Every autumn, on the ninth day of the ninth lunar month, Chinese families climb a hill together. The Double Ninth Festival is the day set aside for honouring elders — and it is usually the one day of the year when adult children look closely at their parents and notice what has quietly changed.
Often it is the eyes. The autumn leaves on the hillside have become a blur of colour. The photograph of a grandchild on a phone screen will not come into focus, however far it is held away.
A decline in eyesight should never be waved away with "it's normal to get old."
China's National Bureau of Statistics reported in January 2026 that at the end of 2025 the country had 322 million people aged 60 or over — 22.8% of the population, or roughly one in every four or five people you pass on the street. In that age group the prevalence of cataract approaches 80%, and among those over 90 it exceeds 90%. Glaucoma, macular degeneration and diabetic retinopathy are all closing in at the same time, and all of them do so silently.
It is not simply "the eyes getting old"
"Of course your eyes go when you get old" is only half true. Presbyopia is real and it is normal: near vision blurs, but distance vision stays clear.
The picture changes when a parent cannot see clearly either near or far, or when any of the following appear:
Any one of these points away from presbyopia and towards one of four diseases.
1. Cataract — do not wait until nothing can be seen
Cataract is the clouding of the ageing crystalline lens: a pane of frosted glass that slowly thickens across the line of sight. In China the prevalence is around 80% after 60 and above 90% after 80. The Chinese Ophthalmological Society's China Cataract Epidemiology Report (2025), published in 2026, puts prevalence at about 42.3% among people over 50 — an estimated 180 million patients nationwide.
The most important change in thinking concerns timing. The old advice to "wait until the cataract is ripe" has been overturned. The International Council of Ophthalmology (ICO) states plainly in its global cataract guidelines that as soon as the clouded lens interferes with normal life, that is the best time for surgery. In current practice, a corrected visual acuity falling below 0.5 (about 20/40) together with interference in daily activities is the signal to be assessed.
Delay carries four risks:
- The operation itself becomes technically harder.
- It can trigger acute angle-closure glaucoma — in severe cases, sight can be lost within 24 to 48 hours.
- It can set off intraocular inflammation.
- Prolonged poor vision allows the brain's visual cortex to degrade, so even a perfectly implanted lens afterwards may not restore best-corrected sight.
When a cataract stops a parent reading a menu, recognising a grandchild's smile, or crossing a road alone, surgery is no longer only about eyesight. It is about preserving the dignity of an independent life.
2. Glaucoma — the thief that makes no sound
Glaucoma is the world's leading cause of irreversible blindness. Prevalence in China is about 2.3% over 40, rising to 4.8% over 65; the Chinese Expert Consensus on Chronic Glaucoma Management (2026) puts overall prevalence at 2.5%, with Chinese patients making up roughly a quarter of the global total. About two-thirds are already at an advanced stage at their first consultation, by which point the visual damage cannot be reversed.
What makes glaucoma dangerous is how quiet it is. Around 50% of patients in developed countries do not know they have it; in developing countries the figure exceeds 90%. Open-angle and chronic angle-closure glaucoma progress slowly, without the acute pain that would prompt someone to seek help, and the visual field is lost at the periphery first, not in the centre. Patients cannot detect it themselves. By the time central vision is affected, the disease is usually at an intermediate or late stage.
Diagnosis rests on four examinations used together: intraocular pressure measurement, fundus photography, OCT (which shows thinning of the retinal nerve fibre layer) and visual field testing.
3. Age-related macular degeneration — stealing the centre of the world
If glaucoma takes the periphery, macular degeneration takes the very centre. The macula sits at the centre of the retina and is where visual information is resolved most sharply.
Age-related macular degeneration (AMD) is a leading cause of low vision and blindness in older people. In China prevalence climbs from 2.44% at 45–49 to 18.98% at 85–89; survey data put it at about 15% over 65 and 37% over 75.
AMD comes in two forms. Dry AMD progresses slowly, the macula degenerating almost like metal rusting. Wet AMD accounts for only 10–20% of cases, but abnormal new vessels grow beneath the macula, bleed and leak — and vision can drop sharply within a short period.
Amsler grid — a two-minute home test. In soft light, cover one eye and stare at the central dot. If the surrounding lines look wavy, blurred or missing, book an eye examination.
The Amsler grid is the standard home check. In soft indoor light, with one eye covered and glasses on, look at the centre point and note whether the lines appear warped, blurred or absent. Any abnormality warrants an examination. From 60 onwards, annual fundus photography is advisable.
4. Diabetic retinopathy — the eye reports on the blood sugar first
In China, diabetic retinopathy affects 24.7% to 37.5% of people with diabetes. Among those who have had diabetes for more than ten years, about 50% have retinal changes; beyond fifteen years the figure reaches 63%.
Its difficulty is that there are almost no symptoms early on. Many patients present only when vision has already dropped markedly or is close to being lost — and by then the lost sight usually cannot be recovered.
Once diabetes is diagnosed, a fundus examination at least every six months is needed whether or not vision has changed. If glycaemic control is poor, the interval shortens to three months, or even one. Control the blood sugar; keep examining the fundus.
A screening schedule for parents
| Who | What to have | How often |
|---|---|---|
| Everyone over 40 | Fundus examination, intraocular pressure | Once a year |
| Anyone with diabetes | Dilated fundus examination | Every 6 months; every 3 months if control is poor |
| High myopia | Targeted retinal screening | Every 6 months |
| Family history of glaucoma | IOP monitoring and optic nerve assessment | As directed by the ophthalmologist |
| Everyone over 60 | Fundus photography | Once a year |
Three things to do this autumn
1. Book a proper eye examination, not just a vision test. A full assessment includes intraocular pressure, fundus photography and OCT. Many eye diseases are visible on professional imaging long before a parent notices anything.
2. Check the home for small hazards. When watching television or using a phone in the evening, keep a soft background light on — sitting in complete darkness for long periods matters especially for those at risk of glaucoma. Reading glasses should be fitted professionally: the cheap pairs sold off the shelf have inaccurate powers and the wrong pupillary distance, which only adds to eye strain.
3. Listen for the casual remarks. "Things look a bit crooked lately." "The lights are so glaring when I go out at night." "There is always a shadow in front of my eye." Remarks made in passing are often exactly the ones that need a doctor.
Looking after ageing eyes is like managing blood pressure or blood sugar: it needs regular, long-term attention. Early detection and early intervention are what protect sight.
About the Eye & Optometry Centre at SinoUnited Health
The ophthalmology and optometry team at SinoUnited Health has spent years in clinical eye care, and its members hold national licences as physicians, nurses and optometrists, together with certification in orthokeratology lens fitting and glaucoma drainage device surgery. Following established clinical guidelines and international standards, the centre uses compliant, internationally specified diagnostic and surgical equipment to provide professional, comfortable eye care for both children and adults.
This article is health education for international patients and their families. It does not replace an individual consultation, examination or diagnosis. If you or a parent notice any change in vision, please contact our international patient team.