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Australian Indigenous HealthBulletin
 
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spacing1What is known about the eye health of Aboriginal and Torres Strait Islander Australians?

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The eye health of Aboriginal and Torres Strait Islander people before non-Indigenous people came to Australia was probably very good [1]. In fact, it is believed that the vision of Aboriginal and Torres Strait Islander people was better than that of non-Indigenous people [2].

Today, however, it is likely that the eye health of Aboriginal and Torres Strait Islander people is not as good as that of non-Indigenous people. The level of blindness among Aboriginal and Torres Strait Islander people appears to be higher than that among non-Indigenous people, with some eye problems much more common among Aboriginal and Torres Strait Islander people than among non-Indigenous people [2] [3].

Importantly, Aboriginal and Torres Strait Islander people are less likely than non-Indigenous people to receive appropriate levels of eye health services and treatment [4] as should be expected in a prosperous country like Australia.

What are the main types of eye conditions that affect Aboriginal and Torres Strait Islander people?

The main conditions affecting the eye health of Aboriginal and Torres Strait Islander people are:

(For details of each of these conditions, see What is known about eye health?)

Information about how these conditions affect Aboriginal and Torres Strait Islander people is provided in the following sections.

What is known about blindness among Aboriginal and Torres Strait Islander people?

A report on Aboriginal and Torres Strait Islander eye health in 1997 reported that blindness occurred up to 10 times more often in the Aboriginal and Torres Strait Islander population than in the non-Indigenous population [2]. For Aboriginal and Torres Strait Islander people blindness was mainly caused by cataracts or damage to the eyes from trachoma.

A major national survey of more than 10,000 Aboriginal and Torres Strait Islander people in 2004-2005 found that:

What is known about eye focussing problems (refractive error) among Aboriginal and Torres Strait Islander people?

The major national survey of more than 10,000 Aboriginal and Torres Strait Islander people in 2004-2005 found that:

The main issues for Aboriginal and Torres Strait Islander people with eye focussing problems are:

This is largely because Aboriginal and Torres Strait Islander people often didn't use mainstream government schemes that provided low-cost glasses [2]. (Low-cost glasses for looking at close objects, which can be bought from community or town stores, are fine to use and do not do any harm.)

The Nganampa Health Council, which provides health services to people in the Anangu Pitjantjatjara (AP) lands of north-western South Australia, makes low-cost glasses available through community stores [4]. These are popular, even after improved access to subsidised, prescription (specially-made) glasses had been organised. The Council covers the ‘gap' payment between the price and the state subsidy for one pair of prescription spectacles per person per year - if these are broken or lost many people turn to the ready-made store spectacles.

What is known about eye problems caused by diabetes (diabetic retinopathy)?

Many Aboriginal and Torres Strait Islander people have diabetes, which can cause an eye problem called diabetic retinopathy and can lead to blindness, as well as a number of other health problems.

There is not much information available about diabetic retinopathy in the Aboriginal and Torres Strait Islander population, but a study in the Katherine region of the Northern Territory in 1993 and 1996 found that that about one in five Aboriginal and Torres Strait Islander people with diabetes had eye problems due to diabetic retinopathy [5]. About one in twelve Aboriginal and Torres Strait Islander people with diabetes were at risk of losing their eyesight, which is a rate similar to that of non-Indigenous people with diabetes.

A study of over 1,500 Aboriginal adults living in remote SA between 1999 and 2004 included over 700 people with diabetes, one in five of whom had signs of diabetic retinopathy [6]. One in twelve of those with diabetic retinopathy had leakage of blood vessels on the central part of the retina, the macula, which is responsible for reading and fine detail vision.

There are a number of relatively simple ways to screen for diabetic retinopathy [7]. Screening with special cameras has been carried out successfully in a number of Aboriginal and Torres Strait Islander settings.

People with diabetes should have their eyes checked every year, unless they already have diabetes related eye problems in which case they should have their eyes checked more often.

With the high and increasing levels of diabetes among Aboriginal and Torres Strait Islander people, it is likely that blindness from diabetic retinopathy will become more common among Aboriginal and Torres Strait Islander people unless the level of screening and treatment increases [8].

What is known about cataract among Aboriginal and Torres Strait Islander people?

According to the major national survey of more than 10,000 Aboriginal and Torres Strait Islander people in 2004-2005 cataracts were around one-and-a-half times more common among Aboriginal and Torres Strait Islander people than among non-Indigenous people [3]. Cataract was reported more frequently by Aboriginal and Torres Strait Islander females (3 in 100 females) than by Aboriginal and Torres Strait Islander males (1 in 100 males).

The level of cataract among Aboriginal and Torres Strait Islander people is slightly higher among Aboriginal and Torres Strait Islander people than among non-Indigenous people, but many Aboriginal and Torres Strait Islander people have quite long delays in having the surgery that can improve their eyesight [2] [4].

The delays are mainly caused by limited access to the surgery, but delays can also because of:

What is known about eye infections among Aboriginal and Torres Strait Islander people?

Trachoma and gonococcal conjunctivitis are two eye infections affecting Aboriginal and Torres Strait Islander people more than non-Indigenous people.

