There are four main eye conditions - cataract, refractive error, diabetic eye disease and trachoma - which together cause 94 per cent of the vision loss among Aboriginal and Torres Strait Islander people. All four conditions can be readily treated.
The Roadmap to Close the Gap for Vision is a sector-endorsed, whole-of-system policy framework with 42 recommendations that aims to reduce the equity gap in eye health between mainstream and Indigenous Australians. The Roadmap focuses attention on these four eye conditions. This article discusses health promotion initiatives around trachoma and diabetic eye disease. (A follow-up article in the next Partyline will look at cataract and refractive error to complete the story.)
Australia is the only developed nation with endemic trachoma and this is present only in some remote Indigenous communities. Trachoma is an infectious eye disease caused by the bacterium Chlamydia trachomatis. Repeated infections in childhood can lead to blindness as an adult. The World Health Organisation (WHO) has a global action plan to eliminate trachoma by the year 2020. The international approach is WHO-developed and known as the SAFE strategy - Surgery for trichiasis; Antibiotic treatment; Facial cleanliness; Environmental improvements.
To increase awareness of the importance of facial cleanliness and address the environmental risk factor elements of the WHO strategy, health promotion activities are actively undertaken in remote communities. Milpa, the trachoma goanna, promotes the ‘Clean Faces, Strong Eyes’ message to children. A suite of culturally-appropriate resources form the Trachoma Story Kit for schools, communities and clinics and reinforce the ‘Clean Faces, Strong Eyes’ message.
Diabetes is a major cause of vision loss and blindness for Aboriginal and Torres Strait Islander people. However, up to 98 per cent of blindness is preventable with regular eye examinations and timely treatment. National Health and Medical Research Council guidelines recommend that Aboriginal and Torres Strait Islander people with diabetes have their eyes tested annually, yet only 20 per cent have had an eye examination in the last year. To improve diabetic retinopathy detection, the Australian Government announced two new Medicare Benefit Schedule items, which will allow the capture of retinal photographs in people with diabetes for both Indigenous and mainstream Australians in general practice settings. The new items will be available from 1 November 2016 and are expected to support opportunistic retinal screening of those who are at risk of vision loss from diabetic eye disease.
As with trachoma, a suite of culturally appropriate diabetes-related health promotion resources has been developed to encourage Aboriginal and Torres Strait Islander people with diabetes to get their eyes checked every year. The ‘Check Today, See Tomorrow’ resources were developed by Indigenous Eye Health at The University of Melbourne as part of a broader program of activity to close the gap for vision. An iterative, engaging, community-driven process was adopted so that the health promotion resources reflected community messages. As some participants remarked “I didn’t listen, I never realised diabetes can affect your eyes”.
The ‘Check Today, See Tomorrow’ resources include traditional health promotion materials and supporting multimedia resources such as music videos, personal story video series, and radio ads. Health services and communities are able to use and integrate key diabetes eye care messages into chronic care programs, community events and social media platforms. The resources can also be modified and adapted to incorporate local imagery to support local priorities.
To order the Trachoma Story Kit and ‘Check Today See Tomorrow’ diabetes eye care resources free of charge, please visit http://iehu.unimelb.edu.au or contact IEH (email: Indigenous-EyeHealth@unimelb.edu.au, phone (03) 8344 9320) for more information.