Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012
Tier 1—Human function—1.16 Eye Health
Why is it important?:The partial or full loss of vision is the loss of a critical sensory function that has impacts across all dimensions of life. Vision loss and/or eye disease can lead to linguistic, social and learning difficulties and behavioural problems during schooling years, which can then lead to poor education outcomes and employment prospects. Visual impairment can affect health related quality of life and independent living (West et al. 2002). It is also found to increase the risk of mortality, earlier nursing home placement, falls, and the use of community support services (Vu et al. 2005; West et al. 1997; Weih et al. 2002; Lamoureux et al. 2004; Ivers et al. 2003; Wang et al. 2003).
In the 2004–05 NATSIHS almost one-third (30%) of Aboriginal and Torres Strait Islander peoples reported a long term eye condition (ABS 2006b). The most common eye health problems reported were short sightedness and then long sightedness, while the largest disparities between Indigenous and non-Indigenous Australians were for blindness, cataract, diabetic retinopathy and trachoma (Taylor et al. 2010b; ABS2006a).
Cataract is a degenerative condition in which the lens of the eye clouds over, obstructing the passage of light. Formerly the leading cause of blindness in developed countries, blindness from cataract is now rare due to a highly effective surgical procedure (McCarty et al. 2000; Taylor et al. 2005). Despite this advance, cataract remains a major cause of vision loss among Aboriginal and Torres Strait Islander peoples (Taylor et al. 2010a).
Diabetic retinopathy is damage to the blood vessels in the retina caused by complications of diabetes. Without treatment, diabetic retinopathy can progress to blindness. Although diabetic retinopathy often has no early symptoms, early diagnosis and treatment can prevent up to 98% of vision loss. The NHMRC recommends that Indigenous Australians with diabetes should have an eye examination every year (NHMRC 2008).
Trachoma is an eye infection that can result in scarring, in-turned eyelashes (trichiasis) and blindness. Australia is the only developed country where trachoma is still endemic and it is found almost exclusively in remote and very remote Aboriginal and Torres Strait Islander populations. Trachoma is associated with living in an arid environment (including the impact of dust); lack of access to clean water for hand and face washing; overcrowding and low socioeconomic status (Taylor 2008).
Findings:The 2008 National Indigenous Eye Health Survey included a sample of 2,883 Indigenous Australians. This survey’s strength was that it was based on actual eye examinations and therefore avoided the problem of undiagnosed conditions. Note: 62% of the sample from this survey was in remote areas. This survey found that around 9% of Indigenous adults had vision impairment and 2% blindness. The study also found that around 1.5% of Indigenous children had low vision and 0.2% blindness. Of those adults with vision impairment, the most common causes were refractive error (54%), cataract (27%), diabetic retinopathy (12%) and trachoma (2%). Vision loss associated with cataract may be more common in very remote areas (5% inland and 4% coastal) compared with major cities (3%), although the sample size did not allow significant differences to be detected by remoteness. Vision loss associated with trachoma was only found in very remote areas, with higher rates inland (1.3%) than in coastal areas (0.4%). The leading causes of blindness for Indigenous adults found in this study were cataract, optic atrophy, refractive error, diabetic retinopathy and trachoma. Approximately 65% of Indigenous Australians who needed cataract surgery had been operated on, and a further 35% still required treatment. Of those who had diabetes, 20% reported having had an eye examination within the last year and 10% had visual impairment. The major differences in findings from this study compared to studies of non-Indigenous respondents are the higher proportions of vision impairment and blindness in the Indigenous adult population from cataract, diabetic retinopathy and trachoma; and better vision for Indigenous children, especially in remote areas (Taylor et al. 2009).
