“Aboriginal and Torres Strait Islander people are overrepresented in rates of eye disease and vision problems.
They are amongst the most common long-term health conditions reported by our communities and most of the vision loss associated with these issues is preventable.
“This successful collaboration with experts and industry is important to NACCHO as access to the right medication and the best medical treatment for Aboriginal and Torres Strait Islander peoples, is our top priority.
In order to close the gap in health rates and experiences, more actions like this in the right direction must be made.”
The National Aboriginal Community Controlled Health Organisation (NACCHO) is proud to have led a successful submission to the Pharmaceutical Benefits Advisory Committee (PBAC) for an expansion to the listing of Prednefrin Forte on the Pharmaceutical Benefits Scheme (PBS).
This item can now be prescribed on the PBS for Aboriginal and Torres Strait Islander patients as of 1 March 2020.
NACCHO worked with a range of experts and stakeholders to seek listing of Prednefrin Forte on the PBS for treatment of post-operative eye-inflammation.
This listing will mean that there is a greater range and better affordability of anti-inflammatory eye drops for Aboriginal and Torres Strait Islander people.
Eye disease is more common in Aboriginal and Torres Strait Islander people compared to other Australians; eye health outcomes are poorer and cataracts more prevalent. Prednefrin Forte (prednisolone and phenylephrine eye drops) is a medication used to treat eye inflammation and swelling that is often considered first-line therapy by ophthalmologists after cataract surgery.
It has advantageous properties and pack size when compared to other similar medicines.
Allergan Managing Director, Nathalie McNeil said, “It has been a pleasure for Allergan to collaborate with NACCHO on this PBAC submission. We are excited about Prednefrin Forte’s contribution towards improved health outcomes for the Aboriginal and Torres Strait Islander communities.”
Vision 2020 Australia CEO Judith Abbott said, “Aboriginal and Torres Strait Islander people currently experience blindness and low vision at three times the rate of non-Indigenous Australians.
“As Strong eyes, strong communities: a five-year plan for Aboriginal and Torres Strait Islander eye health and vision highlights, improving access to timely, culturally sensitive and affordable eye health care is of vital importance.
We welcome this change to current drug scheduling, which will enable Aboriginal and Torres Strait Islander people to access a broader and more affordable range of eye medications, when they are needed.”
“We’re making some really good progress and we’ve seen that what’s been recommended and implemented actually works.
Over the last 10 years, the number of community hotspots for trachoma has reduced from 54 to 13. Trachoma is easily spread between children so ongoing efforts are needed to maintain improvements in hygiene.
As we approach the final year of the steps still need to be taken to guarantee equity by 2020.
We have seen an increase in funding and a three-fold increase in outreach of eye services, but to meet community needs we still have another 25 per cent to go.
The work being done by the Aboriginal and Torres Strait Islander health organisations and all of our partners in eye health has been instrumental in this progress.
We cannot over emphasise the importance of linking primary health care with specialist eye health services.
Ongoing support is vital to ensuring the expanded services are firmly embedded in the ACCHOs and other primary care providers to make sure that the changes are sustainable over the long term. It will not be possible to close the gap for vision without additional funding
Nearly eight years since launching his plan to improve the eye health of Indigenous Australians, University of Melbourne ophthalmologist Hugh Taylor said significant advances are also being made to meet the WHO target for the elimination of trachoma – a blinding eye infection that’s only found in Indigenous communities in Australia – by the end of 2020
Picture above in banner : IEH has developed a ‘toblerone’ (or ‘tent’ shaped) desktop resource and an ‘Asking the Question’ (AtQ) Information Sheet that aims to highlight ways to improve eye care service delivery in mainstream practices and clinics with appropriate identification of Aboriginal and Torres Strait Islander status. See Part 2 below
Professor Taylor highlighted Vision 2020 Australia initiatives as priority areas for government.
“Vision 2020 Australia and its members have launched a five-year plan to improve Indigenous eye health,” Professor Taylor said. “The Strong Eyes, Strong Communities plan calls for $85.5 million to empower ACCHOs, build on our work to close the gap for vision and provide a framework and advocacy program until 2024.
Australia is on track to close the gap for vision for Indigenous Australians by the end of next year, but this won’t be achieved without ongoing support for long-term solutions, according to a new report.
The 2019 Annual Update on the Implementation of the Roadmap to Close the Gap for Vision reveals that : Download HERE
50 per cent of systemic issues identified in Indigenous eyecare have been fixed. Progress is being made on all of the intermediary steps, with almost 80 per cent complete
Outreach eye examinations received by Indigenous Australians have almost tripled in the the last six years
Cataract surgery rates have increased nearly 5 times since 2008, however a further 2400 cataract surgeries are required each year to meet the population need
Indigenous patients still wait 50 per cent longer for cataract surgery in public hospitals, promoting calls for more timely access, resources and case management
The number of Indigenous Australians with diabetes receiving annual eye checks for diabetic retinopathy – which causes vision loss and blindness – has more than doubled over the last 10 years. With 155 retinal cameras being provided to Aboriginal Community Controlled Health Organisations (ACCHO), these rates will continue to improve
Subsidised schemes are being reviewed and strengthened to improve access to prescription glasses
Doctor Kris Rallah-Baker launch the 2019 update on implementation of the Roadmap to Close the Gap for Vision
The 2019 Annual Update on the Implementation of the Roadmap to Close the Gap for Vision was launched today at the Royal Australian and New Zealand College of Ophthalmologists 51th Annual Scientific Congress in Sydney.
Indigenous eye health advocates have designed a new tool to help eyecare practices initiate conversations with patients who identify as Aboriginal or Torres Strait Islander.
The University of Melbourne’s Indigenous Eye Health (IEH) unit is now distributing a desktop resource that has been specially developed for mainstream optometry and ophthalmology practices. The group aims to promote cultural safety and ensure Indigenous patients can access appropriate care.
The two-sided, ‘tent-shaped’ resource has been designed in consultation with the Indigenous community and works as a prompt by asking patients: “Are you of Aboriginal or Torres Strait Islander origin?”. The staff-facing side reminds practice employees to ask the same question to each patient, while remaining sensitive, confident and respectful.
“The prime motivation is to try help the professions of optometry and ophthalmology, and the practices they run, create a setting that Aboriginal and Torres Strait Islander people would consider to be a culturally safe place to receive care,” optometrist and IEH deputy director Mr Mitchell Anjou told Insight.
“There’s no resource like this in mainstream eyecare, and we are now hoping to stimulate conversations within practices about improved approaches to service and care for Aboriginal and Torres Strait Island people who present at their practices.”
While progress has been made, Indigenous communities continue to experience avoidable vision loss and blindness at three times the rate of the non-Indigenous population.
Anjou said stronger data and evidence could assist in eye service planning and delivery, helping to further reduce Australia’s eye health disparity. Improved identification could also have a positive impact in terms of clinical management.
This includes access to targeted services for Indigenous patients such as subsidised spectacle schemes, prioritisation for cataract surgery, and specific Medicare rebates or funding.
