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HomemistoryTracking Indigenous Eye Health

Tracking Indigenous Eye Health

The National Indigenous Eye Health Survey – the first national survey of indigenous eye health in over 30 years – prompted the release of a national report on indigenous eye health. This report had some startling findings, one of which that adult indigenous Australians suffer significantly higher rates of blindness and other eye related health problems than non-indigenous Australians.

Aboriginal children begin life with better eyesight than other Australians, however by the time they reach adulthood, they are six times more likely to be blind.

This distressing information came from the first comprehensive survey of indigenous eye health in three decades.

The survey was conducted by a team from Melbourne University and headed up by Professor Hugh Taylor who leads the Indigenous Eye Health Unit. It was developed through data collected from across the country – from Tasmania and the Tiwi Islands, to the Gold Coast and the Pilbara – giving an accurate picture of the extent and causes of vision loss amongst Aboriginal and Torres Strait Islander people.

It is a national disgrace that more than 94 per cent of the vision loss associated with these eye diseases is preventable and treatable…

“I think it is scandalous that in 2009, in a rich, developed country now in the G-20, that we have third world conditions that many of our Australian people live in,” Professor Taylor said.

The data provided an evidence base to develop new Government policies to finally deliver sustainable eye care services to indigenous communities.

Survey Results

The recently published report came from a comprehensive assessment of more than 2,800 Aborigines and Torres Strait Islanders from 30 communities last year and found that 1.9 per cent of the adult population was blind – six times the rate among non-indigenous Australians.

In launching the survey, Governor- General Quentin Bryce hailed it as a “milestone in indigenous health which highlights the severity and prevalence of ocular conditions”.

The leading causes of the vision loss in indigenous people were cataracts, optic atrophy, refractive error, diabetic eye disease and trachoma – a painful infectious disease that was eliminated from mainstream Australia 100 years ago, but still exists in remote indigenous communities.

Professor Hugh Taylor said the fact that those indigenous children were born with better eyesight than their non-indigenous peers but ended up worse off during their adult years was unacceptable.

“It is a national disgrace that more than 94 per cent of the vision loss associated with these eye diseases is preventable and treatable,” he said.

Professor Taylor said that a lack of early intervention and treatment was often causing deterioration.

He added that eye care services were urgently required, along with facilities to provide reading and distance glasses.

”This survey represents the first step in ‘Closing the Gap’ in vision. The next step will be to review the availability and effectiveness of the current eye health services, to deliver a report within the next six months.

“We will then make recommendations to Government on the best way to develop adequate eye care services for Aboriginal and Torres Strait Islander people,” he said.

The fact is that indigenous children are born with better eyesight than other Australians. This, Professor Taylor said, is largely due to the fact that the gene responsible for myopia, or shortsightedness, is far less frequently found in the indigenous population.

Indigenous Health: the Facts

The survey also showed that blindness from cataracts was 12 times more common among indigenous adults and only 65 per cent of those needing surgery for a cataract had been operated on.

The results indicated that while the situation had improved in some respects over the past 30 years, the levels of blindness from diabetes had increased substantially.

“The survey puts into sharp focus the frighteningly high level of avoidable vision loss and the unacceptable deficiencies in indigenous eye health.”

“We knew there was a problem but the extent of it, and the sad fact that much of it could have been prevented, has shocked us.”

“There is still a large gap between what should be and what the situation is; what is different now is that almost all the blindness is preventable or treatable,” he said.

Professor Taylor lauded the Rudd Government for having committed AUD$58.3 million over three years to tackle chronic eye and ear diseases affecting indigenous communities, including AUD$16m targeted at eliminating trachoma in the indigenous population.


Problems With Vision

  • 35% of adults have never had an eye exam
  • 19% of children reported having had a problem with their vision
  • 58% of these children had seen someone about this

…but 40% were still not satisfied with their vision. 79% of adults reported a problem with their vision

  • 17% of adults who had an eye problem had never had an eye exam Most adults (83%) had sought care

…but still two thirds (64%) were not satisfied with their vision.

In a media release headed ‘Looking Into Indigenous Eye Health’, the Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery, Warren Snowdon, welcomed the report.

What the Minister found particularly disturbing was: “The survey found that 94 per cent of vision loss is preventable or treatable, but 35 per cent of indigenous adults have never had an eye examination.

“The report however also made positive findings for indigenous children, as vision loss in indigenous children was found to be five times less common than nonindigenous children.”

