Indigenous Eye Health in Focus

Twenty-twenty was to be a watershed year for the University’s Indigenous Eye Health team. Then COVID-19 hit, and everything changed. But while it may not be the year of milestones they were expecting, their goals remain within sight.

IEH Group

When Laureate Professor Hugh Taylor AC (BMedSc 1970, MBBS 1971, GDipOphth 1975, MD 1979, Hon LLD 2012) began doing eye tests in remote communities, it wasn’t the problems that most surprised him. Instead, he discovered that many Indigenous Australians had vision that was nothing short of remarkable.

“I found that the average vision of healthy Aboriginal adults was 6/2.5. That means they could read at 6 metres what most people could only read 2.5 metres away,” he says.

“I’d never seen anybody report vision as good as that.”

Despite this, due to a range of environmental and systemic factors, Indigenous Australians experience much higher rates of preventable vision loss than the rest of the population. Professor Taylor began exploring this disparity in the 1970s, while working with the late Fred Hollows AC to provide eye care to Aboriginal and Torres Strait Islander people around the country.

After decades of watching public health campaigns try and fail to make meaningful improvements, he decided enough was enough.

CLOSING THE GAP FOR INDIGENOUS EYE HEALTH

Professor Taylor set up Indigenous Eye Health (IEH) at the University of Melbourne in 2008. IEH and the Centre for Eye Research Australia (CERA) conducted the National Indigenous Eye Health Survey the following year with sobering results: Indigenous Australians experienced six times more blindness than other Australians, and three times more low vision. A staggering 94 per cent of the vision loss was preventable or treatable.

“When you see that our fellow Australians, our First Nations people, are living with six times more blindness, you’ve just got to say, ‘This is not right’. To go from being so much better to being so much worse is scandalous,” says Professor Taylor.

In 2012, IEH released The Roadmap to Close the Gap for Vision, with 42 recommendations to improve Indigenous eye health in Australia.

“The patient journey was like a leaky pipe. There were lots of leaks and cracks along the pathway of care where people would fall out of the system. There weren’t one or three key things that had to be fixed – you actually had to address a whole series of them.”

One of the issues Roadmap aimed to tackle was trachoma, a preventable blinding eye infection. Trachoma disappeared from mainstream Australia over 100 years ago but persists in remote Indigenous communities.

“Australia is the only developed country to still have trachoma,” says Professor Taylor.

“It’s an unusual bacterial infection that spreads from one child’s eye to another. The key to stopping these frequent episodes of infection is to keep children’s faces clean.”

Professor Taylor’s work to eliminate trachoma spans decades, forming part of the World Health Organisation’s Global Elimination of Trachoma by 2020 (GET 2020) campaign. Progress was strong and the goal was within reach: rates of trachoma in endemic areas fell from 21 per cent in 2008 to just four per cent in 2019. This year, IEH was poised to find out whether Roadmap and GET 2020 would meet their goals.

“It was going to be such a great year for celebration and marking progress,” says Professor Taylor.

“Our work for the Global Elimination of Trachoma goes back to '97…some of the other work goes back to 1999. We've been waiting for this for over 20 years.” But, like the rest of the world, they hadn’t factored a pandemic into their plans.

IEH University of Melbourne

COVID-19: AN UNEXPECTED CHANGE IN DIRECTION

Restrictions to slow the spread of COVID-19 have forced many to rethink the way they work. For IEH, it meant adapting their trachoma campaign to help keep remote Indigenous communities safe and healthy.

Professor Taylor, who also has a background in epidemiology, knew his team could leverage their extensive community networks to help guard against the virus.

“We said, ‘We'd better get out and do it’. We worked with community TV and community-run radio and consulted with community-controlled health organisations to make sure we were developing a message that was culturally appropriate and fitted in.”

Luckily, COVID-19 and trachoma share a common enemy: good hygiene. IEH tackled both challenges by expanding their ‘Six steps to stop germs’ trachoma campaign. The six steps became seven with the addition of ‘cough or sneeze into your elbow’.

“The emphasis on hygiene and hand washing is reinforcing our work and our work is reinforcing the COVID-19 work.  The synergy there is terrific,” says Professor Taylor.

“We’ve now developed a series of health promotion materials around COVID-19, building on the existing trachoma messages. We’ve got TV, videos, material for use in schools and things like that, that really link in with COVID-19 activities in communities.”

IEH Washing Hands

LOOKING TO THE FUTURE

While the year hasn’t unfolded the way Professor Taylor hoped, the IEH team has much to be proud of.

“When I started off in the '70s on this National Trachoma Eye Health Program, in some of the communities, 75 per cent of the kids had trachoma. The blindness rates were, at that time, 10 times higher. We've eliminated trachoma now in more than 150 communities that were at risk even a decade ago,” he says.

“Importantly, the National Coalition of Peak Aboriginal Organisations now has an equal role with governments in preparing the new approach to close the gap. At last, it is being done with Aboriginal and Torres Strait Island people, and not to them. This is part of the interaction so urgently needed, and so eloquently set out in the Uluru Statement from the Heart.

“My hope is that we can put in place long term, sustainable provision of eye health services across the country that are culturally safe and accessible and affordable, so that every Australian can get top quality eye care.”

Professor Taylor says the patient care pathways IEH have developed could have applications in many other areas of health.

“Our work is really about linking primary care with a specialist service. What works for eyes should work for ears, hearts, lungs, and kidneys. While we haven't fixed all the issues around Indigenous health, I think those lessons learned will be very useful for some of these other areas.”

To find out more about Indigenous Eye Health at the University of Melbourne, visit: mspgh.unimelb.edu.au/centresinstitutes/centre-for-health-equity/research-group/ieh