More effectively detect and treat particularly common and insidious, non-reversible diseases such as diabetic retinopathy and glaucoma in remote, rural and Indigenous communities in Australia and developing countries.
Vision challenges among Australia’s Indigenous population, in remote and rural communities, and neighbouring developing countries are significant.
In our Indigenous communities, vision loss is three times more common than in non-Indigenous communities. Diabetic retinopathy is the most common cause of vision loss among Indigenous people, with diabetic-induced vision loss 14 times more common than in non-Indigenous people. Diabetes itself is three to five times more common across all age bands in the Indigenous population. One in 10 Aboriginal people with diabetes has vision-threatening diabetic retinopathy.
There is a high incidence of renal failure, stroke and heart disease in the Indigenous population, linked to the changes seen in the eyes. Another common cause of vision loss among Indigenous people is refractive error – however, the treatment for this has greatly improved in the past 10 years with appropriate glasses-wearing rates rising from 20 per cent to 82 per cent compared to the ideal of 94 per cent. Also, visually significant cataract surgical rates have improved, although there are twice as many visually significant cataracts in Indigenous people than in non-Indigenous people.
Our work, our achievements
There is a pressing need to translate best practice for delivery of quality treatment at scale and across distance, particularly using modern imaging and analytical capacity.
How can we leverage the experience and capacity we have built up in remote areas and with our near neighbours, such as Indonesia, to benefit all of our community? How can we leverage our experience with diabetic retinopathy, pathophysiology and insights to directly benefit Aboriginal and non-Aboriginal people and reduce the gap in outcomes in Australia?
- We have already made significant progress in this respect, but much more work is needed to close the gap. Lions Outback Vision was established in 2012 and has been an unparalleled success across Australia. Lions Outback Vision’s work has been widely praised, illustrated by the case study on tele-ophthalmology that was included in the 2019 World Health Organisation’s Report on Vision.
- Lions Outback Vision represents a new paradigm for delivering quality care at distance and at scale, involving optometry and ophthalmology with tele-ophthalmology to break down some remote barriers. It has improved the delivery of glasses and refractive correction, along with cataract surgery provision, and improved the standard of care for diabetic retinopathy.
- We will continue to expand scholarships and mentoring for indigenous placements which have led to several young indigenous doctors and health workers working with Lions Outback Vision and Lions Eye Institute.
- In Indonesia, there are similar challenges in ensuring quality health delivery at scale, over distance. We have a strong track record of teaching and assisting the development of novel treatments across Indonesia. A key example is the development of Virna Glaucoma Drainage Device. Launched in June 2019, the Virna cuts the cost of complex glaucoma surgery by 90 per cent and makes that treatment affordable. It also combines quality teaching and so helps the delivery at scale.
- Childhood eye injuries are the most devastating and preventable environmental cause of blinding eye disease. Through the Joyce Henderson Trust, the Lions Eye Institute has established the epidemiology of eye injury, and is developing education campaigns to potentially reduce the rate of incidence in Australian children.
- An emerging epidemic is childhood myopia, related to environmental exposure. The WA Kidskin Study and the Raine cohort study provide unprecedented opportunities to investigate the causes and progression of myopia in Australian children. A Lions Eye Institute led randomised controlled trial is underway to determine whether atropine treatment in Caucasian children is as effective as that shown in Asian children.
- Glaucoma is a complex disease with genetic predispositions. The Lions Eye Institute currently leads national studies into glaucoma genetic risk assessment and screening of high-risk family members in remote Australian communities as part of the NHMRC/WA Health funded TARRGET study.
- We are investigating the association of glaucoma with obstructive sleep apnoea in the WAVES study, building on our previous work with the Busselton and Raine studies. In those with advanced vision loss, we are investigating the use of adaptive technology to change the lives of people with blindness.
