Eye Health Program Research Articles

Eye health programs within remote Aboriginal communities in Australia: a review of the literature

To review the literature regarding the most sustainable and culturally appropriate ways in which to implement eye health care programs within remote Aboriginal communities in Australia from a primary health care perspective. The search included letters, editorials and papers (published and unpublished) from January 1955 to April 2006. The search revealed 1,106,758 papers, books and other related material. The relevancy of this material was determined by abstract and 378 relevant articles were reviewed in their entirety. After reading the relevant articles and the interview transcripts the themes that emerged from each source were extracted. The ten areas to consider include: clinical practice and access, sustainability, regional-based programs, information technology systems, health worker training, self-determination, cultural and language barriers, funding body responsibilities, embedding specialist programs in primary care services, and other considerations. Further research needs to be undertaken within Aboriginal communities in the area of primary eye health care and barriers to the acceptance of treatment. This may be undertaken using more interactive research methods such as cooperative and narrative inquiry.

Improving Aboriginal health

In recognition of the recent achievements of the Close the Gap campaign, this issue of AHR contains a set of papers focusing on Aboriginal health. At the national Indigenous Health Equality Summit in Canberra in March 2008, the Close the Gap Statement of Intent was signed. This Statement of Intent requires the government, health and social service agencies and the Aboriginal communities to work together to achieve equality in health status and life expectancy between Indigenous and non-Indigenous Australians by the year 2030. (See http:// www.hreoc.gov.au/Social_Justice/health/statement_ intent.html) The first three papers present important policy lessons. Matthews and her colleagues stress the need to strengthen the link between policy formulation and implementation (page 613). Their study found that the lack of progress in improving Aboriginal health may be the result of lack of Indigenous involvement in policy formulation at the senior Australian Government level, limited participation of Indigenous community controlled health organisations in the policy making process and insufficient resources for implementation. Anderson, Anderson and Smylie outline the achievements of the National Indigenous Health Performance Measurement System (page 626), and change management lessons from Aboriginal community controlled health organisations are discussed by Leanne Coombe from the Apunipima Cape York Health Council (page 639). Other papers with a focus on Aboriginal health include a review of emergency department access (page 648), overseas-trained doctors working in rural and remote Aboriginal health settings (page 655) and eye health programs within remote Aboriginal communities (page 664).

Prevalence of trachoma and diabetes‐related eye disease among a cohort of adult Aboriginal patients screened over the period 1999–2004 in remote South Australia

To determine the prevalence of trachoma and diabetes-related eye disease within the adult Aboriginal population screened by the South Australian Eye Health Program between 1999 and 2004 inclusive. The South Australian Eye Health Program visited 22 Aboriginal communities in remote South Australia. Visiting ophthalmologists and optometrists systematically collected data on the cohort of adult patients seen over the period 1999-2004. Prevalence and grade of trachoma according to World Health Organization classification and the prevalence and degree of diabetic retinopathy according to the Early Treatment Diabetic Retinopathy Study and National Health and Medical Research Council guidelines were recorded. A population of 1651 Aboriginal patients was examined. Sixty-two per cent were female and 38% were male. Twenty patients (1.2%) had evidence of active trachoma with 260 (15.7%) patients having either lid scarring, trichiasis or corneal opacity. There was no significant association between gender and the prevalence of trachoma (P = 0.48). Seven hundred and seventy-one patients within the examined population had diabetes mellitus (46.70%). Significantly more women than men were affected and prevalence increased with age (P < 0.0001). One hundred and sixty-nine patients (22%) with diabetes mellitus had features of diabetic retinopathy, and of these patients 77 had background diabetic retinopathy (46%) and 92 (54%) had either proliferative diabetic retinopathy or maculopathy. Prevalence of clinically significant macula oedema among those with maculopathy (14 of 50 patients) was 28%. The data suggest that although trachoma is still endemic in this South Australian Aboriginal population the prevalence and severity are less than previously reported. Diabetes mellitus has a high prevalence within this population and great potential for detrimental visual sequelae.

