Gap for Indigenous vision can be closed

Eye care is the low-hanging fruit in the health gap between Indigenous and non-Indigenous Australians.  The path ahead is clear: eye care is discrete, achievable and will have a huge impact.  It is also very cost effective, especially important in this time of high fiscal scrutiny.

The gap for vision can be closed with consistent government commitment from the Commonwealth and the States and Territories.

If you take the example of Aboriginal and Torres Strait Islander people in Victoria with diabetes, 3000 need an eye exam every year. In NSW, 12,000 Aboriginal and Torres Strait Islanders with diabetes need an eye exam every year. This discrete number of additional services is deliverable. 

Eye care has to be included as part of diabetes case management and referrals followed up.  Up to 98 per cent of blindness from diabetes is preventable with early detection and timely treatment. Unlike many other complications from diabetes and health conditions, diabetic eye disease is entirely manageable and treatable. We have the treatments and the solutions which provide a lasting impact on quality of life.

Since the launch of the Roadmap to Close the Gap for Vision report, developed by the University of Melbourne Indigenous Eye Health Unit in February 2012, the Aboriginal health and eye care sectors have been working with governments to improve the coordination and effectiveness of eye care and increase awareness. The Annual Update on the implementation of the ‘Roadmap to Close the Gap for Vision’ was launched in Hobart in November with Lisa Briggs, CEO of the National Aboriginal Community Controlled Health Organisation and Dr Stephen Best, President of the Royal Australian and New Zealand College of Ophthalmologists.

The Annual Update shows that progress is being made to address the 94 per cent of unnecessary vision loss and blindness experienced by Aboriginal and Torres Strait Islander people.  The Roadmap tackles the barriers that limit access to eye care services for the treatment and prevention of eye diseases and conditions including cataract, diabetic retinopathy, trachoma and refractive error - the need for glasses.  Australia is the only developed country in the world to still have trachoma, although rates are declining in some areas.  Aboriginal Australians have six times the blindness of the rest of Australians.

Eye exams have recently been added to the Indigenous Adult Health Check from General Practice to provide another opportunity for any issues to be picked up and referred for treatment.

Vision loss accounts for 11 per cent of the gap in health and, even more importantly, most of this gap can be closed overnight by providing a pair of glasses or performing cataract surgery. Timely access to laser treatment for those who have diabetic retinopathy also can prevent up to 98 per cent of the vision loss from diabetes.  With improved hygiene, antibiotics and surgery we can eliminate blindness from trachoma. 

Great progress is being made with trachoma rates falling but ongoing effort is required, especially in persistent hot spot areas and with attention to facial cleanliness. In 2004, the then Health Minister Tony Abbott established the National Trachoma Surveillance and Reporting Unit and provided funding for trachoma reduction activities. The collection, collation and, importantly, the reporting of these data were game changing.  They clearly defined the problem and led to expanded government commitment and activity over the following years, including additional government funding and strengthened partnerships between stakeholders across the sector.

In 2009, the overall prevalence of trachoma in Aboriginal children in the Northern Territory was 14 per cent. By 2012, this figure had fallen to just four per cent.

Eye care activities need to be expanded to include the other major causes of Indigenous blindness. There is opportunity now to grab the low hanging fruit of eye care.

It is time to make sure that the Aboriginal and Torres Strait Islander people who aren’t getting access to eye care can get it, and so close the gap for vision.

The Indigenous Eye Health Unit would like to acknowledge support from the following donors; The Harold Mitchell Foundation, The Ian Potter Foundation, Mr Greg Poche AO, the University of Melbourne, Dr David Middleton, Mr Peter Anastasiou, Mr Rob Bowen, Dr Vera Bowen, Mr Noel Andresen, Dr Mark & Alla Medownick, Gandel Philanthropy, CBM Australia, The Cybec Foundation, The Aspen Foundation and “K” Line Logistics. Funding for work on the Implementation of the Roadmap to Close the Gap for Vision has been provided by the Department of Health for 2013 – 2014.

Read more about Hugh Taylor at 

www.medicine150.mdhs.unimelb.edu.au/taylor