Abstract
Routine eye and vision assessments are vital for the detection and subsequent management of vision loss, which is particularly important for Aboriginal and Torres Strait Islander people who face higher rates of vision loss than other Australians. In order to guide improvements, this paper will describe patterns, variations, and gaps in these eye and vision assessments for Aboriginal and Torres Strait Islander people. Clinical audits from 124 primary healthcare centers (sample size 15,175) from five Australian states and territories were conducted during 2005-2012. Main outcome measure was adherence to current guidelines for delivery of eye and vision assessments to adults with diabetes, those without a diagnosed major chronic disease and children attending primary healthcare centers. Overall delivery of recommended eye and vision assessments varied widely between health centers. Of the adults with diabetes, 46% had a visual acuity assessment recorded within the previous 12 months (health center range 0-88%) and 33% had a retinal examination recorded (health center range 0-73%). Of the adults with no diagnosed major chronic disease, 31% had a visual acuity assessment recorded within the previous 2 years (health center range 0-86%) and 13% had received an examination for trichiasis (health center range 0-40%). In children, 49% had a record of a vision assessment (health center range 0-97%) and 25% had a record of an examination for trachoma within the previous 12 months (health center range 0-100%). There was considerable range and variation in the recorded delivery of scheduled eye and vision assessments across health centers. Sharing the successful strategies of the better-performing health centers to support focused improvements in key areas of need may increase overall rates of eye examinations, which is important for the timely detection, referral, and treatment of eye conditions affecting Aboriginal and Torres Strait Islander people, especially for those with diabetes.
Highlights
Aboriginal and Torres Strait Islander Australians experience significantly higher rates of vision impairment than other Australians [1, 2]
From the records of children, 49% (2,415/4,909) had a vision assessment recorded within the past 12 months, 45% (2,085/4,632) had a record of an eye examination and 25% (223/893) had a record of an examination for trachoma
Variation was observed in delivery between states among the audited child records, with participating primary healthcare (PHC) centers in New South Wales (NSW) and South Australia (SA) delivering the most eye assessments and those in the Northern Territory (NT) recording the most trachoma examinations for children
Summary
Aboriginal and Torres Strait Islander Australians experience significantly higher rates of vision impairment than other Australians [1, 2]. As Aboriginal and Torres Strait Islander adults with diabetes, older than 40 years, form 72% of those requiring an eye examination in any year [3], understanding ways to further improve access and uptake of eye assessments for patients with diabetes is important, given their higher risk of preventable vision loss. There is still a shortage of optometric and ophthalmic services in many rural and remote areas [4, 5] and significantly lower rates of eye examinations (by optometrists or ophthalmologists) in areas with higher proportions of Aboriginal and Torres Strait Islander people [4, 6]. Routine eye and vision assessments are vital for the detection and subsequent management of vision loss, which is important for Aboriginal and Torres Strait Islander people who face higher rates of vision loss than other Australians. In order to guide improvements, this paper will describe patterns, variations, and gaps in these eye and vision assessments for Aboriginal and Torres Strait Islander people
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