-related retinal diseases, glaucoma, corneal diseases, and diabetic retinopathy. With the intensification of economic and social development and population aging, the people have higher demands for eye health. The total amount of high-quality ophthalmic medical resources in China is relatively insufficient and unevenly distributed, and the primary eye health service capacity still needs to be strengthened. The task of eye health work remains arduous.

II.Guiding Principles and Basic Principles

(1) Guiding Principles: Guided by Xi Jinping's thought on socialism with Chinese characteristics for a new era, fully implementing the spirit of the 19th National Congress of the Communist Party of China and its subsequent plenary sessions, taking people's health as the center, promoting high-quality development as the theme, and meeting the diverse and multi-level eye health needs of the people as the starting point and foothold, implementing the Healthy China strategy, further constructing a high-quality and efficient eye health service system, and striving to provide eye health services covering the entire life cycle for the people.

(2) Basic Principles:

1.Insist on overall planning and resource integration. Adhere to eye health work serving the people's health. Adhere to the mode of government leadership, multi-department cooperation, and all-society participation in the prevention and treatment of eye diseases. Based on the eye disease spectrum, population distribution, and people's eye disease medical needs, scientifically formulate regional eye health plans, clarify work objectives and task assignments, give targeted guidance, coordinate medical resources in the region, and ensure that specific measures achieve practical results.

2.Insist on improving quality and efficiency and promoting high-quality development. Adhere to the new development concept, take the improvement of the quality and level of eye health services as the core task, promote the high-quality development of eye health management systems, technical guidance systems, and medical service systems, accelerate the expansion of high-quality medical resources and regional balanced layout, and continuously improve the fairness and accessibility of eye health services.

3.Insist on prevention first and a combination of prevention and treatment. Attach importance to early intervention of eye disease factors, focus on coordinated medical treatment and prevention, and promote the transformation of the development of eye health services from disease-centered to people-centered. Strengthen eye health popularization, publicity, and education, emphasize that everyone is responsible for their own eye health, and promote the formation of an atmosphere of everyone's participation, responsibility, and sharing.

4.Focus on key populations and key eye diseases. Pay attention to two key populations, children and adolescents and the elderly, focus on key eye diseases such as myopia, cataracts, fundus diseases, glaucoma, corneal blindness, and promote appropriate technology and treatment modes for the prevention and treatment of eye diseases, and improve the eye health levels of key populations.

III. Main Objectives

During the 14th Five-Year Plan period, efforts will be focused on strengthening the construction of the ophthalmic medical service system, capacity building, and talent team building. The continuous improvement of the ophthalmic medical quality control system will be promoted, and high-quality ophthalmic medical resources will be expanded and extended. Effective measures will be taken to prevent and control myopia in children and adolescents, to further improve the ability to restore vision in cataract patients, to gradually enhance the screening capacity for diabetic retinopathy and other fundus diseases at the grassroots level, and to promote the orderly development of corneal donation.

By 2025, the following goals will be strived for:

1.The coverage rate of annual eye health and vision examination for children aged 0-6 will reach over 90%, and the overall level of children and adolescents' eye health will continue to improve.

2.The coverage rate of effective correction for refractive errors (eREC, see attachment) will continue to increase, and the number of visual impairments caused by high myopia will gradually decrease.

3.The national CSR (case surgery rate) will reach 3500 or above, and the coverage rate of effective cataract surgery (eCSC, see attachment) will continue to improve.

IV. Promoting High-Quality Development of Ophthalmic Medical Service System

1.Strengthening the construction of the ophthalmic medical service system.

