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Eye health can be affected by genetic factors, ageing, premature birth, diseases (such as diabetes), smoking, injuries, UV exposure and nutrition [1]. The eye health of Indigenous people has probably improved overall in recent years, but many Indigenous people are still more likely than non-Indigenous people to suffer from preventable eye conditions, such as trachoma (a bacterial infection) [2]. Of increasing concern for many Indigenous people is diabetic retinopathy, a complication of diabetes that causes damage to the small blood vessels in the retina and can impair vision and may cause blindness.
The eye health of many Indigenous people is also limited by difficulty in accessing optometry or specialist ophthalmology services [3]. For Indigenous people with vision refractive error, for example, the main issues are access to and utilisation of testing, the administrative difficulty of dispensing spectacles, and the cost of spectacles and of repairs [4].
The National Indigenous Eye Health Survey (NIEHS) was the first national eye health survey among Indigenous Australians since the National Trachoma and Eye Health Program (NTEHP) of the late 1970s [2]. The results of the NIEHS, conducted in 2008 by the Indigenous Eye Health Unit at the University of Melbourne, 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 [3]. NIEHS was conducted in all states and territories with the exception of the ACT.
The 2008 NIEHS found that 94% of vision loss among Indigenous people was preventable, but that 35% of adults have never had an eye examination [5]. Blindness rates for Indigenous adults decreased by four times between the late 1970s and the 2008 NIEHS [6], but rates for Indigenous adults in 2008 were still 6.2 times those for other adults [2]. The most common cause of bilateral blindness in adults was cataract (32%), and the most common cause of low vision was uncorrected refractive error (54%). The proportion of blindness caused by corneal diseases (84% of which was due to trachoma) had decreased from 52% in the late 1970s to 9% in 2008.
Only 1.4% of children aged 5-15 years who participated in the 2008 NIEHS were found to have low vision, with more than one-half (56%) due to refractive errors [2]. Vision loss was much less common among Indigenous children than among non-Indigenous children (ratio 0.2).
Eye and sight problems were reported by 30% of Indigenous people who participated in the 2004-2005 NATSIHS, making it the most commonly reported health condition [7]. This level is similar to that documented in 2001. More Indigenous females than males reported eye/sight problems. The age-adjusted levels of eye/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/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).
Overall, a lower proportion of Torres Strait Islander people (26%) than Aboriginal people (30%) reported having eye/sight problems (the difference is not statistically significant), but the proportion was 31% for Torres Strait Islander people living in the Torres Strait area [7].
The 2008 NATSISS reported that 9.3% of Indigenous children aged 4-14 years had some form of eye or sight problems [8]. The most common forms of these problems were long-sightedness (37%) and short-sightedness (28%) [9].
Trachoma, a bacterial infection that has been virtually eliminated in the developed world, still occurs among Indigenous people and can cause blindness [5]. The NIEHS identified that 60% of Indigenous communities in very remote areas had endemic trachoma (defined as a prevalence of active trachoma of more than 5% in 5-9 year-olds). A similar level was documented in the Trachoma surveillance report 2009 [10][11]. This report concluded that trachoma remained a major health problem in Indigenous communities as the prevalence had not changed over the four years of screening, and particularly because there was a large pool of undiagnosed and untreated trachoma among Indigenous children.
Of particular concern is the rise of diabetic retinopathy among Indigenous adults. The NIEHS reported that diabetes was the cause of 13% of low vision and 9% of blindness among Indigenous adults over 40 years of age [2][5]. Diabetic retinopathy was reported to be 30 times more frequent among Indigenous adults than among non-Indigenous adults in 2008.
Helping to 'close the gap' by providing the evidence base to inform practice and policy in Aboriginal and Torres Strait Islander health
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