Anjou said other specific service options may be available, including access to Aboriginal hospital liaison officers, Aboriginal health workers and transport support.
“In some cases, clinical guidelines vary between Aboriginal and Torres Strait Islander Peoples and other Australians, for example the frequency of retinal screening for people with diabetes, which is annual for Aboriginal patients and once every two years for other patients,” Anjou said.
The new resource is supported by Optometry Australia, RANZCO and Vision 2020 Australia.
“ While we have made significant progress over the last decade, we still have much more to do to achieve full eye health equity.
Fred was passionate about partnering with Aboriginal and Torres Strait Islander Peoples and involving them in health programs that affected them.
This is a huge focus for us over the next five years, to empower Aboriginal Community Controlled Health Services by giving them the support and tools they need to provide their own quality eye health services.
Last year, The Fred Hollows Foundation contributed to more than 1,000 cataract surgeries for Aboriginal and Torres Strait Islander Peoples and doubled the number of cataract surgeries in the Katherine region of the Northern Territory.
We thank the Australian Government and our partners for supporting our work and we ask that they join in our efforts to close the gap on eye health for good.”
Launching the strategy on The Foundation’s 27th Anniversary, Indigenous Australia Program Manager Shaun Tatipata pictured above said Australia’s First Peoples are three times more likely to go blind than other Australians and 12 times more likely to have cataract, the world’s leading cause of blindness
The launch was held at the Aboriginal Medical Service in Sydney’s Redfern, to which Fred donated resources when it was first established.
The Fred Hollows Foundation pledges its biggest ever investment to Aboriginal and Torres Strait Islander eye health
The Fred Hollows Foundation today committed its biggest ever investment to Aboriginal and Torres Strait Islander eye health with the launch of its new Indigenous Australia Program Five Year Country Strategy.
The strategy will see The Foundation invest at least $40 million over the next five years to closing the eye health gap for Aboriginal and Torres Strait Islander Peoples.
Dignitaries present included Shadow Minister for Indigenous Australians Linda Burney and Gabi Hollows AO, Founding Director of The Foundation.
The Foundation’s CEO Ian Wishart said Fred’s pioneering spirit was very much alive in the new Country Strategy, which seeks to identify and test better ways to address challenges.
“Empowerment is at the heart of what we do, and today is about empowering Aboriginal and Torres Strait Islander Peoples by giving their eye health an ambitious way forward,” Mr Wishart said.
See the Indigenous Australia Program Five Year Country Strategy here: [link]
Goal 1: Effective cataract treatment is accessible to all Aboriginal and Torres Strait Islander Peoples.
Goal 2: Trachoma, the world’s leading infectious cause of blindness, is eliminated from Australia.
Goal 3: Effective refractive error prevention and treatment is accessible to all Aboriginal and Torres Strait Islander Peoples.
Goal 4: Effective and timely treatment for diabetic retinopathy and other eye conditions is accessible to all Aboriginal and Torres Strait Islander Peoples.
Strengthen regional eye health services.
Train and strengthen the eye health workforce.
Strengthen eye care in Aboriginal Community Controlled Health Services.
Finally eliminate trachoma.
Ensure governments adopt The Strong Eyes, Strong communities
Extra Resources and Save a date Webinar from Healthinfonet
The Australian Indigenous HealthInfoNet, in collaboration with The Fred Hollows Foundation, has launched a series of knowledge exchange tools about eye screening and care.
These new resources provide a broad overview of the screening services available for eye health and outline the roles of various professionals such as regional eye health coordinators, optometrists and ophthalmologists.
Each product has been designed as a useful tool for health workers and practitioners working with Aboriginal and Torres Strait Islander people, to assist in understanding the eye care journey.
This series of knowledge exchange products includes:
a fact sheet for a comprehensive summary of eye screening and care (four pages)
a short animated video offering educational information in an audio-visual format.
To complement the release of these eye health resources, the Australian Indigenous HealthInfoNet and The Fred Hollows Foundation will host a webinar featuring a special guest presenter Dr. Kristopher Rallah-Baker, Australia’s first Indigenous ophthalmologist.
“ Too many Aboriginal and Torres Strait Islander people still experience avoidable vision loss and blindness, and those who have lost vision often find it difficult to access the support and services they need.”
Now is the time for all governments and all sides of politics to join together with Aboriginal and Torres Strait Islander communities, their organisations and Vision 2020 Australia members to close the gap for vision.
That commitment, coupled with additional funding of $85.5 million over 5 years, will change the lives of many Aboriginal and Torres Strait Islander people, their families and their communities.
We look forward to working together to achieve a world class system that delivers culturally safe eye care to all Aboriginal and Torres Strait Islander people.”
Vision 2020 Australia CEO Judith Abbott:
“ The Vision 2020 Australia Aboriginal and Torres Strait Islander Committee have been advocating for change in Aboriginal and Torres Strait Islander eye health and vision care and should be proud of their work in the formation of the Strong Eyes, Strong Communities report.”
As recommended in the report, embedding eye health and vision care into Aboriginal
Community Controlled Organisations will help ensure the eye needs of Aboriginal and Torres Strait Islander peoples are met and the gap in vision loss and blindness is closed.”
National Aboriginal Community Controlled Health Organisation (NACCHO) Deputy CEO Dawn Casey:
Most vision loss can be avoided or prevented through early identification and treatment, but Aboriginal and Torres Strait Islander people experience three times the rate of blindness and vision loss than non-Indigenous Australians and often wait much longer for treatment.
For example, Aboriginal and Torres Strait Islander people are currently waiting 63% longer on average for cataract surgery than non-Indigenous Australians.
Strong Eyes, strong communities describes what needs to be done to close this gap for vision and ensure eye problems in Aboriginal and Torres Strait Islander people are prevented wherever possible and treated early if they do develop.
Vision 2020 Australia has made 24 recommendations to implement the plan, which will require new funding of $85.5 million over the coming five years.
This funding will deliver more eye care services and glasses for Aboriginal and Torres Strait Islander people, support them to access the care they need and support the elimination of trachoma by 2020.
Vision 2020 Australia is also recommending other actions to improve overall planning and local pathways, strengthen the role of local community controlled services and increase access to specialist treatment
Key stats on Aboriginal and Torres Strait Islander People’s eye health
Cataract is the leading cause of blindness for Aboriginal and Torres Strait Islander adults and is 12 times more common than for non-Indigenous Australians.
Aboriginal and Torres Strait Islander people wait on average 63% longer for cataract surgery than non-Indigenous Australians.
Almost two-thirds of vision impairment among Aboriginal and Torres Strait Islander people is due to uncorrected refractive error – often treatable with a pair of glasses.
One in 10 Aboriginal and Torres Strait Islander adults is at risk of Diabetic Retinopathy, which can lead to irreversible vision loss.
Australia is the only developed country to still have Trachoma, found predominately in Aboriginal and Torres Strait Islander communities.
