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Eye health

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Eye health

Eye health can be affected by a number of factors, including genetics, ageing, premature birth, diseases (such as diabetes), injuries, ultraviolet (UV) exposure, nutrition and tobacco use [1][2]. Poor vision can limit opportunities in education, employment and social engagement; it can also increase the risk of injury and be a reason for dependence on services and other people [3][4]. Even partial loss of vision can reduce an individual’s ability to live independently and increase the risk of mortality [3][5].

Vision loss is responsible for 11% of years of life lived with a disability1 for Aboriginal and Torres Strait Islander people; is the fourth leading cause of the gap in health between Indigenous and non-Indigenous people; and increases mortality at least two-fold [6][7]. However, evidence suggests that Indigenous children, particularly those living in remote areas, experience generally better vision than non-Indigenous children, and 94% of vision loss among Indigenous people is preventable or treatable [8]. The Roadmap to close the gap for vision is currently guiding national efforts to increase the accessibility and uptake of culturally appropriate eye care services among Indigenous people [9].

Extent of eye health problems among Aboriginal and Torres Strait Islander people

Eye and sight problems2 (also referred to as diseases of the eye and adnexa) were reported in the 2012-2013 AATSIHS by one-third (33%) of Aboriginal and Torres Strait Islander people (33% of Aboriginal people and 34% of Torres Strait Islander people) [10][11][12], making it the most commonly reported long-term health condition [13]. Eye and sight problems were reported by 38% of females and by 29% of males [14]. After age-adjustment, Aboriginal and Torres Strait Islander people were slightly less likely to report eye and sight problems than their non-Indigenous counterparts (ratios of 0.9 for: males; females; and total persons) [15].

In the 2012-2013 AATSIHS, self-reported eye and sight problems increased with age for both Aboriginal and Torres Strait Islander people and non-Indigenous people [16]. Age-specific proportions ranged from: 9% for Aboriginal and Torres Strait Islander people in the 0-14 years age-group to 92% for those aged 55 years and over; and 11% to 95% for non-Indigenous people in the comparable age-groups. The proportion of eye and sight problems reported by Aboriginal and Torres Strait Islander people was lower than that reported by their non-Indigenous counterparts in all age-groups, apart from those reported for the 35-44 and 45-54 years age-groups in which the proportions were slightly higher among Aboriginal and Torres Strait Islander people. The proportion of Aboriginal and Torres Strait Islander people reporting eye or sight problems was similar in non-remote areas3 and remote areas (both 35%), but lower among those living in very remote areas (25%) [17].

Specific eye conditions

The most common eye conditions reported by Aboriginal and Torres Strait Islander people in the 2012-2013 AATSIHS were: hyperopia (long sightedness: 19%), myopia (short sightedness: 13%), other diseases of the eye and adnexa4 (5.6%), blindness (3.0%), and cataract (1.1%) (Table 26) [15]. After age-adjustment, Aboriginal and Torres Strait Islander people were more likely to report hyperopia, cataract and blindness than non-Indigenous people (ratios of 1.1, 1.4 and 7.4 respectively), but were less likely to report myopia (ratio: 0.8) and other diseases of the eye and adnexa (ratio: 0.5). Blindness showed the greatest disparities in Indigenous:non-Indigenous ratios, with Aboriginal and Torres Strait Islander males and females both more likely to report blindness than their non-Indigenous counterparts (ratios: 6.3 for males and 8.8 for females) [15].

Table 26. Proportions (%)1 of people reporting specific diseases of the eye and adnexa as long-term health conditions2, by sex and Indigenous status, and Indigenous:non-Indigenous ratios, Australia, 2012-2013

Diseases of the eye and adnexa

Males

Females

Persons

Indigenous (%)

Non-Indigenous3 (%)

Ratio4

Indigenous (%)

Non-Indigenous3 (%)

Ratio4

Indigenous (%)

Non-Indigenous3 (%)

Ratio4

Cataract

1.2

1.4

1.7

1.0

2.0

1.2

1.1

1.7

1.4

Myopia

10

21

0.8

15

27

0.8

13

24

0.8

Hyperopia

15

25

1.1

23

31

1.2

19

28

1.1

Blindness5

2.7

0.6

6.3

3.2

0.5

8.8

3.0

0.6

7.4

Other6

5.7

16

0.5

5.5

16

0.5

5.6

16

0.5

Notes:

  1. Proportions are non-age standardised
  2. The condition has lasted, or is expected to last, for 6 months or more
  3. Data for non-Indigenous people are for 2011-12
  4. Ratios are age standardised with the Indigenous proportion divided by the non-Indigenous proportion and based on the 2001 Australian ERP
  5. Includes complete and partial blindness
  6. Other diseases of the eye and adnexa include: glaucoma, macular degeneration, astigmatism and presbyopia

Source: ABS, 2014 [15]

Among Aboriginal and Torres Strait Islander people who reported having diabetes, 29% reported having sight problems due to this condition [18]. After age-adjustment, this proportion was 2.6 times greater than the proportion reported by their non-Indigenous counterparts with diabetes.

