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Published on: September 16, 2025
Quality of refractive error care in China - a cross-sectional unannounced standardised patient study
Ling Lee1,2, Ziyin Zhao3, Anthea Burnett1
1Global Programs Division, The Fred Hollows Foundation, Melbourne, Australia.
Clinical Relevance:
Understanding the quality of care provided by existing refractive error services and aspects that influence quality enables educators and the workforce to develop interventions for delivering high-quality services.
Background:
High-quality eye care services are required not only to address uncorrected refractive error but also maintain the needs of those wearing spectacles. This study aims to evaluate the quality of refractive error care in China by estimating the proportion and assessing factors associated with receiving optimal spectacles.
Methods:
This cross-sectional study utilised trained unannounced standardised patients with various refractive error profiles to attend optical services in 2024 in Dali, China. Patients requested an eye examination, ordered and collected spectacles and a written prescription, and recorded testing provided. Baseline refractions were averaged from measurements conducted by three qualified refractionists. Spectacles and prescriptions were compared against the baseline and optimal criteria, and then against each other to assess appropriateness of spectacles made. Proportions for quality outcomes were calculated with robust standards errors to account for intra-service correlation. Univariable and multivariable logistic regression explored potential associations between spectacle quality and visit factors.
Results:
Fourteen unannounced standardised patients visited 67 optical services completing 259 visits with 249 spectacles dispensed (181 single vision distance, 68 single vision near). Overall, 25.7% (95%CI:20.0-32.4%) and 38.8% (95%CI:33.5-44.5%) of spectacles and prescriptions, respectively, met the optimal criteria. Regression analyses indicated that males (OR:0.42, 95%CI:0.19-0.92, p = 0.03) were at reduced odds of receiving optimal spectacles, whereas those attending rural services were at significantly increased odds of receiving optimal spectacles (OR:2.82, 95%CI:1.40-5.69, p = 0.004).
Conclusion:
The quality of refractive error care in Dali, China, shows a distinct need for improvement. The observed gender disparity in care requires further investigation, while understanding the systems and structures of rural services may provide insights to foster and improve urban services.
