National framework for action to promote eye health and prevent avoidable blindness and vision loss

Key area for action 2: Increasing early detection

Page last updated: November 2005

Objective:

Treatable eye conditions are detected early, so that interventions can be applied to preserve vision and prevent any further vision loss.

Challenges:

Since there are cost-effective treatments for many eye conditions that prevent further vision loss and blindness, early detection of eye disease is imperative. Early diagnosis is also important for those people with sight-threatening eye conditions for which no treatments currently exist, to enable important career, financial and lifestyle decisions to be made.

Glaucoma, some forms of macular degeneration, diabetic retinopathy and trachoma are examples of eye diseases which can be treated effectively to preserve vision, if detected early. In the case of diabetic retinopathy, early diagnosis and treatment may prevent up to 98% of severe vision loss in people with diabetes.

However, Australian community studies show that a significant amount of eye disease remains undetected and untreated. For example, Australian data indicate that a significant proportion of people with diabetes are not being screened adequately for diabetic retinopathy. Screening can be part of the systematic care of all people with diabetes and can be facilitated by many different professionals. There are many advantages to integrating eye checks and screening for diabetic retinopathy into comprehensive mainstream primary health care services that utilise patient recall and information systems and maintain disease registers.

Many eye diseases and disorders have no symptoms or early warning signs. In addition, people tend to believe that decreasing vision is just part of ageing and have little knowledge about available treatments. It is essential therefore that the community and all health care providers are aware of the importance of good eye health and the need for regular eye tests, particularly for those aged 40 and over, those with a family history of eye disease, or those in other high risk groups.

In their routine work with clients, health care providers and other professionals have the opportunity to prompt and remind people to get their eyes tested. Eye checks can also be built into routine health assessments, such as that carried out by well baby clinics, aged care assessment teams or during hospital admission procedures. The role of the Royal Flying Doctor Service in delivering primary and community care health clinics in rural and remote areas means that the service is well placed to educate, appropriately refer and do primary eye care.

Many vision problems begin well before children reach school. Parents, care-givers, child and family health nurses, teachers, general practitioners and paediatric health care providers have a role in ensuring that children with potential eye problems are referred appropriately for expert diagnosis and treatment.

Actions:

Key area for action 2: Increasing early detection
Action areaActions
Public awareness
  • raise awareness of the symptoms of eye disease, the various roles of eye care practitioners and the importance of having regular eye checks, particularly for those over 40 years and those at risk
Primary health care
  • build capacity amongst the primary health care workforce to identify vision loss, detect eye disease and refer appropriately
  • support appropriate distribution of workforce to ensure access to screening by people in rural, regional and remote locations
  • integrate eye health checks into all general health checks, such as the two yearly adult health check for Aboriginal and Torres Strait Islander people and the yearly Health Assessment MBS item for people aged 75 years and over or 55 years and over for Aboriginal and Torres Strait Islander people
  • establish appropriate referral pathways for those detected with low vision or eye disease
People with diabetes
  • continue to promote awareness amongst those with diabetes and their health care providers of the need for regular eye examinations
  • build the capacity of general practitioners, optometrists and physicians to detect and monitor diabetic retinopathy through appropriate education and regular clinical experience
  • encourage the use of non-mydriatic camera to detect eye disease particularly in rural and remote communities
  • develop and utilise patient information and recall systems to monitor care and remind people with diabetes of the need for regular eye checks
  • provide opportunity for increased access to routine eye health assessment for Aboriginal and Torres Strait Islander people with diabetes
Childhood screening
  • encourage practitioners to continue to undertake examination of the eye during the newborn check in the context of adequate early detection programs or systems
  • support further research into the effectiveness of visual acuity screening in infants, pre-school and school aged children
  • ensure screening of children includes trachoma in high prevalence regions
  • support processes to ensure education department staff are aware of visual difficulties, the effect on learning and where and how to seek assistance.

National initiatives that impact on early detection of eye disease

  • National Early Childhood Agenda
  • National Public Health Action Plan for Children
  • National Chronic Disease Strategy
  • National Diabetes Strategy
  • National Strategic Framework for Aboriginal and Torres Strait Islander Health
  • National Aboriginal and Torres Strait Islander Eye Health Program
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