Researchers followed 4.47 million school eye screenings across three developed Chinese cities (Xiamen, Quanzhou, and Zhangzhou) between 2021 and 2024. They wanted to understand why, even in wealthy cities with excellent healthcare access, so many children with vision problems went uncorrected.
The findings were striking: only 22.6% of primary school children who needed glasses were actually wearing them. Among those who did wear glasses, half had the wrong prescription strength. This gap between needing help and getting it—researchers call it the "correction gap"—affects children's learning and development.
The Xiamen Paradox: Why prosperity doesn't guarantee corrected vision
Xiamen, the wealthiest city in the study, had the best overall eye health among children. Yet it had the worst correction rates: 94% of primary school children with refractive errors (focusing problems) went uncorrected. Researchers discovered the reason: when children seem to manage fine and life is going well, parents delay getting glasses, even after screenings show they're needed. They called this "visibility-over-correction bias."
Quanzhou, facing more eye health challenges overall, had much higher correction rates. Parents there noticed their children struggling more visibly with vision and acted faster. This "pain-driven" model shows that parents respond when problems become obvious, not when screenings first detect them.
Ages 5 to 7: the critical window for your child's eyes
The study identified ages 5 to 7 as when children's eyes change dramatically. Myopia (shortsightedness) rates doubled during this period. Missing vision problems during these years can directly affect school performance and development, since children who can't see clearly may fall behind without realising why.
Interestingly, the research also found that within the same city, some neighborhoods had larger vision problem gaps than existed between entire cities. This means local patterns matter as much as overall city wealth.
How Singapore families can avoid the correction gap
Singapore is wealthier and has more developed healthcare than these Chinese cities, which means the "Xiamen Paradox" could easily happen here too. Many Singapore parents might assume excellent healthcare and school screenings catch all vision problems. But this research suggests otherwise.
The key takeaway: passing a school screening doesn't mean your child's vision is fine. Children adapt to poor eyesight without complaining. If your child isn't checked carefully during ages 5 to 7, or if a screening shows refractive errors, getting actual glasses on their face—not just knowing they need them—is what matters for their development and learning.
Act during the critical window
- Schedule a comprehensive eye check for your child between ages 5 and 7, when vision changes most rapidly and often go unnoticed.
- If a school screening flags vision problems, follow through with an optometrist visit and glasses fitting—don't wait for obvious symptoms.
- Don't assume "no complaints" means healthy eyes; children adapt silently to poor vision without telling parents.