Ophthalmology (Eye & Ear Hospital) - Research Publications
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ItemUtilization of eye health-care services in Australia: the National Eye Health Survey(WILEY, 2018-04)IMPORTANCE: National data on eye health-care service utilization will inform Australia's eye health policy. BACKGROUND: To investigate the utilization of eye health-care services by Australians. DESIGN: Cross-sectional survey. PARTICIPANTS: Indigenous Australians aged 40 years and older and non-Indigenous Australians aged 50 years and older. METHODS: One thousand seven hundred thirty-eight Indigenous Australians and 3098 non-Indigenous Australians were recruited from 30 randomly selected sites, stratified by remoteness. Sociodemographic, ocular history and eye health-care service utilization data were collected, and an eye examination was conducted. MAIN OUTCOME MEASURES: Recentness of eye examinations, types of providers used and associated risk factors. RESULTS: Approximately 67.0% of Indigenous Australians and 82.5% of non-Indigenous Australians underwent an eye examination within the previous 2 years. Indigenous status (P < 0.001), male gender (P < 0.001), Outer Regional (P < 0.001) and Very Remote (P < 0.001) residence were associated with less recent examinations. Participants with >self-reported eye disease or diabetes were most likely to have been examined within the past year (P < 0.001). For Indigenous Australians, older age was associated with recent eye testing (P = 0.001). Those with retinal disease and cataract were more likely to see an ophthalmologist (P < 0.001), and those with refractive error were more likely to see an optometrist (P < 0.001). In Regional Australia, non-Indigenouspeople were more likely to see optometrists (P < 0.001), and Indigenous Australians were more likely to utilize other, non-specialistservices (P < 0.001). CONCLUSIONS AND RELEVANCE: Eye examination frequency has improved in Indigenous and non-Indigenous Australians compared with previous population-based research. Further improvements are required in risk groups including Indigenous Australians and those living in Regional and Remote areas.
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ItemPrevalence of retinal vein occlusion in the Australian National Eye Health Survey(WILEY, 2018-04)IMPORTANCE: In Australia, knowledge of the epidemiology of retinal vein occlusion remains scarce because of a paucity of recent population-based data. The National Eye Health Survey (2015-2016) provides an up-to-date estimate of the prevalence of retinal vein occlusion in non-Indigenous and Indigenous Australian adults. BACKGROUND: To determine the prevalence and associations of retinal vein occlusion in a national sample of Indigenous and non-Indigenous Australian adults. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected sites, stratified by remoteness. METHODS: Retinal vein occlusions were graded from retinal photographs using standardized protocols and recorded as central retinal vein occlusion or branch retinal vein occlusion. MAIN OUTCOME MEASURE: Prevalence of retinal vein occlusion. RESULTS: In the non-Indigenous population, the sampling weight adjusted prevalence of any retinal vein occlusion was 0.96% (95% confidence interval: 0.59, 1.6), with branch retinal vein occlusion observed in 0.72% (95% confidence interval: 0.41, 1.2) and central retinal vein occlusion in 0.24% (95% confidence interval: 0.13, 0.47). Any retinal vein occlusion was found in 0.91% (95% confidence interval: 0.47, 1.7) of Indigenous Australians aged 40 years and over, with branch retinal vein occlusion observed in 0.83% (95% confidence interval: 0.40, 1.7) and central retinal vein occlusion in 0.07% (95% confidence interval: 0.02, 0.32). Older age (odds ratio = 1.64 per 10 years, P = 0.006) and the presence of self-reported diabetes (odds ratio = 3.24, P = 0.006) were associated with any retinal vein occlusion after multivariable adjustments. Retinal vein occlusion was attributed as the cause of monocular vision loss (<6/12) in seven (0.25%) non-Indigenous and six (0.36%) Indigenous participants. CONCLUSIONS AND RELEVANCE: These data suggest that retinal vein occlusion is relatively uncommon in the non-Indigenous Australians aged 50 years and over and Indigenous Australians aged 40 years and over. Similar to previous Australian and international reports, the prevalence of retinal vein occlusion rose sharply with age.