Evaluation of an Eye Health Program: The Vision Initiative

Purpose: The aim of this study was to develop an innovative, rapid and economical assessment methodology to determine the knowledge, attitudes and behaviours regarding eye health and to determine the rates of the most common causes of visual impairment and undiagnosed eye disease. Methods: Letters were posted to Seniors Card holders aged 70–79 in 18 randomly selected areas, stratified by socio-economic status. A questionnaire was developed to measure knowledge, attitudes and behaviours regarding eye health. Uncorrected refractive error was determined by measuring presenting and best-corrected visual acuity (VA). Diabetic retinopathy and age-related macular degeneration were assessed using digital non-mydriatic retinal photography. Glaucoma was assessed using Frequency Doubling Technology (FDT) and digital images of the optic nerve head. Cataract was determined using digital retroillumination images of the lens taken with a non-mydriatic camera. The cost for recruiting, examining and grading images for each participant was calculated by dividing the total study cost by the number of participants examined. Results: Of the 13,483 participants invited to participate in the study, appointments were made for 1860 (13.8%) people with 1701 (91%) actually attending. Overall, missing data from the 1695 questionnaires represented less than 1.0% and all participants attended the vision screening over a three-month period. Presenting and best-corrected visual acuity and FDT results on both eyes were obtained on 99% of the sample. The proportion of gradable digital images of the fundus in both eyes in the sample was 89%, while 90% of participants with bilateral presenting VA < 6/12 had assessable lens images. The cost for recruiting, examining and grading images for each participant was approximately AUS$ 150. Conclusion: The recruitment from a mailing obtained the required sample size for the study, allowing a large sample of participants to be examined efficiently over a short period of time. It is important that the most common causes of visual impairment and undiagnosed eye disease can be determined using this rapid assessment methodology.

Incidence and progression of diabetic retinopathy in an Aboriginal Australian population: results from the Katherine Region Diabetic Retinopathy Study (KRDRS). Report no. 2

Abstract Background: The Katherine Region Diabetic retinopathy Study (KRDRS) was carried out in the Lower Top End of the Northern Territory of Australia between 1993 and 1996 as part of the Northern Territory Eye Health Program. It investigated diabetic eye conditions and their determinants in the Australian Aboriginal population of the region. Methods: The KRDRS was comprised of two cross‐sectional surveys, in 1993 and in 1996, and involved a total of 477 subjects with diabetes. Ninety‐six subjects were seen in both surveys and met the criteria for inclusion in the longitudinal study. Each subject underwent a general eye examination and retinal photography. Results: The annual incidence rates of retinopathy were 5.6% (95% CI 3.0–10.0%) and 4.2% (95% CI 2.5–7.0%) in subjects and eyes, respectively. This compares with 8% (in subjects) of the overall Australian diabetic population found in the Newcastle Study of Diabetic Retinopathy. However, each year 1.2% of subjects (95% CI 0.2–3.8%) and 1.3% of eyes (95% CI 0.2–4.5%) with no pre‐existing retinopathy developed vision‐threatening retinopathy. The respective findings for maculopathy were 2.2% (95% CI 0.7–4.6%) and 1.7% (95% CI 0.7–3.2%), and for clinically significant macula oedema (CSME) 1.1% (95% CI 0.2–3.1%) and 0.9% (95% CI 0.3–2.2%). The annual incidence of CSME in those with no maculopathy when first seen was 1.1% (95% CI 0.2–3.3%) and 0.9% (95% CI 0.3–2.2%) in subjects and eyes, respectively. The annual progression to CSME in those with maculopathy was 4.8% (95% CI 0.1–26.5%) and 6.1% (0.7–21.9%) in subjects and eyes, respectively. Conclusion: Results of the KRDRS show that despite a lower overall incidence of diabetic retinopathy among Aboriginal diabetics compared to the general Australian diabetic population, there are important reasons to consider Aboriginal diabetics at special risk. These reasons include the highest reported incidence of vision‐threatening retinopathy in Australia, one of the highest ever reported incidences of CSME in the world and the likelihood that the severity of the problem may be underestimated because of the relatively short observation time and the low average time since diagnosis. It is also acknowledged that the small numbers in the study limit our ability to reliably detect progression between subsets of the population and much larger studies are required to make statistically significant comparisons.

