Eye health
There has been progress in improving the eye health of Indigenous people, but many Indigenous people are still more likely than non-Indigenous people to suffer from preventable conditions, such as trachoma (a bacterial infection) [1, 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, can impair vision and may cause blindness [1, 3].
The eye health of many Indigenous people is also limited by difficulty in accessing optometrist or specialist services [4]. For those with refractive error, for example, the main issues are access to and utilisation of testing, cost of spectacles, the administrative difficulty of dispensing, and the repair of spectacles. Eye health can be affected by genetic factors, ageing, premature birth, diseases (such as diabetes) smoking, injuries, UV exposure and nutrition.
Extent of eye health problems among Indigenous people
Eye and/or sight problems were reported by 30% of Indigenous people who participated in the 2004-2005 NATSIHS [5]. These problems were reported slightly less frequently by Indigenous people living in remote areas (25%) than by those living in non-remote areas (32%). The proportion of eye and/or sight problems reported by Indigenous people living in non-remote areas is slightly higher than the proportion found in the 1995 NHS (28%), but the overall proportions of Indigenous people who reported having an eye and/or sight problem to the 2001 NHS and the 2004-2005 NATSIHS were similar [5].
After adjusting for differences in the age structures of the two populations, eye and/or sight problems overall were slightly more common for non-Indigenous than for Indigenous people. On the other hand, two serious problems – blindness and cataract – were around one-and-a-half times more common for Indigenous than for non-Indigenous people.
Overall, a slightly lower proportion of Torres Strait Islander (26%) than Aboriginal people (30%) reported having an eye and/or sight problem, but the proportion was 31% for Torres Strait Islanders living in the Torres Strait area [5].
According to the WAACHS, 8% of Indigenous children aged 4-17 years did not have normal vision in both eyes (a level significantly lower than the 14% of children in the general population found in the 1993 WA Child Health Survey not to have normal vision in both eyes) [6]. Of the 4-17 year-old Aboriginal children without normal vision in both eyes, 58% used prescribed glasses or contact lenses.
In Australia, trachoma is found almost exclusively within the Indigenous population, either in its infectious (follicular) form or as scarring (resulting from repeated infections over years) [2, 4].
Until recently, it had been difficult to develop an accurate picture of where infectious trachoma remains endemic because of the lack of systematic screening. The establishment in November 2006 of the National Trachoma Surveillance and Reporting Unit (NTSRU), however, means that good information will now available for children living in many parts of WA, SA and the NT [7]. It its first report in December 2007, based on data collected largely before its establishment, the NTSRU has confirmed that infectious trachoma among Indigenous children is still endemic across many remote parts of the country, particularly in central and north-western Australia. The areas with the highest prevalence of active trachoma were the Pilbara, WA, 53%, and Katherine, NT, 30%, but the prevalence was also reported at around 20% for the Kimberley, Midwest and Goldfields regions of WA, the Barkley and Alice Springs Remote regions of the NT, and for the far north-west of SA and the area around Yalata in western SA.
The prevalence of infectious trachoma is much less common among adults, but 20 (1.2%) of 1,651 Indigenous adults screened by the South Australian Eye Health Program in remote SA in 1999-2004 had evidence of active trachoma [8]. Trachomatous scarring (lid scarring, trichiasis or corneal opacity) was found in 260 adults (16%). An even higher level of trachomatous scarring (65%) was documented among 181 adults who attended general ophthalmological outreach clinics to 16 Indigenous communities in remote central Australia in 2003 [9].
There are very limited data available on the prevalence of diabetic retinopathy in the Indigenous population [4], but a cross-sectional study in the Katherine region in 1993 and 1996 found that the crude prevalences of diabetic retinopathy (21%) and vision-threatening retinopathy (7-8%) among Indigenous people with diabetes were similar to those reported for non-Indigenous people with diabetes [10]. The study of 1,651 Indigenous adults living in remote SA in 1999-2004 included 771 people with diabetes, 197 (22%) of whom had features of diabetic retinopathy [8]. Fourteen (8%) of people with diabetic retinopathy had clinically significant macula oedema (CSMO).
References
1 Taylor HR (1997) Eye health in Aboriginal and Torres Strait Islander communities: the report of a review commissioned by the Commonwealth Minister for Health and Family Services, the Hon. Michael Wooldridge, MP. Canberra: Commonwealth Department of Health and Family Services
2 Burns J, Thomson N(2003) Eye health. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press:273-289
3 Irvine J, Kirov E, Thomson N(2003) Diabetes. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press:93-126
4 Taylor V, Ewald D, Liddle H, Warchivker I (2004) Review of the implementation of the National Aboriginal and Torres Strait Islander Eye Health Program. Canberra: Centre for Remote Health
5 Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey, Australia 2004-05. (ABS Cat. no. 4715.0) Canberra: Australian Bureau of Statistics
6 Zubrick SR, Lawrence DM, Silburn SR, Blair E, Milroy H, et al. (2004) The Western Australian Aboriginal Child Health Survey: the health of Aboriginal children and young people. Perth: Telethon Institute for Child Health Research
7 Tellis B, Keeffe JE, Taylor HR (2007) Surveillance report for active trachoma, 2006: National Trachoma Surveillance and Reporting Unit. Communicable Disease Intelligence;31(4):366-374
8 Durkin SR, Casson R, Newland HS, Selva D (2006) Prevalence of trachoma and diabetes-related eye disease among a cohort of adult Aboriginal patients screened over the period 1999-2004 in remote South Australia [in press]. Clinical and Experimental Ophthalmology;
9 Landers J, Kleinschmidt A, Wu J, Burt B, Ewald D, et al. (2005) Prevalence of cicatricial trachoma in an Indigenous population of Central Australia: the Central Australian Trachomatous Trichiasis Study (CATTS). Clinical and Experimental Ophthalmology;33(2):142-126
10 Jaross N, Ryan P, Newland H (2003) Prevalence of diabetic retinopathy in an Aboriginal Australian population: results from the Katherine Region Diabetic Retinopathy Study (KRDRS): report no. 1. Clinical and Experimental Ophthalmology;31(1):32-39
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