The 2012-2013 AATSIHS provides some age-specific data for selected eye diseases (Table 27) [16]. The proportion of Aboriginal and Torres Strait Islander people reporting myopia or other diseases of the eye and adnexa is less in each age-group than that reported by their non-Indigenous counterparts. Hyperopia is also less common among young Aboriginal and Torres Strait Islander people aged 0-14 and 15-24 years of age than among their non-Indigenous counterparts, but more common among Aboriginal and Torres Strait Islander people from 25 years of age onwards. Cataract and blindness are more common among Aboriginal and Torres Strait Islander people than among non-Indigenous people in all age-groups for which data are available.

Table 27. Proportions (%)1 of people reporting specific diseases of the eye and adnexa as long-term health conditions2, by age-group and Indigenous status, and Indigenous:non-Indigenous ratios, Australia, 2012-2013

Diseases of the eye and adnexa

Indigenous people

Non-Indigenous people3

   

Age- groups (years)

Age- groups (years)

Total

 

0-14 (%)

15-24 (%)

25-34 (%)

35-44 (%)

45-54 (%)

55+ (%)

0-14 (%)

15-24 (%)

25-34 (%)

35-44 (%)

45-54 (%)

55+ (%)

Indig (%)

Non-Indig3 (%)

Ratio4

Cataract

np5

np5

0.99

1.08

1.38

7.4

0.0

np5

np5

0.28

0.58

6.3

1.1

1.7

1.4

Myopia

2.210

1110

1210

1810

30

36

4.210

1910

2510

2610

30

36

13

24

0.8

Hyperopia

3.9

8.6

11

2210

6010

6810

4.5

9.5

8.6

1510

5310

6210

19

28

1.1

Blindness6

1.08

2.510

2.9

5.710

5.010

6.410

np5

0.48,10

np5

0.48,10

0.58,10

1.410

3.0

0.6

7.4

Other7

2.710

3.810

5.210

8.110

9.510

1410

4.910

8.810

1310

1410

2110

2710

5.6

16

0.5

Notes:

  1. Proportions are non-age-standardised and are expressed as percentages
  2. The condition has lasted, or is expected to last, for 6 months or more
  3. Data for non-Indigenous people are for 2011-12
  4. Ratios are age-standardised with the Indigenous proportion divided by the non-Indigenous proportion and based on the 2001 Australian ERP
  5. Not available for publication but included in totals where applicable, unless otherwise indicated
  6. Includes complete and partial blindness
  7. Other diseases of the eye and adnexa include: glaucoma, macular degeneration, astigmatism and presbyopia
  8. Proportion has a relative standard error between 25% and 50% and should be used with caution
  9. Proportion has a relative standard error greater than 50% and is considered too unreliable for general use
  10. The difference between the proportion for Aboriginal and Torres Strait Islander people and the comparable proportion for non-Indigenous people is statistically significant

Source: ABS, 2014 [16]

The National Trachoma Surveillance and Reporting Unit provides prevalence data for trachoma detected through screening [19]. In 2014, screening was undertaken in 125 communities in the NT, WA, SA and NSW, and the overall prevalence of active trachoma among children aged 5-9 years (using projected data) was 4.7%. A total of 158 cases were detected (32 in WA, 27 in SA, and 99 in the NT). If left untreated, trachoma can cause scarring and in-turned eyelashes that lead to blindness (trichiasis) [8]. In 2014, at risk communities in the NT, SA and WA were screened for trichiasis, and the condition was detected in 0.5% of adults aged 15 years and over and 0.9% of those aged 40 years and over [19]. A total of 50 cases were detected (11 in WA, 12 in SA, and 27 in the NT).

General practice attendances and hospitalisation

Among Aboriginal and Torres Strait Islander patients, 1.1% of all problems that were managed by GPs in the period April 2008 to March 2013 were related to eye health [20][18]. After age-adjustment, eye health problems among Aboriginal and Torres Strait Islander patients were managed by GPs at a similar rate as that for other patients (rate ratio: 1.0). However they were 3.5 times more likely than other patients to see GPs for the management of cataracts.