Trachoma

Trachoma, which has been a major cause of blindness among Aboriginal and Torres Strait Islander people, is still quite common in some communities in northern and central Australia. Recent evidence about trachoma among Aboriginal and Torres Strait Islander people includes:

The drop in recent years in the number of people affected by trachoma in the AP lands of SA is thought to be due to improvements in social and economic conditions, community development and increased access to medical care [9].

Trachoma was found to be more common in the wet season than in the dry season among preschool and school-aged children living in two communities in the west Kimberley region of WA [11].

Trachoma control programs are based on the strategy SAFE which stands for Surgery, Antibiotic, Facial cleanliness, Environment (see background info) [4]. In areas where people move from place to place, trachoma control programs need to cover larger areas rather than just a single community.
An antibiotic called azithromycin, an effective treatment for trachoma, is available as a free or subsidised medicine [12].

Nearly all the recent information about trachoma among Aboriginal and Torres Strait Islander people relates to the infectious stages, when the disease can pass from person to person. There is little information about Aboriginal and Torres Strait Islander people suffering the later effects of trachoma, where scars can be formed or eyelashes turn in causing damage to the eye, but the following studies give some details:

Gonococcal conjunctivitis

There have been several outbreaks of gonococcal conjunctivitis in Aboriginal populations in central Australia [16]. (See What is known about eye health?, for details about gonococcal conjunctivitis.) A large outbreak occurred in 1997 when nearly 500 people were affected. It is important to monitor the situation and use laboratory tests to confirm cases when outbreaks occur.

Why is the use of eye health services less among Aboriginal and Torres Strait Islander people than among non-Indigenous people?

The use of eye services is less among Aboriginal and Torres Strait Islander people than among non-Indigenous people for a variety of reasons. This is partly because many more Aboriginal and Torres Strait Islander people than non-Indigenous people live in rural and remote parts of Australia, where specialist eye health services - by ophthalmologists (eye doctor) and optometrists (another type of health care professional specialising in eye health) - are less accessible than in major urban and regional centres.

As well as the lack of services where many Aboriginal and Torres Strait Islander people live, other factors contributing to their lower use of eye health services include:

References

  1. Thomson N, Paterson B (1998) Eye health of Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander Health Reviews; 1:
  2. Taylor HR (1997) Eye health in Aboriginal and Torres Strait Islander communities. Canberra: Commonwealth Department of Health and Family Services
  3. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics
  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. 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 & Experimental Ophthalmology; 31(1): 32-39
  6. 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. Clinical & Experimental Ophthalmology; 34(4): 329-334
  7. Diamond JP, McKinnon M, Barry C, Geary D, McAllister IL, House P, Constable IJ (1998) Non-mydriatic fundus photography: a viable alternative to fundoscopy for identification of diabetic retinopathy in an Aboriginal population in rural Western Australia?. Australian and New Zealand Journal of Ophthalmology; 26(2): 109-115
  8. Office for Aboriginal and Torres Strait Islander Health (2001) Specialist eye health guidelines for use in Aboriginal and Torres Strait Islander populations. Canberra: Commonwealth Department of Health and Aged Care
  9. Roden D (2000) Trachoma on the decline. Rural Practice; 4(2): 30-31
  10. Paterson B (2002) Trachoma: new problem or old dilemma. Northern Territory Disease Control Bulletin; 9(2): 1-5
  11. da Cruz L, Dadour I, McAllister I, Jackson A, Isaacs T (2002) Seasonal variation in trachoma and bush flies in north-western Australian Aboriginal communities. Clinical & Experimental Ophthalmology; 30(2): 80-83
  12. Department of Health and Ageing (2004) Australian government response to the review of the implementation of the National Aboriginal and Torres Strait Islander Eye Health Program. Canberra: Department of Health and Ageing
  13. Landers J, Kleinschmidt A, Wu J, Burt B, Ewald D, Henderson T (2005) Prevalence of cicatricial trachoma in an Indigenous population of Central Australia: the Central Australian Trachomatous Trichiasis Study (CATTS). Clinical & Experimental Ophthalmology; 33(2): 142-146
  14. Mak DB, Plant AJ (2001) Trichiasis in Aboriginal people of the Kimberley region of Western Australia. Clinical & Experimental Ophthalmology; 29(1): 7-11
  15. Stocks N, Newland H, Hiller J (1994) The epidemiology of blindness and trachoma in the Anangu Pitjantjatjara of South Australia. Medical Journal of Australia; 160(12): 751-756
  16. Mak D, Smith DW, Harnett GB, Plant AJ (2001) A large outbreak of conjunctivitis caused by a single genotype of neisseria gonorrhoeae distinct from those causing genital tract infections. Epidemiology and Infection; 126(3): 373-378

© Australian Indigenous HealthInfoNet 2013 
This product, excluding the Australian Indigenous HealthInfoNet logo, artwork, and any material owned by a third party or protected by a trademark, has been released under a Creative Commons BY-NC-ND 3.0 (CC BY-NC-ND 3.0) licence. Excluded material owned by third parties may include, for example, design and layout, images obtained under licence from third parties and signatures.

 

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    Last updated: 8 September 2016
     
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