Prevalence of diabetic retinopathy in an Aboriginal Australian population: results from the Katherine Region Diabetic Retinopathy Study (KRDRS). Report no. 1.

The Katherine Region Diabetic Retinopathy Study (KRDRS) was carried out in the Lower Top End of the Northern Territory of Australia between 1993 and 1996 as part of the Northern Territory Eye Health Program. It investigated diabetic eye conditions and its determinants in the Aboriginal Australian population of the region. The study provided cross-sectional data about diabetic retinopathy in the Aboriginal diabetic population of the Katherine region in 1993 and in 1996. A total of 234 people with diabetes were examined in 1993 and 243 in 1996. The prevalence of retinopathy was 18% in 1993 and 21% in 1996. The respective findings for maculopathy were 13% and 10%, for clinically significant macula oedema 8% and 6%, for proliferative stage subject retinopathy 0.9 and 1.3% and for vision-threatening retinopathy 8.5% and 6.7%. In 1993 the prevalence of diabetic retinopathy was 18% in the four major centres compared with 16% in the smaller communities. The findings for 1996 were 25% and 13%, respectively. In 1993 the prevalence of vision-threatening retinopathy was 8% in major centres compared with 7% in other communities. The findings for 1996 were 7% and 8%, respectively. Sex was not significantly related to the prevalence of retinopathy. Diabetic retinopathy is as much a problem in Aboriginal communities as in the wider Australian population but presents a unique set of challenges for health services and for clinicians.

Diabetic macular edema: review and update.

Impairment in the visual acuity and quality of life of diabetic patients with macular edema can undeniably be decreased with systemic and ocular therapeutic intervention, as shown by numerous controlled studies. Such interventions, with early screening and periodic examination, are even more crucial given the increasing survival of patients with diabetic retinopathy. In the 1950s, adjusted 5-year survival rates for patients with PDR were less than 30%, whereas by the end of the century age- and sex-adjusted 5-year survival rates approached 90% for patients with early-onset diabetes and 60% for patients with late-onset diabetes [83]. Furthermore, advances in our understanding of diabetic retinopathy have led to biochemical adjuncts that offer the potential for further reduction of visual loss caused by diabetic macular edema. Despite such advances, the implementation of effective treatments has been hampered by concerns over hypoglycemia after intensive insulin regimens, poor physician compliance regarding guidelines for dilated ophthalmic examinations, and economic barriers to access [84]. Therefore, it is imperative for the ophthalmologist not only to discuss the progression and treatment of diabetic macular edema and the importance of routine examination with patients but also to work with other health care professionals to ensure the evaluation and treatment of associated cardiovascular and neurologic disease. Educational programs, such as those created by the National Eye Health and Education Program [85], may also assist the ophthalmologist in providing patients with the optimal care available in the 21st century.

Trends in the prevalence of trachoma, South Australia, 1976 to 1990.

The eye health of rural Aboriginal Australians is known to be poor. Over the past 20 years, Aboriginal communities in remote parts of Australia have had increasing access to eye health services through the National Trachoma and Eye Health Program (NTEHP). Using published and unpublished data, we examined trends in the prevalence of inflammatory trachoma in the Anangu Pitjantjatjara of South Australia. Comparisons using a generalised linear model of surveys in 1976, 1985 and 1990 indicate that there has been a significant reduction in the age-standardised prevalence of inflammatory trachoma in 0- to 20-year-olds. When the 1990 survey was compared with 1976 interim report data from the NTEHP survey, the odds of inflammatory trachoma in 1990 were 0.25 (95 per cent confidence interval (CI) 0.18 to 0.35). When the comparison was with data from the NTEHP survey of the Red Centre, the odds of follicular trachoma in 1990 were 0.51 (CI 0.42 to 0.62), and in comparison with the 1985 NTEHP review data, the odds of inflammatory trachoma in 1990 were 0.28 (CI 0.20 to 0.39). In the older age groups (20 and over), an increase in the prevalence of inflammatory trachoma was found. Although significant, the increase affected a small proportion of the population and may have been because of difficulty in standardising the trachoma grading between surveys, or systematic grading error in the 1990 survey. This study therefore shows that the eye health of Aboriginal people in Central Australia may be improving. The decline in trachoma is welcome and may be caused by improvements in socioeconomic conditions, community development and increasing access to medical care.