1.1.Strengthening the construction of ophthalmic departments in comprehensive hospitals and ophthalmic specialist hospitals. Based on patient needs and the layout of medical resources, the construction of the ophthalmic medical service system will be incorporated into the overall planning of the regional medical institution setting during the 14th Five-Year Plan period, and the extension and expansion of high-quality ophthalmic medical resources will be promoted. A five-level ophthalmic medical service system will gradually be established, including the national, regional, provincial, municipal, and county levels, with optimized medical resource distribution. The setting and construction of ophthalmic departments in secondary and above comprehensive hospitals will be strengthened to fill the gaps in ophthalmology and its supporting disciplines. At least one secondary and above comprehensive hospital with an independent ophthalmic department will be set up in each prefecture-level city, and county-level comprehensive hospitals with the necessary conditions will be encouraged to independently set up ophthalmic departments and provide outpatient services.

2.Building a high-level ophthalmology medical system. In accordance with the requirements of the national medical center and regional medical center construction plans, ophthalmology-specific national medical centers and regional medical centers should be comprehensively built to create a national and regional ophthalmology medical highland. By leveraging the technical leadership and radiation-driven effect of each center, the overall service capabilities of ophthalmology can be enhanced, gradually reducing the gap in ophthalmology medical service capabilities between regions and urban and rural areas, and reducing the need for patients to seek medical treatment across regions.

3.Constructing an ophthalmology medical service network. Construct a comprehensive, fair, and accessible ophthalmic health service network that suits the national conditions of China. Encourage ophthalmology specialty hospitals and comprehensive hospitals to lead the construction of specialty alliances, integrate specialty medical resources, and promote the overall service capabilities of ophthalmology. Promote the construction of urban medical groups and county-level medical consortia, fully absorb ophthalmology medical resources, establish a division of labor and cooperation mechanism between ophthalmology medical resources and other medical resources within the region, and improve the two ophthalmic health work networks in urban and rural areas. Strengthen the construction of a remote medical cooperation network, use information technology to promote the extension of high-quality ophthalmic medical resources to the grassroots level.

(2) Strengthening ophthalmology medical service capability building.

1.Enhancing ophthalmology medical service capabilities. In accordance with the "14th Five-Year Plan" for the national clinical specialty capability building, support ophthalmology clinical key specialty construction from the national, provincial, and municipal (county) levels, improve the relevant ophthalmology sub-specialty system, and further enhance ophthalmology clinical specialty service capabilities. At the same time, focus on children and the elderly, and emphasize the ability to scientifically correct myopia, cataract surgery, and common eye disease screening. Strengthen the construction of supporting disciplines such as pathology and enhance the ophthalmic pathological diagnosis capabilities.

2.Improving ophthalmology medical service efficiency. Construct a "fast and slow separation" model. Improve the relevant work system and workflow of ophthalmic day surgery, gradually expand the range of diseases treated, and continuously increase the proportion of day surgery over elective surgery, based on the foundation of patients with cataracts and refractive errors undergoing day surgery. Strive for the proportion of day surgery in third-level ophthalmology specialty hospitals to reach 60% by the end of the "14th Five-Year Plan". Strengthen the cooperation between ophthalmology and rehabilitation institutions and grassroots medical institutions, improve the two-way referral mechanism, and transfer postoperative rehabilitation and stable chronic eye disease patients to the grassroots for follow-up. Promote the implementation of appointment-based diagnosis and treatment systems for ophthalmology outpatient clinics and day surgery services, use information technology to continuously optimize medical service models and processes, further improve medical service efficiency, and effectively improve the patient's medical experience.

3.Strengthening grassroots service capability building. In accordance with the basic standards of community hospitals, encourage qualified community hospitals to gradually provide ophthalmology medical services. Relying on urban medical groups and county-level medical consortia, guide appropriate ophthalmic prevention and treatment technology to extend to the grassroots level, promote the application of effective visual acuity screening, fundus screening technology, and implement ophthalmic disease prevention and control measures. Improve the two-way referral and coordination mechanism, and provide reasonable diagnosis and treatment and transfer services for patients with eye diseases.

