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Eye health can be affected by a number of factors, including genetics, ageing, premature birth, other diseases (such as diabetes), smoking, injuries, ultra violet (UV) exposure, and nutrition . Poor vision can increase the risk of injury and limit opportunities in education, employment and social engagement, and also be a reason for dependence on services and other people . Even mild vision loss can reduce an individual’s ability to live independently and increase the risk of mortality .
The National Indigenous Eye Health Survey (NIEHS), conducted in 2008, was the first national eye health survey of Indigenous Australians since the National trachoma and eye health program (NTEHP) in 1976-1980 . The results of the NIEHS have been used to make extensive recommendations to governments on improving eye health service provision and coordination, as well as advocating for ‘closing the gap’ in eye health between Indigenous and other Australians .
The NIEHS estimated that 94% of vision loss among Indigenous people nationally was preventable or treatable , with the leading eye conditions being cataract, refractive error, optic atrophy, diabetic retinopathy, and trachoma .
The NIEHS found that the eyesight of Indigenous children was generally better than that of non-Indigenous children, particularly for children living in remote communities . After adjusting for age and sampling, blindness was five times less common among Indigenous children aged 5-15 years than among non-Indigenous children.
The 2008 NATSISS reported that 9.3% of Indigenous children aged 4-14 years had some form of eye or sight problems . The most common forms of these problems were refractive errors, long-sightedness (37%), and short-sightedness (28%) . Similarly, the 2008 NIEHS reported that more than one-half of low vision (56%) and one-third of blindness (33%) among Indigenous children aged 5-15 years were due to refractive errors .
Eye and sight problems were reported by 30% of Indigenous people who participated in the 2004-2005 NATSIHS, making it the most commonly reported long-term health condition . This level is similar to that documented in 2001.
The rate of low vision for Indigenous adults aged over 40 years was 2.8 times higher than that for non-Indigenous adults according to the 2008 NIEHS. The most common causes of low vision were uncorrected refractive error (54%), cataract (27%), and diabetic retinopathy (13%) .
Eye and sight problems were reported more among Indigenous females than Indigenous males in the 2004-2005 NATSIHS . The age-adjusted levels of eye and sight problems were similar for Indigenous and non-Indigenous females, but the level for Indigenous males was slightly lower than that for non-Indigenous males (ratio 0.9).
The proportions of Indigenous people reporting eye or sight problems were slightly lower for very remote areas (23%), but similar for all other levels of remoteness (30% in outer regional and remote; 32% in major cities; 33% in inner regional areas) in 2004-2005 .
Overall, a lower proportion of Torres Strait Islander people (26%) than Aboriginal people (30%) reported having eye or sight problems in 2004-2005 (the difference is not statistically significant), but the proportion was 31% for Torres Strait Islander people living in the Torres Strait area .
Blindness is more common among Indigenous people than among non-Indigenous people, particularly in the older age-groups . The 2008 NIEHS found that the rate of blindness was 6.2 times higher for Indigenous people aged 40 years or older than for their non-Indigenous counterparts . This disparity represents a decrease from the NTEHP in 1980 when the rate of blindness among people aged 40 years or older was almost 10 times higher for Indigenous people than for non-Indigenous people .
The leading cause of blindness among Indigenous adults in 2008 was cataract (32%) (Figure 2), which was 12 times more common among Indigenous adults than among non-Indigenous adults . Reflecting the high levels of cataract-associated blindness, the hospitalisation rate for cataract extraction surgery was more than twice as high for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2010-11 than it was for their non-Indigenous counterparts .16 The median wait for cataract surgery was around 125 days for Indigenous people and around 85 days for non-Indigenous people.
The next leading causes of blindness for Indigenous people were refractive error and optic atrophy (both 14%), followed by diabetic retinopathy (a complication of diabetes) and trachoma (an infectious eye disease) (both 9%). . Blindness caused by corneal diseases (84% of which was due to trachoma) has decreased from 52% in the late 1970s to 9% in 2008 .
Figure 2. Bilateral vision loss and blindness among Indigenous adults, by type of eye problem, 2008, Australia
Source: NIEHS 2009 
Trachoma has been virtually eliminated in the developed world, but still occurs among Indigenous people . According to the 2008 NIEHS, 60% of Indigenous communities in very remote areas had endemic trachoma.17 In 2010, the prevalence of endemic trachoma among children was reported at 19% in SA, 12% in the NT and 9% in WA .
Diabetic retinopathy, a complication of diabetes that causes damage to the small blood vessels in the retina, can impair vision and cause blindness . This is of increasing concern for many Indigenous people. The 2008 NIEHS reported that diabetic retinopathy was 30 times more common among Indigenous adults than among non-Indigenous adults . Overall, the NIEHS reported that diabetes was the cause of 12% of low vision and 9.1% of blindness among Indigenous adults. Of Indigenous adults with diabetes, only 20% had had an eye exam within the previous year .
Uncorrected refractive error was the cause of more than one-half of vision loss (54%) for Indigenous adults in 2008 . Uncorrected refractive error leading to blindness was five times more common among Indigenous adults than among non-Indigenous adults.
A number of factors limit the timely identification, management and treatment of eye health problems for Indigenous people: the factors include geographical location; socio-economic status; lack of access to transport; and lack of access to health services . The limited availability of eye care providers in more remote areas is such that a four-fold increase in services has been suggested as needed to address the shortage . There may be enough eye care providers in urban areas, but they are not fully utilised by Indigenous people.
Overall, Indigenous people are less likely than non-Indigenous people to access eye health practitioners, optometry, or specialist ophthalmology services . The 2008 NEIHS found that 35% of Indigenous adults have never had an eye examination . The rate of eye examinations provided in areas with a high Indigenous population was two-thirds the rate of areas with a low Indigenous population .