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ItemPrevalence of trachomatous trichiasis in Australia: the National Eye Health Survey(WILEY, 2018-01)IMPORTANCE: Australia is the only developed country to still have pockets of endemic trachoma. The research provides up-to-date, population-based prevalence data of later complications of trachoma amongst a national sample of Indigenous adults. BACKGROUND: To report the prevalence of trachomatous trichiasis (TT) in Indigenous Australians aged 40 years and older. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 1738 (41% male) Indigenous Australians aged 40 years or older, living amongst 30 randomly selected Australian sites, stratified by remoteness. METHODS: Anterior segment examination was performed and trachoma grading for the presence of TT and corneal opacification (CO) was conducted using the WHO (WHO) simplified grading system. MAIN OUTCOME MEASURES: Prevalence of TT. RESULTS: A total of three (0.17%) participants had TT, and there were no confirmed cases of trachomatous CO in the NEHS. All three participants with TT were female and aged 40 years or older. Although they had likely spent their childhoods in more remote areas, two of the three confirmed cases resided in an urban and outer regional area at the time of their examinations. CONCLUSIONS AND RELEVANCE: Our data are in line with ongoing national trachoma surveillance reports that suggest the prevalence of late sequences of trachoma appear to be decreasing in Australia.
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ItemSampling methodology and site selection in the National Eye Health Survey: an Australian population-based prevalence study(WILEY, 2017-05)BACKGROUND: This paper presents the sampling methodology of the National Eye Health Survey that aimed to determine the prevalence of vision impairment and blindness in Australia. DESIGN: The National Eye Health Survey is a cross-sectional population-based survey. PARTICIPANTS: Indigenous Australians aged 40 years and older and non-Indigenous Australians aged 50 years and older residing in all levels of geographic remoteness in Australia. METHODS: Using multistage, random-cluster sampling, 30 geographic areas were selected to provide samples of 3000 non-Indigenous Australians and 1400 Indigenous Australians. Sampling involved (i) selecting Statistical Area- Level 2 sites, stratified by remoteness; (ii) selecting Statistical Area- Level 1 sites within Statistical Area- Level 2 sites to provide targeted samples; and (iii) grouping of contiguous Statistical Area- Level 1 sites or replacing Statistical Area- Level 1 sites to provide sufficient samples. MAIN OUTCOME MEASURES: The main outcome measures involved Sites sites selected and participants sampled in the survey. RESULTS: Thirty sites were generated, including 12 Major City sites, 6 Inner Regional sites, 6 Outer Regional sites, 4 Remote sites and 2 Very Remote sites. Three thousand ninety-eight non-Indigenous participants and 1738 Indigenous participants were recruited. Selection of Statistical Area- Level 1 site overestimated the number of eligible residents in all sites. About 20% (6/30) of Statistical Area- Level 1 sites were situated in non-residential bushland, and 26.67% (8/30) of Statistical Area- Level 1 populations had low eligibility or accessibility, requiring replacement. CONCLUSIONS: Representative samples of Indigenous and non-Indigenous Australians were selected, recruited and tested, providing the first national data on the prevalence of vision impairment and blindness in Australia.
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ItemPrevalence and characteristics of choroidal nevi: the Australian National Eye Health Survey(WILEY, 2018-09)IMPORTANCE: Choroidal nevi are a common incidental finding on fundus examination. The National Eye Health Survey (NEHS, 2015-2016) provides an up-to-date estimate of the prevalence of choroidal nevi in non-Indigenous and Indigenous Australian adults. BACKGROUND: To describe the prevalence and characteristics of choroidal nevi among non-Indigenous and Indigenous Australian adults. DESIGN: Population-based cross-sectional study. PARTICIPANTS: This study included 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected sites, stratified by remoteness. METHODS: Choroidal nevi were graded from retinal photographs using standard protocols. MAIN OUTCOME MEASURES: Prevalence of choroidal nevi. RESULTS: In the non-Indigenous population aged 50 years and over, the weighted prevalence of choroidal nevi was 2.1% (95% CI: 1.4, 3.3). Among Indigenous Australians aged 40 years and over, the weighted prevalence of choroidal nevi was 0.68% (95% CI: 0.4, 1.3). The average maximum diameter, surface area and distance from the disc of the choroidal nevi was 1730 μm, 2 766 800 μm2 and 3400 μm, respectively. After multivariate adjustments, Indigenous participants (OR = 0.28, P = 0.01) and those of older age (OR = 0.79 per 10 years, P = 0.02) were less likely to have choroidal nevi. Choroidal nevus was not the primary cause of vision loss in any participant. CONCLUSIONS AND RELEVANCE: Choroidal nevi were relatively infrequent among NEHS participants, however non-Indigenous Australians had a significantly higher prevalence than Indigenous Australians. Choroidal nevi did not affect visual acuity and the majority were small.