4.Strengthen the implementation of the requirements for prevention and control. Strengthen the collaboration between medical institutions, disease prevention and control institutions, maternal and child health care institutions, and rehabilitation institutions, carry out cross-institutional and interdisciplinary cooperation, establish a combined mechanism for medical treatment, prevention, and rehabilitation of ophthalmic diseases, and provide continuous screening, diagnosis, treatment, and follow-up services for patients. Strengthen the prevention and control of myopia in children and adolescents, eye health care for children aged 0-6, and low vision rehabilitation, and promote the improvement of the medical and preventive integration model. Promote the organic combination of traditional Chinese medicine ophthalmology with modern ophthalmic new technologies and methods, and give full play to the unique role of traditional Chinese medicine ophthalmology in the prevention and treatment of eye diseases.

(3)Strengthen the construction of ophthalmology professional talent team.

1.Optimize the ophthalmology professional technical personnel team. Strengthen the training and education of ophthalmic medical personnel, form a stable and reasonable talent structure for ophthalmology professionals. By the end of the "14th Five-Year Plan" period, strive to have a total of more than 50,000 ophthalmologists, and have more than 3.6 ophthalmologists per 100,000 population. Strengthen the introduction and training of ophthalmology discipline leaders and backbone physicians, focus on cultivating high-level compound ophthalmic medical talents, form a group of high-level leading talents and innovation teams, and promote the high-quality development of the ophthalmology medical team.

2.Strengthen the standardized training of ophthalmology residents. With the core of cultivating clinical diagnosis and treatment ability, deepen the standardized training of ophthalmology residents, so that clinical physicians have good professional ethics, solid medical theory knowledge, and clinical skills to carry out standardized diagnosis and treatment of ophthalmic diseases. Further improve the connection mechanism between standardized training of ophthalmologists and promotion of professional titles.

3.Strengthen continuing medical education and training. Give full play to the technical advantages of national and provincial blindness prevention and treatment technical guidance groups and ophthalmology professional associations, and carry out training for eye disease prevention and control management personnel and professional technical personnel. Build a high-quality faculty team, and conduct different forms of continuing education online and offline to enhance the clinical technical capabilities and level of ophthalmologists.

(4)Strengthen ophthalmic medical quality management.

1.Standardize clinical diagnosis and treatment behavior. Strengthen the awareness of ophthalmologists to practice in accordance with the law, strictly implement the core system of medical quality and safety, and ensure medical quality and safety. Further improve the technical documents such as ophthalmic related diagnosis and treatment specifications, clinical pathways, and diagnosis and treatment guidelines, strengthen the management of ophthalmic drugs, clinical diagnosis and treatment technology applications, and standardize the clinical diagnosis and treatment behavior of ophthalmologists.

2.Strengthen the construction of ophthalmic medical quality management and control system. With the construction of quality control centers at all levels as the core, improve the organizational system of ophthalmic professional medical quality control. Take key ophthalmic diseases and critical technologies as the main line, improve the quality control index system for ophthalmic diseases. With the goal of improving the level of ophthalmic medical quality and technical capabilities, 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. 

V. Strengthening the prevention and control of key eye diseases in key populations

1.Enhancing the prevention and control of myopia.Promoting the prevention and control of myopia in children and adolescents. Implementing the requirements of the "Comprehensive Implementation Plan for the 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." Formulating and revising relevant standards for myopia prevention and control to establish a standard system for children and adolescents' visual health. Strengthening eye care and visual acuity testing services for children aged 0-6. Promoting monitoring and intervention of myopia and risk factors in children and adolescents through a national surveillance system for common diseases and health factors in students. Striving to achieve 100% coverage of myopia monitoring in all counties (districts) nationwide during the 14th Five-Year Plan period, dynamically grasping the changes in myopia rate and risk factors among children and adolescents nationwide. Gradually expanding the population of vision screening among primary and secondary school students, strengthening the construction of vision monitoring networks, and carrying out targeted interventions such as expert visits to schools and health month activities for primary and secondary school students.

2. Promoting scientific correction of myopia. Guiding medical institutions to implement the requirements of the "Guidelines for the Prevention and Control of Myopia" and carry out scientific examinations such as optometry, strengthening early warning and intervention for patients with high myopia, improving early diagnosis and control of myopia, and reducing visual damage caused by high myopia. Guiding medical institutions to standardize myopia correction services, formulate and improve clinical application standards for corneal shaping lenses, strengthen supervision of myopia-related surgical operations, and continuously improve eREC.