“ Regarding the environmental improvements, we know that the NT Aboriginal population has the worst housing in Australia.
Around 60% of Aboriginal people live in over-crowded housing and one third live in poorly maintained houses.
This directly impacts on the ability of our people to maintain healthy living practices such as ensuing their kids have clean faces and clean clothes.
We cannot keep on relying on antibiotics to get rid of trachoma – to be sustainable, there must be major improvements in environmental health and housing.
Improving housing will also lead to improvements in other infectious diseases that are way too common in our people in the NT
John Paterson CEO of the Aboriginal Medical Services Alliance of the NT or AMSANT. See full Speech Part 1 Below
Alice Springs Declaration
At the 2019 Close the Gap in vision 2020 conference, held in Alice springs, delegates heard that improvements in environmental health and housing are essential to eliminate trachoma and to reduce rates of other childhood infections that can lead to serious conditions such as rheumatic heart disease, blindness and deafness.
The conference heard about good progress in reducing trachoma rates but also that there had been some stalling in remote Central Australian communities where trachoma remains endemic and will not be eliminated unless housing is addressed.
Over half of Aboriginal people in the NT live in overcrowded housing and nearly one third live in poorly maintained housing. This is by far the worst result of any jurisdiction in Australia.
The Conference noted that there is currently a political impasse between the Commonwealth and Northern Territory governments which is preventing the completion of an agreement to enable desperately needed Commonwealth investment in Aboriginal housing to be made available.
The Conference was also concerned at the very slow pace of implementation of the Northern Territory government funded housing program, where only 62 million of 220 million has been spent in the first two years.
The delegates demand that both levels of government urgently work to fix this impasse to ensure that Aboriginal housing investment can be made available to address the critical housing needs in the NT and contribute to improving the health and wellbeing of Aboriginal Territorians.
” Supporting and improving the local primary health care service capacity to confidently perform eye assessments should reduce the dependency on visiting eye specialists.
Going forward I see the promotion of these items as a highly effective way of investing in people and communities to have the capacity to manage and improve their own health outcomes.
Building local workforces must be key and I know that’s easier said than done.
The Roadmap to Close the Gap for Vision is a standout example of a program that has been successful in its impact towards closing the First Nations health gap.
Remarkable results have been achieved in just under a decade and the Roadmap recommendations are well on the way to being fully implemented.
Progress in Indigenous eye health has long been a challenge, making the success of this collaborative work even more remarkable.
The Hon Warren Snowdon Opposition Spokesperson Indigenous Health Keynote Address #CTG19 see full speech part 2 Below
Good morning everyone. My name is John Paterson and I am the CEO of the Aboriginal Medical Services Alliance of the NT or AMSANT. As many of you will know, AMSANT is the peak body for Aboriginal community controlled health services in the Northern Territory.
I’d like to begin by acknowledging the traditional owners, the Arrernte past, present and future, of the land on which we’re meeting: Mbantua – also known as Alice Springs.
To everyone here today, welcome to this important conference that is for the first time being held outside of Melbourne.
It will provide us with a great opportunity to share challenges, learnings and new ideas in a key regional centre for Aboriginal Australians who live in remote and very remote settings. Aboriginal culture is strong and proud here, as it is across the NT.
Welcome to the many attendees from the NT and right across Australia. Thank you for the work you do in eye health and your interest in improving Aboriginal health outcomes.
I would like to begin by talking a little about the history of our sector in the NT.
It is a story of self-determination.
And it is a story about the passion and dedication in developing essential primary health care services to our people from the ground up.
It is a story about always being a strong advocate for our people.
Our sector provides comprehensive primary health care from Darwin to the most remote areas of the NT.
Central Australian Aboriginal Congress is 45 years old and is the second oldest ACCHS after Redfern. It is also the largest ACCHS in the NT and one of the largest in Australia.
Keynote from Donna Ah Chee CEO Congress calling on the sector to see Aboriginal and Torres Strait Islander eye health in the context of the bigger picture of Indigenous health.
Miwatj is the largest remote ACCHS in Australia and Utopia is the oldest ACCHS based in a very remote region, having also recently turned 40.
We have in total 26 members – 13 of which provide comprehensive primary health care across the NT.
We work in partnership with the Northern Territory Government, who also provide Aboriginal PHC services to the NT. However, ACCHSs are the larger of the two providers and our sector is expanding in line with the Commonwealth and NT Government commitment to transition PHC services to community control.
The theme of this conference – “Strengthen and sustain” – resonates with the foundational principles of our sector including the need to build capacity and self-determination.
The ACCHS sector aims to provide comprehensive primary health care with our larger services providing a broad and expanding range of services that go beyond providing physical health care. Comprehensive primary health care includes Social and Emotional Wellbeing, social support, youth work, health promotion and prevention, with some now extending into aged care and even disability care.
The broad range of services considered to be part of primary health care is in line with the Alma Ata Declaration of 1978, where primary health care leaders from around the world – including leaders from the Aboriginal community controlled sector – set out a vision of primary health care that is now reflected in how our sector operates.
The declaration emphasised the need for communities to have a say and be involved in the running of primary health care, hence the fundamental importance we attach to our sector being community controlled.
Another principle of the Declaration is that comprehensive primary health care should work with government policy makers and other sectors such as employment and housing, to address the conditions that lead to poor health. Our sector strives to do this at every level, from the community to national levels, and even on the international stage.
In the NT, one of the main ways we are achieving this is by working with other Aboriginal peak bodies in an Alliance called the Aboriginal Peak Organisation NT, or APONT. APONT includes AMSANT, along with the Central and Northern Land Councils, who assist traditional owners and native title holders in the management and development of their land, including through Aboriginal ranger groups and increasingly, community development projects.
The Alma Ata declaration also emphasised the need to aim for equity of outcomes in health care provision – noting that across the world including in rich countries such as Australia, there is an unacceptable health gap between the well off and those living in poverty. As you all know, on our own country, this health gap is even larger between Aboriginal Australians and the rest of Australia. Equity is a foundational principle of our sector.
The first national Aboriginal Health Strategy, in 1989, reflected these principles and others including the need to take a holistic view of health care, including the physical, social, spiritual and emotional health of people.
This strategy recognised the inter-relationship between good health and the social determinants of health and the need to partner with sectors outside health. The strategy also emphasised capacity-building of community-controlled organisations and the community itself to support local and regional solutions to improving health.
This was a fine strategy, however, an implementation plan was not properly developed and the strategy was not properly funded. This has been a recurring story in Aboriginal health over the years.
The most recent national Aboriginal health plan is also based on self-determination, including the need for community control and the critical importance of the social and cultural determinants of health.
As I hope most of you know, there are a national set of Close the Gap targets that are soon due to expire, that guide our efforts to improve Aboriginal health. Sadly only 3 of the 8 target are currently on track – and the health gap is one of those that is not on track.
In fact, despite marked improvement in life expectancy in the NT over the last thirty years, life expectancy in the NT now seems to be stalling which is due to the failure to address social determinants, and the ever-growing chronic disease epidemic in our people.