CAUSES OF VISION IMPAIRMENT

Overall, 94% of vision loss in Indigenous Australians is preventable or treatable.

Blindness from trachoma is not seen in other Australians

For Indigenous children:

• 56% of low vision is due to refractive error

• 40% unknown causes

• 4% congenital Nystagmus

• One child was blind from refractive error and two from unknown causes

For Indigenous adults:

Overall rates of blindness in Indigenous adults are:

• 12 times higher from cataract

• 14 times higher from diabetes

• 5 times higher from refractive error

…than in other Australians

Finding Solutions

Earlier this year the Federal Government pledged almost AUD$60 million in an effort to address indigenous health issues.

The ‘Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes’ initiative will expand eye and hearing health services for Indigenous Australians. Reducing preventable vision and hearing loss will assist to improve education and employment outcome for Aboriginal and Torres Strait Islander people.

In 2009 to 2010, the Department will work with experts in the fields of eye and hearing health, and other key stakeholders to develop and implement strategies to ensure eye and ear health problems are effectively treated.

This will include a major increase in services to address trachoma, an expansion of the Visiting Optometrist Scheme, increased training of health workers in hearing health, investments in medical equipment for hearing screening, improved access to eye and ear surgery, and activities to increase awareness of ear disease and treatment.

“It is unacceptable that indigenous people continue to suffer treatable vision loss at such rates. As we work with indigenous Australians to close the gap in education and employment, we must also address this terrible and preventable health burden,” Mr. Snowdon added.

The new measure includes:

• More than AUD$16 million for a major increase in services to address trachoma in indigenous communities in the Northern Territory, Western Australia, South Australia and other states if trachoma is identified.

• Additional funding of nearly AUD$6.5 million to expand the Visiting Optometrist Scheme to better target primary eye care for indigenous Australians in remote and very remote communities.

• Additional eye surgery where there is a high need for these services, particularly in Central Australia. Following the launch of the survey, Governor-General Quentin Bryce said she hoped it would send a strong message to our health leaders.

“I look forward to seeing what will unfold in its wake,” she said.

Key Findings

Adults

  • Blindness rates in Indigenous adults (1.9%) are 6.2 times the rate in mainstream
  • Low vision rates in Indigenous adults (9.4%) are 2.8 times the rate of mainstream
  • Major causes of blindness in Indigenous adults are cataract (32%), optic atrophy (14%), refractive error (14%), diabetic eye disease (9%) and trachoma (9%)
  • There are about 15,015 Indigenous people with low vision and 3,300 who are blind

Children

  • Indigenous children especially in remote areas have better vision than their mainstream peers
  • Overall, low vision occurs in 1.4% of Indigenous children (age standardised)
  • Vision loss in Indigenous children is 5 times less common than in mainstream children

Cataract

  • Overall, 3.1% of Indigenous adults suffer vision loss from cataract
  • Blinding cataract is 12 times more common in Indigenous adults
  • Only 65% of those needing cataract surgery have been operated on Regular cataract surgery services with adequate capacity are required

Diabetes

  • Diabetic eye disease is the equal third cause of blindness
  • Of Indigenous people with diabetes:
  • 36% have diabetic eye disease
  • Only 20% have had a recent eye examination
  • Only 37% have received the laser surgery they need
  • Regular screening and accessible laser facilities are required

Refractive Error

  • Half of vision loss in both adults and children is due to Refractive Error
  • 39% of adults cannot see normal print
  • Services to provide distance and reading glasses are needed in every Indigenous community

Trachoma

  • Trachoma still occurs in Indigenous people across Australia and still causes blindness
  • 60% of very remote communities have endemic trachoma (defined as a prevalence of active trachoma in 5 – 9 year olds greater than 5%, the highest prevalence was 28%)
  • Overall trachoma affects 7% of children (5 – 15 years) in very remote regions
  • Adults with scarring and in-turned eyelashes from trachoma were found across Australia
  • The Australian Government has in 2009 committed to use the SAFE strategy to eliminate trachoma

Overall, 94% of vision loss is preventable or treatable, but 35% of adults have never had an eye exam.

The National Indigenous Eye Health Survey Minum Barreng (Tracking Eyes) Full Report (12 October 2009) was undertaken by the Population Health Unit at the Centre for Eye Research Australia (CERA) and produced by the University of Melbourne’s Centre for Eye Research and supported by the Vision CRC, Centre for Eye Research Australia, International Centre for Eyecare Education (ICEE), RANZCO Eye Foundation and the Department of Health and Ageing.

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