(2)Enhancing the level of cataract restoration. Promoting the implementation of the rural revitalization strategy, solidly advancing the "Thousand-County Project," deepening the pairing assistance between tertiary hospitals and county hospitals, continuously carrying out activities such as the Brightness Project and Brightness Walk, promoting the sinking of cataract restoration surgical techniques, and improving the cataract restoration surgical capability of county hospitals that meet the recommended standards for comprehensive service capacity of county-level hospitals by the end of the 14th Five-Year Plan period, with more than 90% of them performing cataract restoration surgery. The national CSR should reach over 3500 (for provinces that did not reach 3000 by the end of the 13th Five-Year Plan, efforts should be made to increase by 5% annually). Guiding medical institutions to standardize cataract restoration surgery, promoting the clinical application of small incision extracapsular cataract extraction or phacoemulsification cataract extraction, strengthening surgical quality management, establishing and improving postoperative follow-up systems, and improving eCSC.

(3) Improve the ability to diagnose and treat eye diseases such as fundus diseases and glaucoma at an early stage. Promote early detection, diagnosis, and treatment of fundus diseases such as glaucoma, diabetic retinopathy, myopic retinopathy, macular degeneration, retinal vascular occlusion, and hypertensive fundus lesions. Develop key disease diagnosis and treatment standards, improve the management model for chronic eye disease patients, and reduce the disease burden and blindness rate. Continuously promote the construction of eye-related medical alliances, gradually expand the coverage of fundus photography screening technology to grassroots medical and health institutions, explore the establishment of a "primary examination, superior diagnosis" service model, and improve the diagnosis and treatment ability of fundus diseases and glaucoma. Implement technical schemes for grading and treating eye diseases such as diabetic retinopathy, and promote the "thousand-county project" to establish chronic disease management centers in county-level comprehensive hospitals and steadily advance family doctor signing services, thus constructing an eye disease and chronic disease management system.

(4) Improve the ability to rescue corneal blindness. Rely on existing medical resources to plan and standardize the construction of eye banks. Implement the requirements of the "Eye Bank Management Norms" and "Eye Bank Operation Technical Guidelines," standardize the acquisition, processing, preservation, and use of donor corneas, and ensure that the donor corneas are traceable. Strengthen the clinical application management of corneal transplantation technology and implement full-process quality control of corneal transplantation. Establish a corneal donation model that is suitable for China's national conditions, increase publicity, encourage social participation, advocate corneal donation, and expand the source of corneal donors. Emphasize the construction of talent teams and related technical training, improve the level of corneal transplantation, and achieve 100% national coverage of corneal transplantation technology in all provinces.

(5) Improve the prevention and treatment level of other eye diseases. Monitor trachoma incidence and consolidate the achievements in eliminating blinding trachoma. 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 rate of retinopathy of prematurity. Further improve the treatment level of amblyopia, ocular surface diseases, orbital diseases, and eye trauma. Strengthen the diagnosis and treatment services for genetic eye diseases.

VI. Building a Support Platform for Eye Health Services

(1)Strengthen the construction of the eye health service platform for children aged 0-6. Combining with the basic public health services of the country, implement eye health care and vision screening for children aged 0-6, ensuring that the coverage rate reaches over 90%. Implement the "Service Specification for Eye Health Care and Vision Screening for Children Aged 0-6 (Trial)" and give full play to the collaborative role of grassroots medical and health institutions, maternal and child health institutions, and comprehensive hospital ophthalmology departments, to build a child eye health service network with division of labor, emphasis, and close cooperation, screening common eye diseases in children early and correcting poor vision. Promote the establishment of electronic medical records for children and adolescents' visual health, timely update refractive development health data, and transfer them in real-time upon enrollment.