In 2013-14, there were 3,150 hospital separations for diseases of the eye and adnexa among Aboriginal and Torres Strait Islander people in Australia, accounting for 0.8% of separations identified as Indigenous [21]. A more detailed analysis of hospitalisation data is available for the period 2011-12 to 2012-13 [20]. In this period, there were 5,674 hospitalisations for diseases of the eye and adnexa among Aboriginal and Torres Strait Islander people, the majority of which (58%) were for cataracts [18]. After age-adjustment, Aboriginal and Torres Strait Islander males and females were less likely to be hospitalised for diseases of the eye and adnexa than their non-Indigenous counterparts (rate ratios of 0.7 and 0.8 respectively) [20]. Aboriginal and Torres Strait Islander people were less likely to be hospitalised for these eye conditions in non-remote areas than their non-Indigenous counterparts (rate ratio 0.7), but they were more likely to be hospitalised for them in remote and very remote areas (rate ratios of 1.2 and 1.5 respectively).

References

  1. Australian Bureau of Statistics (2009) National Aboriginal and Torres Strait Islander social survey, 2008. Retrieved 11 April 2011 from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0?OpenDocument
  2. Biotext (2008) Risk factors for eye disease and injury: literature review. Canberra: National Health and Medical Research Council, Australia
  3. Australian Health Ministers’ Advisory Council (2012) Aboriginal and Torres Strait Islander health performance framework: 2012 report. Canberra: Office for Aboriginal and Torres Strait Islander Health, Department of Health and Ageing
  4. Access Economics (2004) Clear Insight: The economic impact and cost of vision loss in Australia. : Access Economics Pty Limited
  5. Taylor HR, Boudville A, Anjou M, McNeil R (2011) The roadmap to close the gap for vision: summary report. Melbourne: Indigenous Eye Health Unit, the University of Melbourne
  6. Vos T, Taylor HR (2013) Contribution of vision loss to the Indigenous health gap. Clinical & Experimental Ophthalmology; 41(3): 309–310
  7. Taylor HR, Anjou MD, Boudville AI, McNeil RJ (2012) The roadmap to close the gap for vision: full report. Melbourne: Indigenous Eye Health Unit, the University of Melbourne
  8. Taylor HR, National Indigenous Eye Health Survey Team (2009) National Indigenous eye health survey: minum barreng (tracking eyes): summary report. Melbourne: Indigenous Eye Health Unit, The University of Melbourne
  9. Abouzeid M, Anjou MD, Taylor HR (2015) Equity in vision in Australia is in sight. Medical Journal of Australia; 203(1): 21-23
  10. Australian Health Ministers' Advisory Council (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report. Canberra: Department of the Prime Minister and Cabinet
  11. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13. Canberra: Australian Bureau of Statistics
  12. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 25 [data cube]. Retrieved 26 March 2014 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&table%2025%20selected%20health%20characteristics%20by%20aboriginal_torres%20strait%20islander%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&8759176B7100FFF0CA257CA6000E3759&0&2012-13&2
  13. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 3 [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%203%20selected%20health%20characteristics,%20by%20state_territory%202012-13-australia.xls&4727.0.55.001&Data%20Cubes&D43DB1D697BED77ECA257C2F00145D04&0&2012-13&27.11.2013&Latest
  14. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 4 [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%204%20selected%20health%20characteristics,%20by%20sex%202012-13-australia.xls&4727.0.55.001&Data%20Cubes&497BBEB2AFC1B23DCA257C2F00145D2E&0&2012-13&27.11.2013&Latest
  15. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 5 [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%205%20long-term%20conditions%20by%20sex%20by%20indigenous%20status,%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&5C97CE7DA7059C06CA257C2F00145D5A&0&2012-13&27.11.2013&Latest
  16. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 6 [data cube]. Retrieved 26 March 2014 from
  17. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 2 [data cube]. Retrieved 26 March 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%202%20selected%20health%20characteristics,%20by%20remoteness%20area%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&9F3D9B7052520B1BCA257CA6000E31B5&0&2012-13&26.03.2014&Latest
  18. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
  19. The Kirby Institute (2015) Australian trachoma surveillance report 2014. Sydney: The Kirby Institute, University of New South Wales
  20. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014: data tables. Retrieved 11 June 2015 from http://www.aihw.gov.au/indigenous-data/health-performance-framework/
  21. Australian Institute of Health and Welfare (2015) Admitted patient care 2013–14: Australian hospital statistics. Canberra: Australian Institute of Health and Welfare

Endnotes

  1. Calculated in this case as the multiplication of prevalent cases of vision loss multiplied by the appropriate disability weight for mild, moderate and severe vision loss [6].
  2. Eye and sight problems include: cataract; glaucoma; disorders of the choroid and retina; disorders of the ocular muscles, binocular movement, accommodation and refraction; visual disturbances and blindness; and other diseases of the eye and adnexa [13].
  3. Non-remote areas include major cities and inner and outer regional areas [17]
  4. Other diseases of the eye and adnexa include: glaucoma, macular degeneration, astigmatism and presbyopia [15].
 
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