In May 2003 the 56th World Health Assembly passed resolution WHA56.26 on the elimination of avoidable blindness in recognition of the fact that 45 million people in the world today are blind and that a further 135 million people are visually impaired. The resolution urged member states to develop a national Vision 2020 plan in collaboration with non-government organisations and the private sector to prevent avoidable blindness.
In Australia the main causes of blindness and vision loss are macular degeneration, cataract, glaucoma, diabetic retinopathy, uncorrected or under-corrected refractive error, retinitis pigmentosa, eye injuries and trachoma, which is present in some remote regions of Australia.
In accordance with the World Health Assembly resolution, the focus of the National Eye Health Framework is on the elimination of avoidable blindness and vision loss in Australia, rather than the provision of rehabilitation services. Avoidable blindness and vision loss refer to visual impairment due to conditions that are potentially preventable through the modification of known risk factors, or for which effective treatments exist to restore sight or prevent further vision loss.
The prevalence of eye disease in AustraliaBased on the results of the 2001 National Health Survey, 9.7 million Australians or 51% of the population had at least one sight problem. The most commonly reported eye disorders were refractive errors, such as long-sightedness, short-sightedness, presbyopia and astigmatism. Cataract was reported by 2% of respondents and glaucoma by 1%. The prevalence of sight problems increases rapidly with age, reaching 87% by ages 45-54 and 96% by ages 75 and over, and is more common in females (55%) than males (47%).1Vision impairment and blindness are among the major causes of disability. According to the 1998 Survey of Disability, Ageing and Carers “loss of sight” was the reason or part of the reason for disability given by 1,349,800 persons in Australia.
It is estimated that in Australia 116,000 people present to hospitals or general practitioners each year with unintentional eye injuries. Many people do not wear eye protection when performing high risk activities, such as welding and grinding, particularly in the home environment. Injuries also occur when eye protection is ill- fitting or not worn at appropriate times.2
The social and economic costs of eye diseaseRecent independent economic analysis undertaken by Access Economics for the Centre for Eye Research Australia estimated the total cost of vision disorders in Australia to be $9.85 billion per annum.3 Direct and indirect costs include health system costs, early entry into supported accommodation or an aged care facility, early reliance on home and community care and social welfare systems, carer costs, loss of participation in the community including employment, as well as individual costs such as mobility devices, transport, building modification and lower employment rates.
Groups at particular riskCertain population groups are at particular risk of developing eye disease, including Aboriginal and Torres Strait Islander Peoples, older people, people with a family history of eye disease, people with diabetes and marginalised and disadvantaged people.
Although in Australia the number of children at risk of blindness is small, prevention of avoidable childhood blindness and vision loss is particularly important, because of the years of sight lost that ensue and the severity of implications for child development.
People with diabetes are at increased risk of developing eye disease, particularly diabetic retinopathy, cataract and glaucoma. It is estimated that as many as one million Australians have diabetes, though many are unaware of it. Age at onset and duration of diabetes are key factors influencing the prevalence of eye disease in people with diabetes. For example, in young people with diabetes (aged less than 30 years at diagnosis) the prevalence of diabetic retinopathy is 25 percent during the first 5 years after diagnosis, rising to 50 percent after 15 years since diagnosis.4After the age of 40 the amount of visual impairment and blindness increases threefold with each decade of age.5 It is estimated that as the population ages, vision impairment will emerge as the most prevalent health condition amongst older people. Blindness and vision loss restrict mobility and increase morbidity amongst older people, leading to a greater risk of depression, falls and hip fractures with an associated rise in hospital admissions and demand on community health and welfare services.
As with many other health conditions, Aboriginal and Torres Strait Islander people are potentially at increased risk of developing avoidable blindness and vision loss and are less likely to access eye health care practitioners than other Australians. Uncorrected refractive error, correctable with spectacles, is a leading cause of visual impairment in Aboriginal and Torres Strait Islander Communities, followed by cataract, diabetic retinopathy and trachoma. Australia is the only developed country with trachoma that persists in some regions.
Principles to guide the development of the National Eye Health FrameworkThe National Eye Health Framework has taken the following principles as its starting point. Actions should:
- take a consumer-oriented approach, recognising that current and future consumers are the starting point for policies and programs aimed at preventing blindness and vision loss.
- focus on high risk groups, recognising that specific population groups are at particular risk of avoidable blindness and vision loss.
- focus on primary prevention, recognising that many of the risk factors of eye disease are modifiable.
- take a holistic approach, recognising that eye health can be linked to a person’s general health status and that, in turn, vision loss may impact on a person’s emotional, social and physical wellbeing.
- take a life course approach, recognising that complex interactions between life events, biological risks and health determinants produce varying patterns of vision function, eye disease and vision impairment at each stage of an individual’s life.
- be based on evidence, ideally from peer-reviewed research and evaluation, that the proposed actions will lead to a decrease in preventable blindness and vision loss; and where research is not available, the potential of the action items, judged on the basis of current knowledge and experience, to reduce blindness and vision loss.
- be based on a partnership approach, recognising that the best outcomes will be achieved through all players working in partnership towards commonly agreed objectives.
- maximise linkages across the health and eye care sector to relevant national and state based public health strategies and initiatives.
Australian Institute of Health and Welfare 2004. Australia’s Health 2004. Canberra: AIHW
A.L. Imberger, A.E. Altmann, W. Watson 1998 Unintentional Adult Eye Injuries in Victoria (Monash University Accident Research Centre 1998 unpublished report)
Eye Research Australia 2004 Clear Insight: The Economic Impact and Cost of Vision Loss in Australia A Report prepared by Access Economics Pty Ltd. The Centre for Eye Research Australia, Melbourne 2004
Australian Institute of Health and Welfare 2002. Diabetes: Australian Facts 2002. AIHW Cat.No. CVD 20 (Diabetes Series No 3) Canberra: AIHW
Hugh R Taylor 2001 Eye Care for the Community Centre for Eye Research Australia 2001 (unpublished report)
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