Report, Soapbox

Can we close the gap by 2020?

In 2008, Aboriginal and Torres Strait Islander adults had 6x more blindness than other Australians. The leading cause was unoperated cataract followed by uncorrected refractive error, diabetic retinopathy and trachoma. One third had never had an eye exam.

This led to the development of the Roadmap to Close the Gap for Vision, launched in 2012. The roadmap recognised the pathway of care, or the patient’s journey, was complex – like a leaky pipe. If only one or two leaks were fixed, the water would still drip from other parts of the network.

It also set out a long-term plan to provide well-coordinated regional care and local support for Indigenous people that was appropriately resourced to meet population-based needs.

Since 2012, Indigenous eyecare has significantly improved with strong support from the Aboriginal Community Controlled Health sector, eyecare stakeholders and successive governments as set out in the roadmap’s 2019 Annual Update.

Last year’s report on Indigenous Eye Health Measures by the Australian Institute of Health and Welfare (AIHW) shows the number of outreach eye examinations for Indigenous Australians had tripled, the rate of eye exams for those with diabetes and the number of cataract operations had both more than doubled, and trachoma rates were falling. 

This is the result of numerous changes in the eyecare system; organised regional networks, changes in Medicare item numbers, enhanced screening for diabetic retinopathy and a lot of work that has been done on trachoma.

However, more needs to be done, especially when it comes to eyecare for those with diabetes.

The rate of diabetes in Indigenous Australians has increased from about one tenth that of non-Indigenous Australians in the 1970s to now be 4x or 5x higher. Everyone with diabetes is at risk of blindness, with up to 98% preventable with regular exams and timely treatment.

Every Indigenous person with diabetes needs to have an eye exam each year. They may have a normal exam or they may need referral for retinopathy. However, those with diabetes are also at increased risk of cataract and refractive change, so referral pathways need to be developed for these issues as well.

For these reasons, people with diabetes form a key target group for Indigenous eye services. They account for 75% of the Indigenous adults who need an eye exam each year, and the subsequent referral pathways for refraction and cataract surgery can be used by all whether they have diabetes or not.

However, AIHW reports that only 42% of Indigenous Australians with diabetes actually had their required eye exam – well below the rate for non-Indigenous Australians. This is despite the new MBS Item 12325 for non-mydriatic retinal photography and the inclusion of a retinal exam in the Health Adult exam MBS 715. The Commonwealth has now provided non-mydriatic retinal cameras to more than 150 Aboriginal Medical Centres.

To promote the need for annual screening exams, a range of health promotion materials has been developed with community input and are available on the Indigenous Eye Health Unit’s website. Similarly, a range of more technical materials to help clinic staff are also available, including a free online course on grading diabetic retinopathy.

It’s clear regional stakeholder networks require additional funding for optometry and ophthalmology outreach services, and local case-management to meet the region’s population-based needs. This would enable all those needing examination or referral to be properly managed. Further, people requiring treatment for retinopathy, whether by laser or intravitreal injections, should have ready access to bulk-billing or public hospital services without long waits.

The Strong eyes, strong communities report by Vision 2020 Australia and its members has set out the requirement for additional government funding.

Although in 2019 the Council of Australian Governments Health Council set the elimination of Indigenous avoidable blindness by 2025 as a high priority – also included in the Long Term National Health Plan – we are still waiting for additional funding committments.

Despite the strides being made, further efforts are still needed to improve the screening and treatment of diabetic retinopathy and help close the gap for vision. We all have a role to play in this.

ABOUT THE AUTHOR

Name: Melbourne Laureate Professor Hugh Taylor AC
Qualifications: MD, BS, LLD(Hons), DO, BMedSci, FAAHMS, FRANZCO
Workplace: Indigenous Eye Health Unit, Melbourne School of Population and Global Health, University of Melbourne
Position; Harold Mitchell Chair of Indigenous Eye Health
Location: Melbourne
Years in profession: 49