We can close the gap for vision

Significant improvements are being made in the eye health of Aboriginal and Torres Strait Islanders. The 2015 National Eye Health Survey showed that Aboriginal and Torres Strait Islander adults have three times more vision loss compared with other Australians, but that this inequity has been reduced from six times in 2008.

Progress in care outcomes is evident for the key conditions contributing to vision loss and blindness for Aboriginal and Torres Strait Islander Australians: refractive error, cataract, diabetic retinopathy and trachoma. All four conditions are preventable or treatable, and diabetic retinopathy, which may be asymptomatic in early and middle stages, can lead to permanent vision loss if not diagnosed and treated in time.

Eye health interventions are also often simple and cost effective. Refractive error can be fixed by access to glasses, and cataract can usually be fixed by surgery. Diabetic retinopathy may require ongoing treatment, however with appropriate screening (annually for Indigenous people with diabetes), good vision can be maintained.

Indigenous Eye Health (IEH) at The University of Melbourne provides support to regional stakeholder groups around Australia in identifying local patient eye care pathways, and ongoing barriers and solutions to access in the region. Among other things, IEH produces eye health promotion literature which can be customised for each region.

Access to screening and treatment in eye care remains inequitable. Indigenous Australians are more likely to use the public system and outcomes are below population-based needs and likely to involve longer waits for elective surgery (such as cataract).

The Roadmap to Close the Gap for Vision, launched in 2012 by IEH and endorsed by the eye health and Indigenous health sectors, details 42 health systems and policy recommendations to close the eye health gap between Aboriginal and Torres Strait Islander people and other Australians. To date, 19 of the 42 recommendations have been fully implemented, and 102 out of 138 projected activities towards implementation of the recommendations have been completed.

Access and equity considerations are central to the policy approach of the Roadmap.

There has been an increased rates of eye examinations and diabetic eye screening, an increase in the rate of cataract surgery (36 per cent rise in public hospital admissions since 2008), and a reduction by over three-quarters in the rates of trachoma for at-risk communities since 2008. Combined, these achievements all contribute to the significant reduction in avoidable blindness rates over the past decade.

To complement and strengthen the ongoing work of implementation of the Roadmap, the Australian eye health sector, under the umbrella of Vision 2020 Australia, recently launched Strong Eyes, Strong Communities, a new five-year strategic document, to build on the progress made and improving Indigenous eye health.

What can rural health practitioners do to help?
Health practitioners can contribute to the efforts to close the gap for vision in simple ways through their everyday work.

The annual health assessments for Aboriginal and Torres Strait Islander peoples (MBS item number 715, or 228 for non-VR providers) should include an eye screening check that tests vision and ocular health.

Diabetic retinopathy screening (indicated annually for Aboriginal and Torres Strait Islander patients) includes a retinal check with ophthalmoscopy or a retinal photo. The MBS item 12325 is billable for a graded retinal photo and vision assessment.
 
Good communication between all those involved with local and regional eye health pathways is key to ensuring that patients are screened, referred appropriately and can access treatment. Across Australia, regional coalitions of relevant service-delivery stakeholders meet regularly to discuss local barriers and solutions for improved outcomes.

It is important to offer patients opportunities to identify as Aboriginal and/or Torres Strait Islander in an appropriate manner, and to record their identification. Organisations like the Royal Australian College of General Practitioners, the Australian Indigenous Doctors Association, and the Australian Institute of Health and Welfare have all developed detailed guidance for ‘asking the question’.

If your service is not within an Aboriginal community controlled organisation (ACCHO), ensure that your practice is welcoming and affordable to local Aboriginal and Torres Strait Islander patients. This can include simple steps like having clinicians and support staff complete cultural competency training, advising staff about relevant support and billing policies, and establishing contact with local ACCHOs to better understand local needs.