July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Prevalence and Determinants of Vision Impairment in Indigenous Australians: The Predicting Renal, Ophthalmic and Heart Events in the Aboriginal Community (PROPHECY) Study
Author Affiliations & Notes
  • Jose Javier Estevez
    Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
    Aboriginal Health Unit, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
  • Natasha Howard
    Aboriginal Health Unit, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
  • John Landers
    Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
  • Jamie E Craig
    Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
  • Alex Brown
    Aboriginal Health Unit, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
  • Footnotes
    Commercial Relationships   Jose Estevez, None; Natasha Howard, None; John Landers, None; Jamie Craig, None; Alex Brown, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1387. doi:https://doi.org/
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      Jose Javier Estevez, Natasha Howard, John Landers, Jamie E Craig, Alex Brown; Prevalence and Determinants of Vision Impairment in Indigenous Australians: The Predicting Renal, Ophthalmic and Heart Events in the Aboriginal Community (PROPHECY) Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1387. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To determine the prevalence, social and biomedical determinants of vision impairment (VI) among a population-based cohort of Indigenous Australians.

Methods : The Predicting Renal, Ophthalmic and Heart Events in the Aboriginal Community (PROPHECY) Study was established from 18 geographical clusters (urban to very remote) with an Aboriginal Medical Service and/or a significant resident Aboriginal population. Participants (n=1047) underwent a standardised biomedical examination and interviewer-led questionnaires. Eye health status was determined through an eye examination including visual acuity (VA), refraction, dilated slit-lamp examination and combined retinal photography/optical coherence tomography. The prevalence and aetiology of bilateral VI (presenting bilateral VA <6/12) were determined, and psychosocial (e.g chronic stress), biomedical (e.g laboratory confirmed diabetes) and social (e.g educational attainment) risk markers were identified using multivariate logistic regression.

Results : The overall prevalence of VI for the cohort was 18.7% (n = 196; range, 6.6% [15–34 years]–35.9% [55+ years]). The leading causes of VI were refractive error (62.9%), cataract (11.7%) and diabetic retinopathy (10.7%). After adjusting for age, univariate risk indicators significantly associated with VI included; being female (OR 1.73; 95% CI 1.22–2.46, p=0.002), unemployed (1.58; 1.09-2.29, p=0.015), having diabetes (1.43; 1.00-2.04, p=0.049) and a self-reported history of stroke (2.00; 1.11-3.62, p=0.021). Participants with post-secondary education were at lower risk of VI (0.54; 0.39-0.78, p≤0.001). After purposeful selection (p<0.25) multivariate analyses of gender, education, body mass index, unemployment, history of stroke and diabetes diagnosis, only gender and education remained significant.

Conclusions : The main cause of VI for Indigenous Australians remains refractive error. Diabetes-related VI prevalence was higher than in previously reported studies. Indigenous Australians who are female and without post-secondary education are at higher risk of VI and further investigation of social factors in conjunction with chronic disease comorbidities such as diabetes and stroke is warranted. Gender differences and social risk factors require public health prioritisation to achieve equitable eye health care for Indigenous Australians.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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