Cost-minimization analysis of capsulotomy after ECCE and IOL implantation.

An economic evaluation of capsulotomy for posterior capsular opacification after extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation was carried out using a cost minimization model. This model demonstrates the use of cost comparison to aid the decision making process. A flow-chart of capsulotomy mode, with associated complications, is illustrated. Costs of complications are calculated using assigned probability for each tree. Overall comparative costs are displayed graphically Further, the model is presented using a computer-assisted spreadsheet with an added calculation program. Variables can therefore be adjusted with instantaneous outcomes visually displayed. We present several examples with different sets of variables and find that, in most instances, YAG capsulotomy is a more economical option than surgical capsulotomy. This finding is a relevant finding in planning for eye health programs, particularly in developing countries. We suggest that the model be modified using local parameters in order to provide optimal benefits in similar health programs.

The epidemiology of blindness and trachoma in the Anangu Pitjantjatjara of South Australia.

To determine the prevalence of trachoma and blindness in the Aboriginal population in the Anangu Pitjantjatjara and Yalata lands of South Australia. A population-based prevalence survey undertaken in conjunction with routine South Australian Aboriginal Trachoma and Eye Health Program trips during 1989 and 1990. A group of 1514 individuals aged 0-90 years, or approximately 58% of the estimated Aboriginal population in the Anangu Pitjantjatjara and Yalata lands, was examined. Active inflammatory trachoma was found in 17.6% of the group (266 individuals), cicatricial trachoma in 25.2% (382) and binocular blindness (Australian definition) in 1.5% (22). The major causes of monocular and binocular blindness were trachoma, cataracts and trauma. Two per cent of women (17 of 849) were blind, compared with 0.8% (5 of 665) of men (odds ratio, 3.22; 95% confidence interval, 1.03-10.43). Although trachoma is still endemic in the "traditional" Aboriginal population of SA, its prevalence and severity appear to be less than previously recorded. However, the prevalence of blindness is comparable with that found in developing countries and the causes are still largely preventable. Further effort is required to reduce trachoma and preventable or treatable blindness in these communities.

Trachoma: 1985 update in Western Australia.

Aboriginal preschool and school children were surveyed in the Eastern Goldfields Region and the Eastern Kimberley Region of Western Australia between 1979 and 1985. Statistics from these surveys show that there has been an apparent change in pattern of follicular trachoma since the National Trachoma and Eye Health Programme in some of the communities. The prevalence of follicular trachoma in the 0 to 9 year old age groups had declined from 26.4% in 1977 to 8.8% in 1984/1985 in the Eastern Goldfields and Red Centre combined (0.10 greater than p greater than 0.05). The prevalence reduction occurred in areas where there have been improvements in school hygiene and housing. The prevalence of cicatricial trachoma has also apparently declined from 65% in 1977 to 39% in 1985 in the Red Centre, from 39% in 1977 in the Eastern Goldfields to 21.7% in 1985, and from 58% in 1977 to 24.9% in 1985 in the Eastern Kimberley, Communities at risk were identified and recommendations made for frequency of continued screening, depending on age, distribution and location.

Evaluation of Trends in Middle Ear Disease among Australian Aborigines

The Gompertz hazard model of age incidence of disease is applied to estimation of disease trends in a community. The trend estimate is based on proportions of individuals with disease experience in different age groups at one point of time, and may be used as an indicator of the changing health of a community. A major application of the method is to ear health data collected among Australian aboriginal children by the National Trachoma and Eye Health Program of the Royal Australian College of Ophthalmologists.

