James Costa
James Costa is an intern at Cosmos. He has completed his Master of Journalism at the University of Melbourne.
A long term and well funded project to reduce the incidence of eye disease in Indigenous communities is having significant impact, with a forecast that one devastating illness will soon be all but eliminated.
Preventable vision problems, such as trachoma and cataracts, affect Indigenous people aged 40 and over at much higher rates than non-Indigenous Australians of the same age.
But a new report from the Australian Institute of Health and Welfare (AIHW), shows a dramatic fall in trachoma – a bacterial eye infection – with rates among children aged 5 to 9 dropping from 14% in 2007 to under 2% last year.
Trachoma is caused by Chlamydia trachomatis and can lead to the eyelids turning inwards, and rubbing against the eye creating pain and damage to the surface of the eye. Repeated infections can cause blindness.
Shaun Tatipata, who is of Wuthathi/Ngarrindjeri and Torres Strait Islander descent and the founding director of Deadly Vision Centre, told Cosmos that Australia had made “really good progress” in reducing the rate of trachoma.
“We know that’s a result of strong collaboration across agencies and with our Aboriginal Community Controlled Health Organisations.
“Success in screening and early detection, but also health promotion activities and good hygiene practices, and access to health hardware and clean washing facilities is what’s driving these improvements,” Tatipata says.
Trachoma is the leading preventable cause of blindness in the world and in Australia, it only affects Aboriginal and Torres Strait Islander people. Those living in remote and very remote areas are at the highest risk, according to the Kirby Institute.
Since 2009, the Australian Government has invested more than $72 million, through Closing the Gap – Improving Eye and Ear Health Services, to support eliminating trachoma by improving environmental conditions in affected areas, and developing trachoma control and health promotion initiatives.
Initially there was a national goal to get rid of trachoma in Australia by 2020 – these efforts failed – and again in 2022 after the target date was updated.
Associate Professor Mitchell Anjou, director of the Indigenous Eye Health Unit at the University of Melbourne in Victoria, says that elimination of the disease is now hopefully expected in “late 2025 to early 2026”.
Anjou says that there remain outstanding issues in improving community housing, washing facilities and environmental health to sustain these reduced rates.
“Of course, there’s a lot of work to be done to ensure that the prevalence rates don’t return,” Tatipata says. “We need to invest in community-led models which can foster greater ownership and leadership to ensure that communities can maintain these prevalence rates in the future.
“This is going to be critical.”
Anjou agrees, saying that “additional investment is required to maintain outcomes against population growth but also to eliminate long standing inequities”.
According to the report, 19.5 per cent of First Nations peoples had an eye examination by eye care professionals in 2023. This rate has stayed mostly stagnant since 2012-13, whereas the rate of eye checks among non-Indigenous people is increasing.
An AIHW spokesperson says cataracts are the leading cause of blindness among First Nations adults, but more First Nations peoples had undergone cataract surgery in 2022-23 than five years earlier.
The report also shows the median wait time in 2022-23 for cataract surgery among First Nations peoples is 159 days, compared to 119 days for the non-Indigenous community.
The inequity of waiting times suggests: “inherent systemic issues” disadvantaging First Nations care, Anjou says.
“We’re not seeing the investment that we need,” Tatipata says.
“Unless we invest in addressing some of the backlog, unless we invest in innovative approaches and models which allow us to create or facilitate culturally safe pathways to cataract surgeries, for example… we’re not going to close the gap for vision.
“Something as simple as coordinating the scheduling of cataract surgery for a group of Aboriginal and Torres Strait Islander people from the one Aboriginal Medical Service or community… can result in greater peer support to attend and strengthen cultural safety considerably if done right”.