I believe we would have seen much more progress towards closing the gap if the vision first set out in 1989 in the National Aboriginal Health Strategy had been implemented by both the Federal and State governments, including the critical need to commit to self-determination.
While that precious opportunity has foundered for the last three decades, I believe we are once again at a critical juncture and seeing a shift towards governments working in equal partnership with our people. This trend must continue if we are to see sustainable improvement.
At a national level, I am very heartened to see that the process to refresh the Closing the Gap targets is now developing into an equal partnership between Aboriginal leaders across Australia and Commonwealth, State and Territory governments through the Council of Australian Governments or COAG process.
We now, for the very first time, have a large group of Aboriginal peak bodies working closely with government to set the forward agenda for tackling the health gap. Our national peak organisation, NACCHO, led by an inspiring Aboriginal Alice Springs leader – Pat Turner – is at the vanguard of this work.
I represent APONT on this national coalition, ensuring that our leadership in the Northern Territory continues to influence the national agenda. We will be working hard to ensure that the targets reflect the critical issues affecting the health of our people – across the social determinants, and including issues such as housing, the skyrocketing imprisonment rates and tragically high rates of children in the child protection system.
How does all of this high-level government policy relate to eye care?
We know that our Aboriginal community controlled health services in the NT are under resourced.
Six years ago, a study was done in a small ACCHS in the NT – one of our better funded services. The study looked at how much it cost to carry out all the chronic disease care recommended by the CARPA manual – which is the guideline that all our services use.
It found that the service was under funded to the tune of $1700 per person per year. This funding gap may have increased since then. The AMA has recently reiterated that there is a large funding gap in Aboriginal primary health care.
We cannot build specialist services, including specialist eye services, on a foundation of an under-resourced primary health care sector. Our sector must be properly funded.
Trachoma is often described as a disease of poverty, which is one of the reasons why its continued existence in Australia, and almost exclusively in Aboriginal communities, is a national disgrace.
The World Health Organisation has developed the SAFE strategy for eliminating trachoma.
I am sure most of you know that the S stands for surgery, A for antibiotics, F for facial cleanliness and E for Environmental Improvements.
Regarding the environmental improvements, we know that the NT Aboriginal population has the worst housing in Australia.
Around 60% of Aboriginal people live in over-crowded housing and one third live in poorly maintained houses.
This directly impacts on the ability of our people to maintain healthy living practices such as ensuing their kids have clean faces and clean clothes.
We cannot keep on relying on antibiotics to get rid of trachoma – to be sustainable, there must be major improvements in environmental health and housing.
Improving housing will also lead to improvements in other infectious diseases that are way too common in our people in the NT, including skin sores and sore throats – which can both precipitate RHD; and with skin sores also being linked to high rates of renal disease.
A recent data linkage study found that over-crowded housing was by far the biggest reason for children missing school – accounting for over 30 days of missed school a year on average.
We know that poor school attendance is very closely linked to poor school results. Our children need decent living conditions if they are to thrive both physically but also socially and at school.
What is AMSANT doing about the shocking state of housing in the NT?
AMSANT has worked as part of the APONT alliance in supporting the formation of an Aboriginal Housing committee, AHNT, and is supporting AHNT to become the recognised Aboriginal housing peak body for the NT. Along with AHNT, we are working closely with NT Department of Housing to develop a community led housing strategy, to return Aboriginal housing to community control.
This is a long journey – but it is already bearing some fruit.
However, currently, as many of you will be aware from recent media reports – the NT and Commonwealth are at a stand-off about desperately needed Commonwealth funding for remote Aboriginal housing.
We must have cooperation between the two levels of government to address our housing crisis. We are tired of the excuses and political stand offs, while our communities suffer.
If they would for one moment stop and listen to us, come and talk with us, they would hear our message loud and clear – we want a seat at the decision-making table.
It the Prime Minister and the State and Territory Premiers and Chief Ministers can agree on an equal partnership with Aboriginal peak bodies on Closing the Gap, then the Commonwealth and NT governments can do the same for Aboriginal housing. We say – make it happen!
And now to eyes.
Eye health matters. In Australia, people with even mild vision loss have a risk of dying that is 2.6 times higher than those with good vision.
Vision loss causes 11% of the Indigenous health gap, meaning it accounts for 11% of years of life lost to disability for Indigenous people. It is the third leading cause of the gap behind cardiovascular disease and diabetes.
The 2008 National Indigenous Eye Health Strategy demonstrated the huge gap between the eye health of Indigenous and other Australians:
Indigenous adults were 6 times more likely to become blind as non-Indigenous, despite 94% of this vision loss being preventable or treatable;
Australia was the only developed country in the world to have endemic trachoma in some regions;
And yet studies showed that Indigenous children have better eyesight than others.
However, as you know, a lot is happening in the eye space and primary health care is a critical part of that work.
The work done to close the gap for vision has been very successful. The progress made on the Roadmap to Close the Gap for Vision, which comprises action against over 40 recommendations, is substantial and impressive, particularly given the number of stakeholders in many sectors who have contributed to its achievements.
One of the achievements in the NT has been the formation and ongoing success of regional eye health coordination groups, which are collaborations and partnerships involving all the key eye health stakeholders including primary health care, and are an important component of the Roadmap to Close the Gap for Vision.
The Central Australian and Barkly collaboration has been working effectively for 10 years now, and has been joined in recent years by a Top End collaboration.
AMSANT is involved in both groups and has been funded by the Fred Hollows Foundation to become more involved, including through a position supporting the Central Australian committee.
However, I hope that you have got the message that everyone in health care – including those in eye health care – need to think more broadly about health and not just focus on their part of the gap.
The Aboriginal vision of health is holistic and specialist services need to be built on a strong primary health care foundation.
The international health research has shown that health systems built on a strong primary health care foundation are more equitable affordable and sustainable.
I believe that the eye care gap will not sustainably close – along with the rest of the health gap – if we do not have political commitment to self-determination, and an equitable approach to funding Aboriginal primary health care, based on need.
And we also need a commitment to fixing the social determinants of health, equitably, based on need and Aboriginal-led.
We must avoid the situation where specialist areas advocate separately to government for their bit of Aboriginal health funding without seeing the bigger picture and the lack of resources on the ground in primary health care.
We need to work together in true partnership if we are to close the gap and that means we MUST be at the decision-making table, not an afterthought.
So thank you for all the work that you do in eye health care- we do appreciate it.
And I hope that you enjoy the two days and go back to your work refreshed, invigorated and inspired.
Part 2 : ADDRESS TO THE CLOSE THE GAP FOR VISION BY 2020
From the outset I want to stress that Federal Labor is acutely aware that Australia remains the only developed country with endemic trachoma, which is only found in our Aboriginal and Torres Strait Islander communities.
Further, while we acknowledge the scourge of Trachoma, cataract is the leading cause of blindness for Aboriginal and Torres Strait Islander adults and is 12 times more common than for non-Indigenous Australians. We have seen inroads in the rates of trachoma, many thanks to people in this room.
Trachoma has dropped from 21 per cent in outback children in 2008 to 3.8 per cent in 2018 and is on track to be eliminated by the end of 2020. This is a marvellous achievement and I again want to thank the tireless effort, tenacity and dedication of those in this room over the last decade in ensuring this has remained a front and centre issue for consecutive governments across partisan lines.
Today I want to discuss three things:
Where to now and looking beyond 2020
How we can build on the success of the Roadmap in other spaces and;
What to expect from a Shorten Labor Government
As the incidence of Trachoma lessens and is likely to be completely eliminated come 2020/21, we will face different vision-loss challenges. Blindness and impaired vision among Aboriginal people was six times the national rate in 2008, and it is now down to three times the national rate. However, Aboriginal and Torres Strait Islander Australians are still most likely to experience permanent vision impairment, with most cases of avoidable blindness resulting from uncorrected refractive error, diabetic retinopathy and cataracts.
One in 10 Aboriginal and Torres Strait Islander adults is at risk of Diabetic Retinopathy, which we all know can lead to irreversible vision loss. Aboriginal and Torres Strait Islander people wait on average 63% longer for cataract surgery than non-Indigenous Australians. Almost two-thirds of vision impairment among Aboriginal and Torres Strait Islander people is due to uncorrected refractive error- often treatable with a pair of glasses.
And I want to note here, that I welcomed Minister Wyatt’s announcement in August last year to commit $2 million to provide Aboriginal and Torres Strait Islander people with easier access to affordable prescription glasses. This was a positive first step.
The case for well-informed advocacy around uncorrected refractive error, diabetic retinopathy and cataracts in the First Nation population must be a priority for this sector come 2020 and beyond. As we edge towards the complete elimination of Trachoma the traction from governments’ and the funding which comes attached I anticipate will lessen. This will be no surprise to people in this room.
Security of funding will decline without ongoing strategic advocacy from the sector. There will need to a be a sustained and coordinated approach as there has been with the Roadmap to ensure this doesn’t curtail the inroads that are being made in other areas of vision loss. For example; Aboriginal and Torres Strait Islander Australians with diabetes have significantly fewer recommended eye checks than the non-indigenous Australian population and this incidence is particularly escalated in remote and regional areas [35% comparted with 64% respectively].
The total indirect cost of blindness as a result of diabetic retinopathy and diabetic macular oedema, the most frequent manifestations of diabetic retinopathy, is estimated to be more than $28,000 per person. Early investment into coordinated primary healthcare presents a powerful fiscal argument for governments at all levels.
These are the sorts of messages I encourage the sector to advocate for, we are in fiscally uncertain times so governments are constantly looking for costefficient measures. The fact the up to 98 per cent of diabetes-related blindness can be prevented through annual eye exams and timely treatment in the early stages of disease, is compelling.
Investing in professional development and training to enhance existing clinicians’ skills to perform eye-health assessments can produce significant savings for both the patient and the tax payer. I am a proponent of the MBS 715 item [Aboriginal Health Check] and the annual MBS 12325 item [Diabetic Retinopathy Screening] to be employed in all instances, as both schedule items promote early screening and diagnosis, preventing future complications and the costs associated with vison impairment.
The establishment of diabetic eye screening rates as a key performance indicator for Primary Health Networks is a sensible way to drive MBS revenue and improve eye health outcomes. Further, employing MBS item service delivery models, is a sustainable model of care which does not rely on ongoing or recurrent government funding. Increased information-sharing around the schedule benefits can produce significant preventative health gains to the target communities as well as provide large fiscal returns to service practices. It’s a no brainer.
Further, supporting and improving the local primary health care service capacity to confidently perform eye assessments should reduce the dependency on visiting eye specialists. Going forward I see the promotion of these items as a highly effective way of investing in people and communities to have the capacity to manage and improve their own health outcomes.
Building local workforces must be key and I know that’s easier said than done.
The Roadmap to Close the Gap for Vision is a standout example of a program that has been successful in its impact towards closing the First Nations health gap. Remarkable results have been achieved in just under a decade and the Roadmap recommendations are well on the way to being fully implemented. Progress in Indigenous eye health has long been a challenge, making the success of this collaborative work even more remarkable. This work has undergone rigorous scientific process and has a strong evidence base.
Importantly it has been strongly supported by local communities and organisations, including leading peak bodies and philanthropic organisations.
This disciplined coordination is what I think other sectors can really look towards and aspire to. And I must say this discipline is attributed in major part to the work of Professor Taylor. Stopping trachoma and other infections through the promotion of good hygiene practices and the emphasis on health hardware are pathways to negate further chronic health conditions.
Including: Ear infections and otitis media
Tooth and gum disease
And I think most markedly
Rheumatic Heart Disease
The Roadmap has been able to achieve comprehensive culturally safe coordination in navigating all levels of care which is critical when managing health conditions, such as avoidable blindness. Skilled workforce shortage complications in regional areas can ultimately be ameliorated by investing in people and communities to have the capacity to manage and improve their own health outcomes.
I know Diabetic retinopathy cameras and trained operators are being placed in more than 150 Aboriginal health clinics across Australia and this ideally must be the model we aspire for in other complex health areas. This model has been promoted and driven throughout the Roadmap.
To reiterate my major point, Labor is committed to Closing the Gap in eye health. The Roadmap was established under Labor and has since made significant improvements to the eye health of First Australians, as I’ve acknowledged. A Shorten Labor Government is committed to fully implementing the Roadmap to Close the Gap for vision.
A Shorten Labor government appreciates there is still work to be done to close the gap to meet the 2020 deadline. As an outcome of the Roadmap there are many regions of Australia where successful eye care programs have been developed providing high quality eye care for First Australians.
We acknowledge these successes and aim to build on and enhance these existing services. Now is the time to consolidate this good work and finally end avoidable blindness to ensure we meet our World Health Organisation obligations and successfully eliminate Trachoma. As Professor Taylor says, “we can’t afford to take our foot off the accelerator.” Equitable access to specialist and general eye health care services is critical to reducing high rates of preventable blindness among Aboriginal and Torres Strait Islander people.
We’ve seen too many cases of good work in Aboriginal affairs left unevaluated and subsequently dismantled, especially under the Abbott/Turnbull/ Morrison government. The Tackling Indigenous Smoking program is a case in point which we’ve witnessed under this Government.
Guiding all the decisions under a Shorten Labor Government will be evidence- based policy. The Federal Labor team will certainly have more to say on this and you can expect further announcements in the coming months in the lead up to the election. But I can say that any further investments will be to meet the 2020 Roadmap.
Under a Shorten Labor government we will be prioritising:
The national implementation of regional coordinators
Population based funding of outreach services
Case management and local coordination
Prompt housing repair and maintenance to ensure First Australians have access to safe and functioning bathrooms
We’re at the pointy end of finalising our election commitments but I do want to use this opportunity to encourage the experts before me to bring forward any policy proposals you have. If anyone wishes to share any policy ideas, as some have already, by all means I am open to hearing them and sharing them with my Federal Labor team. And for anyone in this room who isn’t aware I have an open-door policy, so please don’t hesitate to get in touch in near future.
“Aboriginal and Torres Strait Islander people have three times the rate of vision impairment and blindness as compared to non-Indigenous Australians.”
“This is totally unacceptable, especially when almost two-thirds of impaired eyesight can be corrected by prescription glasses.”
Health Minister Greg Hunt said the investment would allow Vision 2020 Australia to work with state and territory governments to streamline, standardise and improve their schemes that provide subsidised glasses to First Nations people
Photo above NACCHO File : Brien Holden Vision Institute with Edwina at Danila Dilba ACCHO Darwin
“To help achieve equity of access to subsidised glasses, Vision 2020 will work with governments to ensure their schemes align with eye health principles developed by Optometry Australia and the National Aboriginal Community Controlled Health Organisation.
“These principles have been supported by Aboriginal Health Forums conducted across the nation.”
Indigenous Health Minister Ken Wyatt AM
“Under some State and Territory schemes at the moment, only a third of Aboriginal and Torres Strait Islander people needing glasses are actually receiving them.
We need to do what we can to provide cost-certainty and affordable access to prescription spectacles for our people.”
Dr Dawn Casey, Acting Deputy CEO of the National Aboriginal Community Controlled Health Organisation (NACCHO) and Chair of the Vision 2020 Australia policy committee for Aboriginal and Torres Strait Islander Health also welcomed the investment
Part 1 Program Puts Better Vision for First Nations People in Sight
The Turnbull Government has committed $2 million to provide Aboriginal and Torres Strait Islander people with easier access to affordable prescription glasses.
Welcomes @GregHuntMP and @KenWyattMP major investment to provide approx. 18,000 Aboriginal and Torres Strait Islander people with easier access to affordable prescription glasses.
Indigenous Health Minister Ken Wyatt AM said introducing a nationally consistent system to simplify and ensure better access to affordable glasses would significantly improve people’s vision and overall quality of life.
“Not only does poor vision adversely affect a person’s general wellbeing, it can be a significant barrier to education and employment, and can restrict a person’s mobility and social interaction,” said Minister Wyatt.
“The cost of prescription glasses often deters Aboriginal and Torres Strait Islander people from visiting an optometrist to have their sight checked.”
“This can also delay detection of other serious vision-threatening conditions such as diabetic retinopathy, cataracts and glaucoma.”
A trial to improve the provision of prescription glasses in the Kimberley and Pilbara areas of Western Australia yielded positive outcomes, including improved patient medication compliance and greater independence.
Vision 2020 Australia was established in 2000 and has an experienced board including Aboriginal and Torres Strait Islander representatives.
The Turnbull Government’s 2018-19 Budget included an additional $3 million to extend First Nations eye health activities, on top of an existing $31.3 million commitment to eye health activities
Part 2 New investment in spectacles for Aboriginal and Torres Strait Islander people welcomed by Vision 2020 Australia
Vision 2020 Australia welcomes the Australian Government investment of $2 million to increase access to subsidised spectacles for Aboriginal and Torres Strait Islander people.
The one-off funds have been allocated to Vision 2020 Australia to work with the Australian Government to encourage State and Territory Governments to enhance the existing arrangements for subsidising the cost of spectacles.
Vision 2020 Australia CEO Judith Abbott said: “Our members have been actively advocating for this investment that will help make spectacles more affordable for up to 10,000 Aboriginal and Torres Strait Islander people across our country.”
“Around 60 per cent of blindness among Aboriginal and Torres Strait Islander people is due to issues that can be corrected with glasses, so this is a very positive step. We look forward to working with the government as part of Vision 2020 Australia’s ongoing commitment with our members to reduce blindness and vision loss.”
Minister for Indigenous Health the Hon. Ken Wyatt said: “While subsidised spectacle schemes exist in all Australian states and territories, the existing schemes vary and in some cases, have limited impact in overcoming barriers to access.
This new investment is being provided to encourage State and Territory Governments to work with Vision 2020 Australia to establish a nationally consistent approach to spectacle subsidies.”
“We want to remove affordability barriers so Aboriginal people can get glasses when they need them, regardless of where they live
” To mark NAIDOC Week 2018 and this year’s theme ‘Because of Her, We Can!’, Vision 2020 Australia is celebrating the roles and achievements of some of the incredible Aboriginal and Torres Strait Islander women working in the eye health sector.
These women perform a range of roles across a number of areas in the sector, but they are all proud of their cultures, passionate about their work and driven to help improve health outcomes in Indigenous communities and beyond.”
Dr Casey spoke at the Close the Gap for Vision by 2020: Striving Together National Conference in March about the longevity of ACCHOs delivering clinically effective health outcomes for over 40 years: “Our mob trust us”. While medical professionals have a role to play in closing the gap, sustainable approaches must be embedded in ACCHOs ”
1.Robyn Bradley, Aboriginal Health Liaison Officer – Royal Victorian Eye and Ear Hospital
Robyn’s father’s ancestors emigrated from England and Scotland in the early 1800s and her mother’s family are from the Dhauwurd Wurrung peoples more commonly known as Gunditjmara in Western Victoria.
“I am proud to belong to this beautiful and ancient land. If you listen quietly you can still hear the dreamtime stories of our elders rustling through the bush, whispered over the dessert country and swirling around our brilliant coastlines. I am proud I come from this perfectly crafted tapestry of ancient first nation peoples, emigrants, convicts, pioneers, bushrangers and first fleeters.
“I am also proud to share my passion for my culture and beliefs as an Aboriginal Health Liaison Officer at the Eye and Ear. I get to meet with community and act as a steward to help them receive the highest possible level of care – care that considers what is culturally appropriate and meets their unique needs.”
2. Aboriginal women of the Aboriginal Health Council of South Australia
Since its inception, the Aboriginal Health Council of South Australia (AHCSA) has looked to the leadership of Aboriginal and Torres Strait Islander Women as trailblazers and advocates for better health outcomes for their communities.
Currently there are seven Aboriginal Women working in various roles within the AHCSA Secretariat. The women’s kinship ties extend all over the country and all are united in their efforts to contribute to improving health for their communities, acting as advocates for increased and improved access to Hospital and Health Services and creating opportunities for their communities, particularly the next generation.
Keearny Maher is a Wiradjuri woman who specialises in vision impairment at VisAbility WA. Her cultural ties originate in Narrandera, NSW through her mother and Wiradjuri woman Ann-Maree Bloomfield.
“One rewarding aspect of my role is helping people find independence again after vision loss, particularly in the simple activities we all take for granted, like making a hot cuppa.”
Keearny’s role takes her all over WA, with some of her career highlights extending overseas, including volunteer work as an occupational therapist in Ukraine and India with children with varying disabilities.
Rosamond Gilden, Research Assistant – Indigenous Eye Health at the University of Melbourne and member of Orthoptics Australia
Upon completing a Masters in Orthoptics, Rosamond worked in the private and public sector. To pursue her interest in research, Rosamond joined the Centre for Eye Research Australia as Clinical Coordinator of the National Eye Health Survey. It was during this time she became aware of the poor eye health outcomes for Indigenous Australians and wanted to make a difference.
In 2016, Rosamond commenced work with Indigenous Eye Health and is part of the Roadmap team whose goal is to Close the Gap for Vision by 2020. Rosamond has used her experiences as a clinician to inform the current work that she is now undertaking and is grateful for the opportunity she has each day to contribute to a sector that has a sincere interest in improving eye health outcomes for Aboriginal people.
4. Jenny Hunt, Eye Health Worker – Walgett Aboriginal Medical Service in partnership with Brien Holden Vision Institute
Jenny is a proud Gamilaraay woman who has been providing eye care services in partnership with the Brien Holden Vision Institute Aboriginal Vision Program for the past 10 years to the Walgett community.
“I find the eye program rewarding when I see the relief and smile on my people’s faces when they first put their glasses on. I feel proud. Also, if they do not attend their optometrist or ophthalmologist appointments, I will chase them up and take them there myself because I know how important it is for them.
“I have excellent communication with the outreach location workers and they do a wonderful job getting the patients in for our clinics. I travel to Narrabri, Collarenebri, Goodooga, Pilliga and Lightning Ridge for clinics as well as the one we run in Walgett. Without the help from these workers, there would be no eye clinics.”
5.Faye Clarke, Diabetes Educator/Care Co-ordinator – Ballarat and District Aboriginal Co-operative in partnership with Indigenous Eye Health at the University of Melbourne
Faye is a Gunditjmara, Wotjobaluk and Ngarrindjeri woman who works with Aboriginal communities in the Ballarat and wider Grampians region of Victoria to help promote eye health and help those living with diabetes. Faye is passionate about working in Indigenous eye health and was excited to work with the IEH team on the Roadmap to Close the Gap for Vision.
“Vision is such an essential part of our life and when it is threatened it makes all the difference to someone’s quality of life. My dual role as a Care Co-ordinator means I can take on roles in both education and co-ordinating their path in the health care system.
“I am passionate about Indigenous eye health because of the work I do but also because of the clients I work with who are affected by threats to their vision.”
6.Simone Kenmore, Manager of South Australian Trachoma Elimination Program – Country Health South Australia
Simone is a Yankunytjatjara woman from the Anangu Pitjantjatjara Yankunytjatjara Lands in remote South Australia. Simone works with Indigenous communities and health professionals across Australia to inform a model of best practice to work towards the elimination of trachoma in South Australia, and is passionate about improving health outcomes for Indigenous communities.
“I have always been passionate about working in programs that contribute to improved outcomes for Indigenous communities. My work in trachoma is driven by the fact that it is a preventable disease. By sharing what we know about eye health, building the capacity of our communities and working in partnership across health, education and housing we can eliminate trachoma and prevent blindness for future generations.”
(Image and content provided by Indigenous Eye Health at University of Melbourne)
7.Emma Robertson, ITC Care Coordinator – Karadi Aboriginal Corporation
Emma is a Palawa woman working in a health promotion role at Karadi Aboriginal Corporation in Tasmania, encouraging people to come in for regular eye checks. Emma believes this year’s NAIDOC Week is a great chance to honour the women who have influenced her and her work in Indigenous health.
“I thinks this year’s theme is one of the best yet. I get to honour the women who were before my time that set the path that now enables me to work in my areas of passion around Indigenous health. It also makes me feel proud as an Aboriginal mum and the role I am playing in setting what I hope is a great role model for my daughters – that with hard work, determination and good people around you, you can make a profound difference in the lives of others.”
(Image and content provided by Indigenous Eye Health at University of Melbourne)
“The three main causes of vision impairment in adults were uncorrected refractive error, cataract and diabetic retinopathy.
On the positive side, the report indicates that more Indigenous Australians are accessing eye health services provided through specific service programs.
The report finds that in 2014-15 more Indigenous Australians received an eye examination than in the previous twelve months; that the gap in accessing cataract surgery compared to non-Indigenous Australians is narrowing; and the rate of blindness for Indigenous Australians has decreased from 1.9 per cent in 2008 to 0.3 per cent in 2016.
While the report shows improvements are being made in Closing the Gap in Indigenous eye health, more needs to be done.”
Eye diseases and vision problems are common long-term health conditions experienced by Aboriginal and Torres Strait Islander people and the Minister for Indigenous Health, Ken Wyatt, today welcomed the release of a report that looks at the effectiveness of national eye health programs.
Launching the Indigenous Eye Health Measures 2016 report, released by the Australian Institute of Health and Welfare (AIHW), Minister Wyatt said that one-third of Aboriginal and Torres Strait Islander people reported one or more long-term eye conditions in 2016.
“This report is important because from here we can build an evidence base for monitoring changes in Indigenous eye health, and identify service delivery gaps at the regional level,” Minister Wyatt said.
Key findings in the report reveal that:
This first national report on the Indigenous eye health measures compiles data from a range of sources and presents findings at the national, state and regional levels.
In 2016 the prevalence of bilateral vision impairment for Indigenous Australians aged 40 and over was 10.5% and the prevalence of bilateral blindness was 0.3% (both affecting an estimated 18,300 Indigenous Australians aged 40 and over).
The 3 leading causes of vision impairment for older Indigenous adults were refractive error (63%), cataract (20%) and diabetic retinopathy (5.5%).
Repeated untreated trachoma infections are a cause of vision loss in some remote Indigenous communities, but the prevalence of active trachoma in children aged 5–9 in at-risk communities fell from 14% in 2009 to 4.6% in 2015.
The age-standardised proportion of Indigenous Australians who had had an eye examination by an eye-care professional in the preceding 12 months increased from 13% in 2005–06 to 15% in 2014–15.
There were 6,404 hospitalisations (4.5 per 1,000) of Indigenous Australians for eye procedures in the two year period 2013—15.
Between 2005–07 and 2013–15 the age-standardised Indigenous hospitalisation rate for cataract surgery increased by over 40% from 4,918 to 7,052 per 1,000,000.
In 2014–15, the median waiting time for elective cataract surgery was 142 days for Indigenous Australians, with 3.4% of Indigenous Australians who waited for more than 1 year for cataract surgery.
Hospitalisation rates for cataract surgery were higher for Indigenous Australians in Remote and Very remote areas combined, while waiting times were longest in Inner regional areas.
The number of occasions of service for Indigenous patients under the Visiting Optometrists Scheme (VOS) almost tripled between 2009–10 and 2014–15 rising from 6,975 to 18,890.
Comparison with non-Indigenous Australians
Indigenous Australians suffered from vision impairment or blindness at 3 times the rate of non-Indigenous Australians, based on age-standardised rates.