An environmental and demographic analysis of otitis media in rural Australian aborigines.

Otitis media (OM) and tympanic scarring prevalence among rural Australian Aboriginal children is examined in relation to age, sex, community size and 34 environmental variables pertaining to living conditions and climate. The environmental variables are reduced to a smaller set of underlying factors via Principal Components Analysis. With age and sex standardized, a multivariate analysis is performed. OM prevalence is profoundly age-dependent, and is related negatively to community socioeconomic status and the presence of swimming facilities. Scarring prevalence is shown to be subject to substantial inter-observer variation, and with the appropriate adjustment manifests an inverse relationship with winter warmth. The data were collected under the National Trachoma and Eye Health Program.

Social and Economic Barriers to Cataract Surgery in Rural South India: A Preliminary Report

A follow-up study of cataract patients advised to have surgery was conducted in five villages near Madurai, South India. Interviews conducted with 82 individuals provided information on treatment undertaken after surgical recommendations were made, as well as demographic and attitudinal variables. Of those advised to have surgery, 14.6% had the operation. Of those not having surgery, 81.8% said they wanted it, but cited both economc and social barriers to its use. To increase acceptance of surgery, eye health programs must consider both financial and social factors regarding the cataract patient and his family.

CATARACT-THE ULTRAVIOLET RISK FACTOR

Ophthalmic examination of 64 307 Aborigines and 41 254 non-Aborigines in remote rural Australia during the course of the National Trachoma and Eye Health Program revealed a positive correlation between the prevalence of senile cataract and levels of climatic ultraviolet (UV) radiation. Aborigines were more likely to be affected by senile cataract than non-Aborigines. It seems that Aborigines who live in areas of higher UV irradiation are more likely to acquire cataract; more likely to acquire the condition earlier in life; and more likely to be blind or visually disabled by it, than their counterparts living in areas of low UV irradiation. Provision of adequate shelter in areas of high insolation, where most cases of cataract occur, is likely to be an effective preventive measure.

The National Trachoma and Eye Health Program

Australian Journal of OpthalmologyVolume 5, Issue 3 p. 149-150 Free Access The National Trachoma and Eye Health Program* The Honorable Ralph Hunt, The Honorable Ralph Hunt Minister for Health, The Commonwealth of AustraliaSearch for more papers by this author The Honorable Ralph Hunt, The Honorable Ralph Hunt Minister for Health, The Commonwealth of AustraliaSearch for more papers by this author First published: October 1977 https://doi.org/10.1111/j.1442-9071.1977.tb00236.x † *Presented at the Melbourne Congress, March 1977. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume5, Issue3October 1977Pages 149-150 RelatedInformation

The National Trachoma and Eye Health Program

The National Trachoma and Eye Health Program, is conducted by the Australian College of Ophthalmologists and financed by the Federal Government. Its five aims are: 1. The elimination of trachomatous blindness in Australia. 2. The presentation of the ocular health status of persons in rural Australia to interested agencies. 3. The provision of immediate eye care to the people in rural Australia. 4. The establishment of continuing eye care for rural Australia. 5. The training of medical, paramedical, and interested lay people in those skills necessary to provide eye care in rural Australia.

NATIONAL TRACHOMA AND EYE HEALTH PROGRAMME

Medical Journal of AustraliaVolume 1, Issue 3 p. 48-48 Comment NATIONAL TRACHOMA AND EYE HEALTH PROGRAMME First published: 01 January 1977 https://doi.org/10.5694/j.1326-5377.1977.tb130500.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue3January 1977Pages 48-48 RelatedInformation

Eye Health and Safety Programs

Eye Health and Safety Programs

A need for an awareness campaign about nutrition and hygiene while conducting school eye health programs

DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5285 Nepal J Ophthalmol 2011; 3(2): 220