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ItemTreatment coverage rates for refractive error in the National Eye Health survey(PUBLIC LIBRARY SCIENCE, 2017-04-13)OBJECTIVE: To present treatment coverage rates and risk factors associated with uncorrected refractive error in Australia. METHODS: Thirty population clusters were randomly selected from all geographic remoteness strata in Australia to provide samples of 1738 Indigenous Australians aged 40 years and older and 3098 non-Indigenous Australians aged 50 years and older. Presenting visual acuity was measured and those with vision loss (worse than 6/12) underwent pinhole testing and hand-held auto-refraction. Participants whose corrected visual acuity improved to be 6/12 or better were assigned as having uncorrected refractive error as the main cause of vision loss. The treatment coverage rates of refractive error were calculated (proportion of participants with refractive error that had distance correction and presenting visual acuity better than 6/12), and risk factor analysis for refractive correction was performed. RESULTS: The refractive error treatment coverage rate in Indigenous Australians of 82.2% (95% CI 78.6-85.3) was significantly lower than in non-Indigenous Australians (93.5%, 92.0-94.8) (Odds ratio [OR] 0.51, 0.35-0.75). In Indigenous participants, remoteness (OR 0.41, 0.19-0.89 and OR 0.55, 0.35-0.85 in Outer Regional and Very Remote areas, respectively), having never undergone an eye examination (OR 0.08, 0.02-0.43) and having consulted a health worker other than an optometrist or ophthalmologist (OR 0.30, 0.11-0.84) were risk factors for low coverage. On the other hand, speaking English was a protective factor (OR 2.72, 1.13-6.45) for treatment of refractive error. Compared to non-Indigenous Australians who had an eye examination within one year, participants who had not undergone an eye examination within the past five years (OR 0.08, 0.03-0.21) or had never been examined (OR 0.05, 0.10-0.23) had lower coverage. CONCLUSION: Interventions that increase integrated optometry services in regional and remote Indigenous communities may improve the treatment coverage rate of refractive error. Increasing refractive error treatment coverage rates in both Indigenous and non-Indigenous Australians through at least five-yearly eye examinations and the provision of affordable spectacles will significantly reduce the national burden of vision loss in Australia.
