Building a legacy behind the data

Dr Mohamed Dirani, head of health services and evaluative research at the CERA, initially conceived the idea of the NEHS in mid-2014 after identifying that the available eye-health data was outdated and limited, drawn from two sub-national eye studies from the early 1990s and an indigenous eye health survey conducted in 2008.Dr Dirani approached Professors Hugh Taylor (head of the University of Melbourne’s Indigenous Eye Health Unit) and Jonathan Crowston (managing director of CERA) with a project proposal and, once it was fine-tuned, aligned himself with Vision 2020 Australia to assist with lobbying and fundraising while also leading a CERA team to conduct the research.MORE THAN DATA COLLECTION“It was an impossible timeframe,” Dr Dirani commented. “Data collection began on 11 March 2015 and finished on 18 April 2016 – so that was 13 months and seven days to go to 30 different regions across the country and recruit and examine 4,836 individuals.” The study – which, overall, took 2.5 years – did not just involve data collection, though.{{quote-A:R-W:480-I:2-Q: Correctible, treatable and preventable eye conditions such as refractive error and cataracts still accounted for the majority of vision impairment and blindness -WHO:Dr Mohamed Dirani, head of health services and evaluative research at the CERA}}“We wanted to change the structure and processes of population-base studies so we incorporated a referral syst,” Dr Dirani stated. “When you perform these clinical tests, you’ll incidentally pick up cases. We wanted to make sure that our research came with service – we were actually writing recommendation letters to ensure there was some sort of follow up.”This proved particularly important in indigenous communities and rote areas, with a third of the population ultimately being referred for a number of reasons. What Dr Dirani found most alarming, though, was that correctible, treatable and preventable eye conditions such as refractive error and cataracts still accounted for the majority of vision impairment and blindness within these communities.“That’s problatic,” he said. “We need to increase the frequency of eye examinations in the indigenous communities across the country and ensure we’re not utilising a ‘one size fits all’ approach. We need to develop specifically tailored programs to address these issues in individual communities – otherwise improvent is going to be a very staggered and slow process.”THE NEXT STAGore generally, Dr Dirani said there was a need to assess the effectiveness of optometric and ophthalmic intervention, recommending this occur through a collaborative and coordinated approach between eye-care professionals, researchers, government, and any other interested stakeholders. Nonetheless, he said some great work was being done across the country with mobile eye services, eye-screening programs and teleophthalmology.“We’ve got a metric in this baseline prevalence eye data and now we need to do a follow-up to assess the impact these interventions are having on reducing the prevalence of vision loss,” he stated.This follow-up assessment will form the next part of Dr Dirani’s study, with planning to begin within the next six months and a new round of data collection to take place in early 2018. Dr Dirani estimated this process would take about 14 to 15 months and that the results would be ready in 2019.The data will also be reported to the World Health Organization (WHO) to assess whether or not there has been a 25% reduction in avoidable blindness by 2019, the target of the WHO’s Global Action Plan of which Australia is a signatory.“Australia is certainly leading the way in reducing the prevalence of vision impairment and blindness, particularly with completion of this study,” Dr Dirani commented. “There’s a legacy being built but we’re halfway there. We’ve still got to produce this follow up and assess the reduction in vision loss over the last 10 years.”ADDITIONAL BENEFITSDr Dirani was appreciative of the Federal Government and the organisations and companies that helped fund the NEHS, saying their support provided many benefits beyond collating information on the prevalence of vision impairment and blindness.“It enabled me to ploy and work with 40 local Aboriginal workers and ensured that our research methodology was culturally appropriate,” he said. “I developed friends across the country with Aboriginal Medical Services, building trust and relationships with elders, aunties and uncles within communities. This was invaluable, and going back and conducting follow-up studies in these communities will be a pleasure. It also powered several young people to pursue careers in research.”Reflecting on the NEHS overall, Dr Dirani concluded, “I’m very proud to have conducted translational research that will now inform policy development, economic analysis, and the effective utilisation and direction of resources. These things are important in developing a legacy – having a real, robust indicator as to how much we are improving or decreasing the burden of vision loss in the community.”