Eye disease and vision loss are prevented, where possible, through addressing known modifiable risk factors.
Challenges:The development of preventive approaches to eye disease and injury is crucial to the elimination of avoidable blindness and vision loss. A range of universal, selective and targeted preventive measures need to be put in place that collectively address the known modifiable risk factors for eye disease and injury. Strategies aimed at reducing the risk of eye disease and injury occurring are broad ranging and involve many different players from different portfolio responsibilities, professional groups and sectors.
Raising general public awareness about eye health is the first line of defence in reducing the risk of avoidable blindness and vision loss. Better integration of population based eye health promotion with broader public health promotion activity will ensure greater coordination of activity around modifiable risk factors that are common to eye disease and related chronic disease. Greater collaboration between eye care agencies will help to ensure that clear consistent messages about eye health and risk factors are promoted through coordinated activity.
Health care providers, both specialist eye health and generalist medical, nursing and allied health workers, have many opportunities to inform and advise the public about eye health in their day to day work with clients, especially high risk groups with chronic disease. Other professional groups with a role in promoting eye health include teachers, child care workers, counsellors, social workers, pharmacists, and the aged care workforce.
Over 95% of general practitioners are members of the Divisions of General Practice. Divisions, as part of local health infrastructure, are well placed to participate in community-based strategies to promote eye health and prevent eye disease and injury.
However, awareness raising is only one component of a broad approach to prevention. To maximise effectiveness, eye health education needs to be integrated with other health promotion measures to create enabling environments that support, reinforce and sustain individual behaviour change.
A number of communicable and chronic diseases lead to the development of eye complications, so initiatives aimed at reducing the incidence of communicable and chronic disease will potentially reduce the risk of avoidable blindness and vision loss. The best outcomes are likely to be achieved through the development of linkages with the relevant current national public health strategies and initiatives that impact on eye health through the establishment of partnership and other cooperative arrangements.
There is some evidence that lifestyle risk factors (smoking, poor nutrition, excessive alcohol consumption, lack of physical activity) contribute to the development of eye disease. In particular, there is good evidence that both cataract and macular degeneration are probably due in part to smoking. Eye trauma is often associated with excessive alcohol consumption.
Lifestyle risk factors are also implicated in the development of many chronic diseases such as diabetes mellitus, hypertension and hyperlipidaemia, which are in turn causal factors for, or exacerbate the development of, eye diseases. Eye complications of diabetes include diabetic retinopathy and a greater risk of developing glaucoma and cataract. Obesity and lack of physical activity are thought to be the most important contributory factors to the development of Type 2 diabetes. Accordingly making the link to initiatives aimed at reducing obesity and promoting physical activity has the potential to yield dividends in preventing diabetic retinopathy.
Many infants and young children are at risk of vision problems because of preventable pre-natal or perinatal factors. The foundations of good eye health are established in utero and depend upon the optimum health of pregnant women. Eye development in the fetus may be affected by communicable diseases such as rubella and toxoplasmosis or exposure to teratogenic substances such as alcohol. Factors in the newborn period that affect eye health include retinopathy of prematurity and ophthalmia neonatorum. Amblyopia is a treatable condition that may present in early childhood and, if untreated, can lead to permanent vision loss in the affected eye.
Trachoma remains prevalent in some remote regions of Australia. Predominantly Aboriginal and Torres Strait Islander children may be affected. Untreated trachoma in childhood may lead to increased risk of blindness in adulthood resulting from trichiasis. Trachoma control in endemic regions requires a holistic, coordinated and sustained public health response with the involvement of public health units, primary health care services and housing and essential services in affected geographical regions to reduce the risk. The Communicable Diseases Network Australia is currently examining the issue of trachoma surveillance and control measures.
Damage to the eye can occur from exposure to high levels of ultra violet radiation and glare. There is potential to work collaboratively with skin cancer prevention initiatives to raise public awareness of the need to protect the eyes as well as the skin from ultra- violet radiation. Video terminals are not thought to cause permanent ocular damage, but the use of good eye care practices needs to be encouraged amongst office workers, as an integral part of occupational health and safety.
The risk of eye injuries can be reduced through awareness raising and the adoption of eye protection measures when high risk activities are being undertaken in the workplace, home environment or at sporting events. Strategies to reduce high risk alcohol consumption may also be of benefit in reducing the number of eye injuries consequent to alcohol related violence.
In summary, there are many opportunities in Australia to address modifiable risk factors for blindness and vision loss. Maximum gains in prevention are likely to be achieved through establishing strong linkages to relevant national public health strategies that impact on eye health and addressing common causes and risk factors for chronic disease.
|Key area for action 1: Reducing the risk|
|Raising public awareness||
|Maternal and child health||
|People with diabetes||
|Eye injury prevention||
National initiatives that impact on the reduction of risk of eye disease and injury:
- National Agenda for Early Childhood
- National Public Health Action Plan for Children
- Australian Research Alliance for Children and Youth
- Immunise Australia Program
- National Chronic Disease Strategy
- National Drug Strategy
- National Tobacco Strategy
- National Alcohol Strategy
- National Drug Strategy Aboriginal and Torres Strait Islander Peoples’ Complementary Action Plan 2003-2006
- National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000 to 2010
- National Domestic Violence Strategy
- Be Active Australia: A Health Sector Agenda for Action On Physical Activity 2004-08
- Eat Well Australia: An Agenda for Action for Public Health Nutrition 2000-2010
- Healthy Weight 2008- Australia’s Future The National Action Agenda for Young People and their Families
- National Community Awareness and Infrastructure – Lifestyle Prescriptions Initiative
- National Diabetes Strategy
- National Strategic Framework for Aboriginal and Torres Strait Islander Health
- National Aboriginal and Torres Strait Islander Eye Health Program
- National Injury Prevention Plan – 2004 onwards
- National Aboriginal and Torres Strait Islander Safety Promotion Strategy
- National Occupational Health and Safety Strategy