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ItemParticipant referral rate in the National Eye Health Survey (NEHS)(PUBLIC LIBRARY SCIENCE, 2017-04-04)PURPOSE: To present the rates of referral of participants in the National Eye Health Survey (NEHS) for further eye care. MATERIALS & METHODS: A national sample of 3098 non-Indigenous Australians aged 50-98 and 1738 Indigenous Australians aged 40-92 years living in 30 randomly selected sites was recruited using a door-to-door approach. Participants completed a general questionnaire and a series of eye tests, including vision and anterior segment assessment, intra-ocular pressure measurement, visual field testing and fundus photography. A predefined protocol was used to guide the referral of participants for follow up eye care. An ophthalmologist was on-call to assist with the triaging of participants. RESULTS: Of the total sample, 32.1% (994/3098) of non-Indigenous participants and 43.6% (757/1738) of Indigenous participants were referred for further eye care (p<0.001). A significant difference in referral rates for Indigenous Australians was observed between regions of differing geographic remoteness [range = 32.2% (Inner Regional)-60.4% (Very Remote), p <0.001]. After adjusting for covariates, males (OR = 1.24, 95% CI: 1.06-1.46), older age (OR = 1.02 per year, 95% CI: 1.01, 1.02) and longer time since previous eye examination (OR = 1.15 per year, 95% CI: 1.12, 1.19) were associated with higher rates of eye care referral in the non-Indigenous population. In the Indigenous population, older age (OR = 1.02 per year, 95% CI: 1.01-1.03), self-reported diabetes (OR = 1.70, 95% CI: 1.37-2.12), greater geographical remoteness (OR = 1.19, 95% CI: 1.09-1.29) and longer time since previous eye examination (OR = 1.10 per year, 95% CI: 1.07, 1.13) were associated with a higher rate of referral after multivariate adjustments. A total of 25 participants (1.4%) were referred for urgent follow-up of potentially sight threatening conditions. CONCLUSIONS: Our data has identified several high risk groups that required ophthalmic referral including older Australians, non-Indigenous men, Indigenous Australians with self-reported diabetes and those residing in very remote populations who may benefit from improvements in the provision and/or uptake of eye health services. Future longitudinal research is warranted to evaluate the feasibility and efficacy of implementing a referral protocol within a population-based research setting.
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ItemThe validity of self-report of eye diseases in participants with vision loss in the National Eye Health Survey(NATURE PORTFOLIO, 2017-08-18)We assessed the validity and reliability of self-report of eye disease in participants with unilateral vision loss (presenting visual acuity worse than 6/12 in the worse eye and equal to or better than 6/12 in the better eye) or bilateral vision loss (presenting visual acuity worse than 6/12 in the better eye) in Australia's National Eye Health Survey. In total, 1738 Indigenous Australians and 3098 non-Indigenous Australians were sampled from 30 sites. Participants underwent a questionnaire and self-reported their eye disease histories. A clinical examination identified whether participants had cataract, age-related macular degeneration, diabetic retinopathy and glaucoma. For those identified as having unilateral or bilateral vision loss (438 Indigenous Australians and 709 non-Indigenous Australians), self-reports were compared with examination results using validity and reliability measures. Reliability was poor for all four diseases (Kappa 0.06 to 0.37). Measures of validity of self-report were variable, with generally high specificities (93.7% to 99.2%) in all diseases except for cataract (63.9 to 73.1%) and low sensitivities for all diseases (7.6% in Indigenous Australians with diabetic retinopathy to 44.1% of non-Indigenous Australians with cataract). This study suggests that self-report is an unreliable population-based research tool for identifying eye disease in those with vision loss.
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ItemThe Prevalence of Self-Reported Diabetes in the Australian National Eye Health Survey(PUBLIC LIBRARY SCIENCE, 2017-01-03)OBJECTIVE: To present the prevalence of self-reported diabetes in Indigenous and non-Indigenous participants in the National Eye Health Survey. RESEARCH DESIGN AND METHODS: 3098 non-Indigenous Australians aged 50-98 years and 1738 Indigenous Australians aged 40-92 years were examined in 30 randomly selected sites, stratified by remoteness. A history of diabetes was obtained using an interviewer-administered questionnaire. RESULTS: 13.91% (431/3098) of non-Indigenous Australians and 37.11% (645/1738) of Indigenous Australians had self-reported diabetes. The age-adjusted prevalence of self-reported diabetes for non-Indigenous and Indigenous Australians was 11.49% and 43.77%, respectively (p <0.001). The prevalence of self-reported diabetes increased markedly with age (OR = 1.04 per year, p = 0.017). Indigenous Australians living in very remote areas were more likely to have self-reported diabetes than those in major city areas (OR = 1.61, p = 0.038). CONCLUSIONS: The prevalence of self-reported diabetes in Australia was high, with the prevalence being almost 4 times higher in Indigenous Australians compared with non-Indigenous Australians. With the prevalence of diabetes likely to increase, the results of this national survey may inform future policy, planning and funding allocation to assist in controlling the diabetes epidemic.