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The eye health of Indigenous people before non-Indigenous people came to Australia was probably very good [1]. In fact, it is believed that the vision of Indigenous people was better than that of non-Indigenous people [2].
Today, however, it is likely that the eye health of Indigenous people is not as good as that of non-Indigenous people. The level of blindness among Indigenous people appears to be higher than that among non-Indigenous people, with some eye problems much more common among Indigenous people than among non-Indigenous people [2] [3].
Importantly, Indigenous 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.
The main conditions affecting the eye health of Indigenous people are:
(For details of each of these conditions, see What is known about eye health?)
Information about how these conditions affect Indigenous people is provided in the following sections.
A report on Indigenous eye health in 1997 reported that blindness occurred up to 10 times more often in the Indigenous population than in the non-Indigenous population [2]. For Indigenous people blindness was mainly caused by cataracts or damage to the eyes from trachoma.
A major national survey of more than 10,000 Indigenous people in 2004-2005 found that:
The major national survey of more than 10,000 Indigenous people in 2004-2005 found that:
The main issues for Indigenous people with eye focussing problems are:
This is largely because Indigenous 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 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.
Many Indigenous 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 Indigenous population, but a study in the Katherine region of the Northern Territory in 1993 and 1996 found that that about one in five Indigenous people with diabetes had eye problems due to diabetic retinopathy [5]. About one in twelve Indigenous 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 Indigenous 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 Indigenous 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 Indigenous people, it is likely that blindness from diabetic retinopathy will become more common among Indigenous people unless the level of screening and treatment increases [8].
According to the major national survey of more than 10,000 Indigenous people in 2004-2005 cataracts were around one-and-a-half times more common among Indigenous people than among non-Indigenous people [3]. Cataract was reported more frequently by Indigenous females (3 in 100 females) than by Indigenous males (1 in 100 males).
The level of cataract among Indigenous people is slightly higher among Indigenous people than among non-Indigenous people, but many Indigenous 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:
Trachoma and gonococcal conjunctivitis are two eye infections affecting Indigenous people more than non-Indigenous people.
Trachoma, which has been a major cause of blindness among Indigenous people, is still quite common in some communities in northern and central Australia. Recent evidence about trachoma among Indigenous people includes:
The drop in recent years in the number of people affected by trachoma In the Anangu Pitjantjatjara 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 Indigenous people relates to the infectious stages, when the disease can pass from person to person. There is little information about Indigenous 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:
There have been several outbreaks of gonococcal conjunctivitis in Indigenous 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.
The use of eye services is less among Indigenous people than among non-Indigenous people for a variety of reasons. This is partly because many more Indigenous 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 Indigenous people live, other factors contributing to their lower use of eye health services include:
