Causes of Vision Loss in Indigenous Online Tutoring

The prevalence and causes of vision loss in Indigenous
Australians: the National Indigenous Eye Health

Survey
Summary of the article

The core focus of the review is on “The prevalence and causes of vision loss in Indigenous Australians: the National Indigenous Eye Health Survey” which has been conducted by Taylor et al. (2010). The occurrence of eye related impairments and visual loss has been witnessed more in Aboriginal Australians, which has been considered as motivation to conduct underlying research, with an aim to explore the extent to which vision loss prevails among indigenous Australia, along with exploration of its causes. The study has made comparison between indigenous and non-indigenous Australians, by measuring Visual Acuity (VA), visual field testing, trachoma grading and lens photography.

Adopted Methodology and its appropriateness

The insight from Australian Indigenous Geographical Classification was used from the census of 2006 to identify the indigenous geographical areas and regions. Based on the data, five major stratums were identified, which were named as; major city, inner regional, outer regional, remote and very remote. From these stratums, selection of five areas was made on random selection basis. In order to reach the geographical community size of about 300 indigenous Australia, few smaller community areas were merged together. The initial target sample of indigenous people included both children as well as adults, whereby children of 5 to 15 years of age were 2007, and adults with age of 40 years and above were 1655. On the other hand, sample of indigenous Australians was drawn from 6 remote locations and only 163 adults aging 40 years and above were chosen to constitute initial target sample.
In order to obtain demographic data, self-administered questionnaire was used with the aid of interpreters, which was followed by the eye examination of all individuals. The eye examination has encompassed the testing of visual acuity and field assessment with Humphrey frequency doubling technology (FDT). Likewise, diagnosis for Trachoma, fundal photographs and glaucoma was also conducted. The arrangements of treatment as well as for referrals was made throughout the examination process. The collection of demographic data and eye examinations were performed in the light of ethical standards, as ethics approval was obtained from Human Research Ethics Committee of the Royal Victorian Eye and Ear Hospital, board of the National Aboriginal Community Controlled Health Organization and other relevant entities. Two different methods of analysis were used for categorical and continuous variables. The categorical data was measured using Chi-sqaure test, while in order to measure continuous data, Mann–Whitney–Wilcoxon test or Student t-test was used.
The chosen methodology has allowed the researchers to gain access to national level data, which has made it highly generalizable study as national scope is difficult to accomplish. On the other hand, the stratified sampling design has allowed to seek required level of variability in the sample and lowered biases in the data collection (Taylor, Boudville & Anjou, 2012).

Findings

Of the total chosen sample, 1694 children were eligible from indigenous communities, 1189 were eligible adults from indigenous people, while 136 non-indigenous adults were eligible. It was found from the study that of eligible children, the low vision was witnessed among 1.5%, while among eligible indigenous adults, 9.4% have shown low vision and 1.9% were blind. Moreover, the adults who belonged from cities have low blindness as compared to other regions. Such as, adults who belonged from NSW have low impairments rates in contrast to all other regions. Overall for the children, eye impairments were low for those who lived in major cities and this difference was statistically significant. Further the studies have revealed that relative risk of impairment in indigenous adults was 2.8 for low vision and 6.2 for blindness, as compared to mainstream adults. The results have also shown that indigenous adults have near vision issue and they were unable to read normal sized texted without reading glasses. The causes of eye impairments in indigenous Australian were mainly cataract, uncorrected refractive error and ocular trauma. The results of the study have clearly highlighted that eye impairments were more likely in indigenous Australians. However, it is considerable that mainly difference were found to be non-significant across two groups, which could mainly be the result of smaller sample size of indigenous Australians.

Limitations

The key limitation of the study pertains to the notion that in order to make comparison of eye health issues of indigenous and non-indigenous people, the sample size of non-indigenous Australian was very low. In order to draw comparison of two groups, there should be equal or nearly equal number of participants (Lovett, 2018), such that sampling biases can be reduced and most accurate results can be deducted. Additionally, only mainstream Australian adults were chosen and there was no reference point available to compare the impairments and vision of indigenous children. Additionally, for the fewer children, ophthalmic examination was not accessed, which is important to asses vision impairments (Kelaher, Ferdinand & Taylor, 2012).

Implications

This study is the first national survey on vision status of aboriginal indigenous people of Australia, in the past 30 years. These results can be used by health care providers and policy makers to improve the eye care facilities in remote and very remote communities, with the view of improving vision status of indigenous Australians. Additionally, the causes of eye related impairments can be tracked through results of the study and by addressing these causes, blindness and visual impairments can be lowered among Australian Aboriginal and Torres Strait people. However, it should be considered that data for study was conducted in 2008 and thus there need to further explore the recent condition of vision status of indigenous Australians.

Conclusion

Overall, the national level survey of vision condition of aboriginal Australian has made this study worthy for research stream and it has provided clear insight on prevalence as well as on causes of visual impairments among indigenous people of Australia. However, it is also considerable that comparison was not made effectively and thus it cannot be clearly said that non-indigenous Australians are surely enjoying better vision status in contrast to indigenous people. For implying these results, further exploration could be considered suitable, such that eye health care can be improved for indigenous communities.

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References

Kelaher, M., Ferdinand, A., & Taylor, H. (2012). Access to eye health services among indigenous Australians: an area level analysis. BMC ophthalmology, 12(1), 51.
Lovett, L. (2018). Meeting the eye-care needs of Australia’s Indigenous people. Bull World Health Organ, 96, 670-671.
Taylor, H. R., Xie, J., Fox, S., Dunn, R. A., Arnold, A. L., & Keeffe, J. E. (2010). The prevalence and causes of vision loss in Indigenous Australians: the National Indigenous Eye Health Survey. Medical Journal of Australia, 192(6), 312-318.
Taylor, H. R., Boudville, A. I., & Anjou, M. D. (2012). The roadmap to close the gap for vision. Medical Journal of Australia, 197(11), 613.

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