The 2004–05 NATSIHS included a representative sample of 10,044 Aboriginal and Torres Strait Islander peoples, however this survey is limited to reporting on people’s awareness of problems rather than any objective assessment of eye health problems. The survey found that one third of Indigenous Australians reported eye or sight problems. Long sightedness (16%) and short sightedness (10%) were the most common problems reported followed by partial/complete blindness (3%) and cataract (1%). After adjusting for differences in the age structure of the two populations, Indigenous Australians reported higher rates of cataract and partial/complete blindness than non-Indigenous Australians. In the 2008 NATSISS 8% of Indigenous children aged 1–14 years were reported to have eye or sight problems.Top of page
A study from the Eastern Goldfields of WA found that 25% of Aboriginal and Torres Strait Islander peoples with diabetes showed signs of diabetic retinopathy and 75% of Aboriginal and Torres Strait Islander peoples with vision loss also had diabetes. Having diabetes increased the risk of vision loss from any cause by 8.5 times (Clark et al. 2010). A study of remote communities in Central Australia found myopia to be rare, especially in younger people; and a high prevalence of vision loss due to cataract and diabetic retinopathy. The study also noted the ongoing occurrence of trichiasis and vision loss from trachoma (Landers et al. 2010). In 2010, The National Trachoma Surveillance and Reporting Unit reported the prevalence of trachoma in children aged 11–14 years in 240 at-risk communities in the NT, SA, and WA combined as 11%. Prevalence of trachoma was 12% for those aged 1–4 years, 13% for those aged 5–9 years and 11% for those aged 11–14 years. Prevalence was 19% in SA, 12% in the NT and 9% in WA.
Based on the BEACH survey, eye problems were managed in 1% of GP consultations among Aboriginal and Torres Strait Islander patients during the period April 2006 to March 2011. Overall rates were similar to non-Indigenous with main differences in higher rates for trachoma and lower rates for refractive error. Hospitalisation rates for diseases of the eye (mainly cataracts) were lower for Aboriginal and Torres Strait Islander peoples than non-Indigenous Australians. Hospitalisations for eye diseases have increased for Indigenous Australians between 2004–05 and 2009–10 (NSW, Victoria, Qld, WA, SA and the NT). The cataract surgery rates in 2009–10 were lower for Indigenous Australians nationally (6.4 per 1,000) compared with non-Indigenous Australians (8.7 per 1,000) (SCRGSP 2011a).
Implications:Eye health can be affected by premature birth (see measure 1.01), diseases such as diabetes (see measure 1.09), smoking (see measure 2.15), injuries (see measure 1.03), and nutrition (see measure 2.19), as well as environmental factors, genetic factors and ageing. In addition, factors such as geographic isolation, economic disadvantage, a lack of transport and a lack of access to health services can limit the opportunities for prompt identification, management and treatment of eye health problems (OATSIH 2001).
It has been estimated that 94% of vision loss in the Aboriginal and Torres Strait Islander population is preventable or treatable (Taylor et al. 2010b). Among Aboriginal and Torres Strait Islander peoples, the largest contributing factor in cataracts progressing to blindness is difficulty accessing cataract surgery (Taylor et al. 2010a).
The National Framework for Action to Promote Eye Health and Prevent Avoidable Blindness and Vision Loss was endorsed by the Australian Health Ministers' Conference (AHMC) in 2005.
The 2009 Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes budget measure provides approximately $25 million over four years to improve the eye health of Aboriginal and Torres Strait Islander peoples. Sixteen million dollars of this has been allocated to significantly expand the national effort to eliminate trachoma. Approximately $6.5 million has been provided to expand the number of Indigenous optometric services conducted under the Visiting Optometrists Scheme. In addition, funds under the measure have enabled the continuation of work to improve eye health under the Central Australia and Barkly Integrated Eye Health Strategy, and to support the work being done by the Indigenous and Remote Eye Health Service (IRIS). These programs will positively impact on rates of Aboriginal and Torres Strait Islander eye health conditions requiring ophthalmic treatment. Funding for the measure is ongoing.Top of page
The Medical Specialist Outreach Assistance Program (MSOAP) Ophthalmology is currently in its second year of operation. The focus of this measure is on delivering additional cataract surgery in rural and remote locations, but also includes treatment for diabetic retinopathy. Funding for this expansion is $5 million over four years. The Australia Society of Ophthalmologists is funded through the measure to identify and plan for services to be delivered through the MSOAP service providers.
Figure 58—Proportion of Indigenous adults with vision loss, by cause and remoteness, 2008
Source: National Indigenous Eye Health Survey, 2008Top of page
Table 16—Trachoma screening coverage and prevalence, at-risk communities, Indigenous children, by jurisdiction, 2010
Estimated Indigenous population at risk
Children examined for trachoma
Children with active trachoma
Active trachoma prevalence (1-14 years)
Trachoma prevalence 1-9 years
(..) Data not available due to small numbersTop of page
Source: National trachoma surveillance and reporting unit
Source: National trachoma surveillance and reporting unit