(2)Strengthen the construction of the diagnosis and treatment rehabilitation platform for low vision. Continuously improve the setting rate of low vision clinics in third-level comprehensive hospitals and specialized eye hospitals. Encourage third-level comprehensive hospitals and specialized eye hospitals with conditions to carry out visual function evaluation, rehabilitation needs assessment, and develop and implement rehabilitation plans for low vision. Improve the referral mechanism between ophthalmic medical institutions and low vision rehabilitation institutions, and unblock the two-way referral channel. Strengthen the construction of the low vision rehabilitation talent team, enhance the standardized training of low vision rehabilitation technology, and improve the low vision rehabilitation ability of ophthalmic medical staff.

(3)Strengthen the construction of the eye health information platform. Actively promote the application of "Internet +" medical service model in the field of ophthalmology, use information technology such as Internet diagnosis and treatment and remote medical treatment to improve the accessibility of ophthalmic medical services. Promote the deep integration of emerging technologies such as big data, artificial intelligence, and 5G with ophthalmic services, carry out the application of artificial intelligence in eye disease prevention, diagnosis, and follow-up, and improve the ability of early screening for eye diseases. Establish an ophthalmic case database, strengthen the collection, statistical analysis of ophthalmic case data, and provide data support for clinical scientific research.

(4)Strengthen the construction of the eye health popular science propaganda platform. Establish and improve a public eye health popular science knowledge base and popular science propaganda platform. Give full play to the technical advantages of ophthalmic professionals, use new mainstream media to strengthen eye health education, enhance public awareness of eye disease prevention and treatment, and create a good social atmosphere. Take "paying attention to universal eye health" as the main theme, and focus on national eye care day, world vision day, and other time points to strengthen eye health popular science propaganda. Guide ophthalmic medical institutions to organize public welfare activities such as ophthalmic disease consultations and popular science education during the peak periods of children and adolescents' visits in summer and winter vacations.

(5) Strengthen the construction of the scientific research platform for enhancing eye health. Adhere to the development concept of technological innovation, strengthen innovation in clinical diagnosis and treatment techniques, and promote the transfer, transformation, and popularization of research results. Play the role of the National Clinical Research Center for Ophthalmology and its collaborative research network, conduct collaborative research in clinical, public health, and health economics fields. Strengthen epidemiological research on key eye diseases, monitor the prevalence, incidence, and changes in the disease spectrum of major blindness-causing eye diseases in China, and grasp the situation of eye diseases and their socioeconomic burden in China.

VII. Organizational Implementation

(1)Strengthen organizational leadership. Health administrative departments at all levels should attach great importance to eye health and prevention of blindness work, strengthen the implementation of responsibilities, and coordinate and promote it as a key work of the construction of Healthy China. Strengthen communication and coordination with disability federations, education, civil affairs, finance and other departments to form a policy force. Pay attention to the construction and evaluation of blindness prevention technical guidance groups at all levels to ensure that the work achieves practical results.

(2)Fulfill target responsibilities. Health administrative departments at the provincial level should formulate regional work plans by the end of March 2022 based on this plan and combined with local conditions, form a timetable and roadmap, clarify division of labor, and fulfill responsibilities. Places with conditions can carry out special work on eye health to promote the development of eye health work.

(3)Strengthen monitoring and evaluation. Health administrative departments at the provincial level should formulate monitoring and evaluation plans for the development of the eye health cause during the 14th Five-Year Plan period in their respective regions, and do a good job in dynamic monitoring and evaluation of planning implementation. Monitor and evaluate the progress of the work regularly, discover problems in a timely manner, and study and solve them. The National Health Commission will evaluate and report on the implementation of the plan by health administrative departments at all provincial levels in due course.

(4)Strengthen publicity and guidance. Health administrative departments at all levels should attach importance to eye health-related publicity work, and strengthen personnel policy training. Fully leverage the role of the media, improve social recognition and support, and create a good social atmosphere for implementing various policy measures.

Source: Official website of the National Health Commission of the People's Republic of China.