Near-vision impairment and unresolved vision problems in Indigenous Australian adults.

BACKGROUND: To describe near-vision impairment, self-reported unresolved vision problems and barriers to having near-vision correction in Indigenous Australians. DESIGN: A nationwide population-based study designed to determine the causes and prevalence of vision loss and utilization of eye care services. PARTICIPANTS: Indigenous Australians aged ≥40 years. METHODS: Using a multistage random cluster sampling methodology, 30 geographical areas stratified by remoteness were selected to obtain a representation of Indigenous Australians. Visual acuity was conducted using a standard E chart. A questionnaire collected data on eye health, eye care service utilization and vision-related quality of life. MAIN OUTCOME MEASURES: Near-vision impairment defined as presenting binocular near visual acuity

Eye health service access and utilization in the National Indigenous Eye Health Survey.

BACKGROUND: To determine access to and utilization of eye health services for indigenous Australians. DESIGN: A national, stratified, random cluster sample was drawn from 30 communities across Australia that each included about 300 indigenous people. PARTICIPANTS: A total of 1189 indigenous adults aged 40 and above were examined, representing 79% of the target population. METHODS: Eye health services data including nature and availability of facilities and workforce supply were collected for comparison with eye health prevalence data. The data were collected in 2008. MAIN OUTCOME MEASURES: Low vision prevalence and coverage rate for distance refractive correction. RESULTS: The full-time equivalent availability of an optometrist working in an Aboriginal Medical Service was significantly associated with both a decrease in the prevalence of low vision (t = -2.41, P = 0.02) and an increase in the coverage rate for distance refractive correction (t = 2.99, P = 0.006). These associations were not replicated when comparing availability of private or hospital-based optometry in each community. Regional eye health coordinators appeared to provide an improved utilization of Aboriginal Health Services and therefore improved access to Aboriginal medical service optometry. CONCLUSIONS: Eye health services for indigenous Australians need to be provided in culturally appropriate facilities with clear links to the indigenous community to optimize access to care and reduce the prevalence of vision impairment. The adequate provision of accessible eye care services is an important component in 'closing the gap' in vision loss for indigenous Australians.

Prevalence of self-reported diabetes and diabetic retinopathy in indigenous Australians: the National Indigenous Eye Health Survey.

BACKGROUND: To assess the prevalence of diabetes and diabetic retinopathy in indigenous Australians aged ≥40 years. DESIGN: The National Indigenous Eye Health Survey used a stratified, multistage cluster probability sampling frame to provide a representative sample of the indigenous Australian population. PARTICIPANTS: One thousand one hundred and eighty-nine eligible indigenous adults were examined using standardized procedures. METHODS: Each participant underwent a comprehensive eye examination included presenting and best corrected visual acuity, visual field, fundus and lens photography. MAIN OUTCOME MEASURES: Diabetic retinopathy. RESULTS: The prevalence of diabetes in the 1189 eligible indigenous adults was 37.3% (95% confidence interval: 34.6-40.2%). The prevalence of diabetic retinopathy among 394 people with diabetes was 29.7% (95% confidence interval: 25.2-34.2%), and 17.8% (95% confidence interval: 14.0-21.6%), 8.9% (95% confidence interval: 6.1-11.7%) and 3.1% (95% confidence interval: 1.3-4.7%) for mild or moderate diabetic retinopathy, clinically significant macular oedema and severe or proliferative diabetic retinopathy, respectively. Diabetic retinopathy was presented in 6.3% in those who did not report diabetes. The risk of diabetic retinopathy increased with duration of diabetes (the adjusted odds ratios were 3.4 for 10-19 years, 6.1 for 20-29 years and 25.8 for ≥30 years). CONCLUSIONS: The prevalence of self-reported diabetes in indigenous Australians is more than eight times higher than that in non-indigenous Australians. The prevalence of diabetic retinopathy in people with diabetes is similar to that of non-indigenous Australians.

Self-reported vision and health of indigenous Australians.

PURPOSE: To describe the self-reported vision, history of eye disease and general health of indigenous Australian participants in the National Indigenous Eye Health Survey. METHODS: Using a multistage cluster sampling methodology, 30 geographic areas, stratified by remoteness, were selected to provide a representative population of indigenous Australians aged 5-15 years and 40 years and over. Before an eye examination, participants completed a questionnaire about their eye health and eye care facilities consulted, satisfaction with their vision and general health. RESULTS: A total of 1694 indigenous children (49.2% female, mean age 9.5 ± 2.9 years) and 1189 adults (61.0% female, mean age 53.1 ± 9.7 years) participated. Three-quarters of adults (259/342) and 88.4% of children (129/146) wore the right distance glasses. Adults from remote areas were less likely to have refractive error (P = 0.002) as well as males versus females (P = 0.02). Similar results were found for children. Adults wearing appropriate distance glasses were as satisfied with their vision as people with normal vision who did not need glasses (P = 0.6). Both groups were more satisfied with their distance vision than people with poor presenting vision (P = 0.007). Self-report of cataract, diabetic retinopathy, glaucoma and age-related macular degeneration did not match with clinical findings (P < 0.001). Over 37% of adults (417/1187) and 1.3% of children (22/1691) reported having diabetes. CONCLUSION: The National Indigenous Eye Health Survey provided information to guide future planning of eye health prevention strategies for indigenous Australians. Findings indicate the importance of correcting refractive error to improve quality of life. Prevention messages should be renewed in appropriate sociocultural formats.