In 2014–15, a lower proportion of Indigenous Australians (15%) had had an eye examination by an optometrist or ophthalmologist in the preceding 12 months compared with non-Indigenous Australians (20%), based on age-standardised rates.
Indigenous Australians had a lower age-standardised rate of hospitalisations for eye diseases compared with non-Indigenous Australians (10 and 13 per 1,000, respectively), but 3 times the rate for injuries to the eye (1.3 and 0.4 per 1,000, respectively).
Indigenous Australians also had a lower age-standardised rate of hospitalisations for cataract surgery than non-Indigenous Australians (7,044 and 8,415 per 1,000,000, respectively).
In 2014–15, the median waiting time in days for those who had elective cataract surgery was longer for Indigenous Australians (142) than for non-Indigenous Australians (84).
“We now have a very valuable source of data we can use to improve eye health through better detection, management and treatment of eye disease in Aboriginal and Torres Strait Islander communities,” Minister Wyatt said.
The Indigenous Eye Health Measures report is the first national report on the Indigenous eye health measures.
It brings together comprehensive data from a range of sources and presents this information at the national, state and regional level.
The Australian Government is investing around $72 million over 2013-14 to 2020-21 to improve eye health for Indigenous Australians.
” Diabetes is also a leading cause of vision loss and blindness in Indigenous people and causes 12% of vision loss cases and 9% of blindness cases — rates that are 14 times higher than those in the non-Indigenous population.4
There are many reasons why Indigenous people with diabetes do not receive the appropriate care they need; the Roadmap to close the gap for vision lists 35 individual problems that need to be dealt with to provide this care.7,8
The Roadmap to Close the Gap for Vision has played a part in prompting actions that contribute to this improvement. The Roadmap outlines a whole of system approach to improving Indigenous eye health, and achieving equity between Aboriginal and non-Aboriginal eye health outcomes.
There is however still work to be done on Closing the Gap for Vision. For example, half of Indigenous participants with diabetes had not had the recommended retinal examination.
NACCHO has been involved with the Roadmap from its inception, and had a long relationship with Indigenous Eye Health at the University of Melbourne, and with RANZCO. We’re pleased with the great work and good progress beingmade.”
Every patient with diabetes is at risk of losing vision, but up to 98% of the cases of severe vision loss could be prevented.1 At any given time, about a third of patients with diabetes will have diabetic retinopathy, and one in ten will experience sight-threatening retinopathy requiring prompt treatment.2
The National Health and Medical Research Council (NHMRC) guidelines recommend an eye examination every 2 years for non-Indigenous Australians with diabetes, and annual examinations for Indigenous people with diabetes.3
However, approximately only half of non-Indigenous patients with diabetes and only one in five of Indigenous Australians with diabetes receive the recommended eye examinations.4
Although the prevalence rates of diabetes have increased dramatically in Australia over recent years, they have increased even more so among Indigenous people. In the 1970s, the prevalence of diabetes among Indigenous people was one-tenth that of non-Indigenous people,5 and now it is about five times higher.6
For patients with diabetes, maintaining good vision is an essential goal. Not only is good vision important in its own right but, without it, patients cannot manage their diabetes, look after medications, check blood sugars, check their feet and attend clinic appointments unassisted, let alone manage home dialysis.
Diabetes is also a leading cause of vision loss and blindness in Indigenous people and causes 12% of vision loss cases and 9% of blindness cases — rates that are 14 times higher than those in the non-Indigenous population.
4 There are many reasons why Indigenous people with diabetes do not receive the appropriate care they need; the Roadmap to close the gap for vision lists 35 individual problems that need to be dealt with to provide this care.7,8
Consistent with the Roadmap is an important announcement in the May 2016 federal Budget of the new Medicare items for non-mydriatic photography (listed in November 2016), which will enable easy and affordable eye screening within the primary care setting for patients with diabetes.9 This is a very important development and a game changer for both non-Indigenous and Indigenous people with diabetes.
The new item numbers cover a test of visual acuity and a retinal photograph.9 Patients with abnormalities in the eye will need to be referred to a specialist for further assessment and treatment. Patients with a normal eye examination will be reviewed again according to the NHMRC recommendations.
Non-mydriatic cameras are now readily available, and most are at least semi-automatic, making them easier to use by clinic staff. Moreover, non-mydriatic cameras do not require the use of dilating drops, which facilitates patient assessment.
The patient does not need to wait and there is no discomfort of blurry vision for several hours as the drops wear off. Testing visual acuity and taking a retinal photograph in the primary care setting means that a separate specialist appointment is not required, and the eye examination can be easily incorporated into the care plan.
If the vision is found to be impaired or a photograph cannot be obtained, then the patient requires a comprehensive eye examination and should be referred to a specialist, as in the case of visible signs of retinopathy.
This method provides real benefits to patients because the eye examination becomes an integral part of their normal care, avoiding in many cases the need for an additional eye examination and allowing timely treatment, if required. There is a real advantage for the clinic as well, since they can be sure that their patients are receiving the necessary eye examinations.
Moreover, there are also advantages for optometrists and ophthalmologists, because people with diabetes who particularly need their care — those with retinopathy and vision loss — will be referred, rather than them seeing people for widespread screening.
Of course, it is expected that the overall number of people with diabetes being screened will increase significantly, and that changes in the eye will be found much earlier and severe retinopathy will be avoided.
There is also a tangible advantage to the community through cost savings in the identification and care of retinopathy, which will prevent unnecessary blindness and vision loss.10
The impact will be particularly noted among Indigenous people with diabetes, who represent three-quarters of the Indigenous adults who need an eye examination each year.7,
8 In addition to diabetic retinopathy, people with diabetes have an increased risk of cataract and may also need a change in glasses.
To provide adequate eye care to people with diabetes, a referral process for the treatment of retinopathy needs to be established, along with a process of specialist referral for appropriate further investigation and treatment — including post-operative follow-up when required — for those who need cataract surgery or refraction. Those who do not have diabetes will also use these pathways.
The focus on eye care for Indigenous people with diabetes will therefore deal with over 70% of the eye care needs in the community, and it will also assist with providing care for Indigenous patients who do not have diabetes. Again, it is a real game changer.
There are a number of resources to assist with the uptake and promotion of these new services. There are online modules aimed at helping clinic staff learn more about the eye care required for people with diabetes,11,12 for conducting eye examinations and for grading diabetic retinopathy.
In addition, culturally appropriate health promotion material has been specifically developed with close community involvement, which aims to alert and inform patients and the community about the need for regular eye examinations.13
It is said that “what is not measured is not done” and that “what is not monitored cannot be managed”. It is very important that appropriate monitoring and evaluation processes to track performance are put in place at the clinic, regional, jurisdictional and national levels. The diabetic eye screening rate should be a key performance indicator for primary care and diabetes clinics.
The new Medicare item number for non-mydriatic diabetic retinopathy screening is a major advance in closing the gap for vision.
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