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Background Vision 2020 was initiated in 1999 and many relevant activities are ongoing, but little information is available on what it has achieved and what constraints it faces. It is not yet clear if funding is the most important constraint. Nepal is one of the underdeveloped countries, but an advanced country in preventing avoidable blindness.The aim of this study was to compare the situation in China and in Nepal in prevention of avoidable blindness.Methods Data from literature review and a field visit were combined. All statistical analyses were carried out with SPSS Version 11.5. The chi-square test was used for comparisons involving categorical variables.Results The blindness rate is higher in Nepal than that in China (P＜0.05). The average number of cataract operations performed by one ophthalmologist is much lower in China than in Nepal. The cataract surgical rate (CSR) is much lower in China than in Nepal (P＜0.001). High cost of the surgery and inadequate qualifications of human resources were found in China. Cataract surgical outcome in China compared well with intational standards.Conclusions Progress towards the Vision 2020 target in China is much slower than that in Nepal. Further attention to address this issue is urgently needed.