Cataract in indigenous Australians: the National Indigenous Eye Health Survey.

BACKGROUND: To determine the prevalence of vision loss due to cataract in indigenous Australians. METHODS: A national, stratified, random cluster sample was selected in 30 communities across Australia. Data collection was undertaken in 2008. Adults 40 years and older were examined using a standardized protocol that included a questionnaire. The presence of visually significant cataract was assessed. RESULTS: Response rates were good and 1189 indigenous adults were examined and overall recruitment was 72%. Low vision (<6/12-6/60) due to cataract occurred in 2.52% (1.63-3.41%) and blindness (<6/60) in 0.59% (95% CI: 0.24-1.21%). The cataract coverage rate (proportion of those with visually significant cataract who had been operated on) was 65.3% (95% CI: 55.0-74.6%). Projections suggest that there are 3234 indigenous adults with vision loss from cataract. CONCLUSIONS: Cataract remains a major cause of vision loss in Aboriginal and Torres Strait Islander peoples. There were no significant regional or state differences in the prevalence of cataract or of cataract surgical coverage, which suggests that increased cataract surgery services are required across the country to address cataract in indigenous Australians.

The prevalence and causes of vision loss in Indigenous Australians: the National Indigenous Eye Health Survey.

AIM: To determine the prevalence and causes of vision loss in Indigenous Australians. DESIGN, SETTING AND PARTICIPANTS: A national, stratified, random cluster sample was drawn from 30 communities across Australia that each included about 300 Indigenous people of all ages. A sample of non-Indigenous adults aged > or = 40 years was also tested at several remote sites for comparison. Participants were examined using a standardised protocol that included a questionnaire (self-administered or completed with the help of field staff), visual acuity (VA) testing on presentation and after correction, visual field testing, trachoma grading, and fundus and lens photography. The data were collected in 2008. MAIN OUTCOME MEASURES: VA; prevalence of low vision and blindness; causes of vision loss; rates of vision loss in Indigenous compared with non-Indigenous adults. RESULTS: 1694 Indigenous children and 1189 Indigenous adults were examined, representing recruitment rates of 84% for children aged 5-15 years and 72% for adults aged > or = 40 years. Rates of low vision (VA < 6/12 to > or = 6/60) were 1.5% (95% CI, 0.9%-2.1%) in children and 9.4% (95% CI, 7.8%-11.1%) in adults. Rates of blindness (VA < 6/60) were 0.2% (95% CI, 0.04%-0.5%) in children and 1.9% (95% CI, 1.1%-2.6%) in adults. The principal cause of low vision in both adults and children was refractive error. The principal causes of blindness in adults were cataract, refractive error and optic atrophy. Relative risks (RRs) of vision loss and blindness in Indigenous adults compared with adults in the mainstream Australian population were 2.8 and 6.2, respectively. By contrast, RRs of vision loss and blindness in Indigenous children compared with mainstream children were 0.2 and 0.6, respectively. CONCLUSION: Many causes of vision loss in our sample were readily avoidable. Better allocation of services and resources is required to give all Australians equal access to eye health services.

The prevalence of trachoma in Australia: the National Indigenous Eye Health Survey.

OBJECTIVE: To determine the prevalence of trachoma among Indigenous Australians. DESIGN, SETTING AND PARTICIPANTS: A national, stratified, random cluster sample survey of Indigenous children (5-15 years) and adults (>or= 40 years) in 30 communities across Australia. Data collection was undertaken in 2008. MAIN OUTCOME MEASURES: Results based on a standardised protocol that included trachoma grading and double grading of photographs of the tarsus. RESULTS: 1694 Indigenous children and 1189 Indigenous adults were examined. Recruitment rates were 84% for children and 72% for adults. The overall rate of follicular trachomatous inflammation among children was 3.8%, ranging from 0.6% in major cities to 7.3% in very remote areas; 50% of communities in very remote areas had endemic rates (> 5%). Trachomatous scarring (TS) occurred among 15.7% of adults, trachomatous trichiasis (TT) among 1.4% and corneal opacity (CO) among 0.3%. TS was found in all regions and TT in all except major cities and inner regional areas. The highest community rates for TS were 58.3%; for TT, 14.6%; and for CO, 3.3%. CONCLUSION: Blinding endemic trachoma remains a major public health problem in many Aboriginal and Torres Strait Islander communities. Although active trachoma is predominantly seen in very remote communities, scarring and blinding sequelae occur among Indigenous people across the country. The Australian Government's recent commitment to eliminate blinding trachoma is welcomed and much needed.