Prevalence and Causes of Visual Loss Among the Indigenous Peoples of the World

Abstract

IMPORTANCEStudies have documented a higher disease burden in indigenous compared with nonindigenous populations, but no global data on the epidemiology of visual loss in indigenous peoples are available. A systematic review of literature on visual loss in the world's indigenous populations could identify major gaps and inform interventions to reduce their burden of visual loss.OBJECTIVE To conduct a systematic review on the prevalence and causes of visual loss among the world's indigenous populations.EVIDENCE REVIEW A search of databases and alternative sources identified literature on the prevalence and causes of visual loss (visual impairment and blindness) and eye diseases in indigenous populations. Studies from January 1, 1990, through August 1, 2017, that included clinical eye examinations of indigenous participants and, where possible, compared findings with those of nonindigenous populations were included. Methodologic quality of studies was evaluated to reveal gaps in the literature.FINDINGS Limited data were available worldwide. A total of 85 articles described 64 unique studies from 24 countries that examined 79 598 unique indigenous participants. Nineteen studies reported comparator data on 42 085 nonindigenous individuals. The prevalence of visual loss was reported in 13 countries, with visual impairment ranging from 0.6% in indigenous Australian children to 48.5% in native Tibetans 50 years or older. Uncorrected refractive error was the main cause of visual impairment (21.0%-65.1%) in 5 of 6 studies that measured presenting visual acuity. Cataract was the main cause of visual impairment in all 6 studies measuring best-corrected acuity (25.4%-72.2%). Cataract was the leading cause of blindness in 13 studies (32.0%-79.2%), followed by uncorrected refractive error in 2 studies (33.0% and 35.8%).CONCLUSIONS AND RELEVANCE Most countries with indigenous peoples do not have data on the burden of visual loss in these populations. Although existing studies vary in methodologic quality and reliability, they suggest that most visual loss in indigenous populations is avoidable. Improvements in quality and frequency of research into the eye health of indigenous communities appear to be required, and coordinated eye care programs should be implemented to specifically target the indigenous peoples of the world.

Knowledge and Attitude Towards Corneal Donation

“…24 Another study found a lack of knowledge and willingness among 3 rd year medical students. 25 Overall, our study participant demonstrated a decreased level of knowledge in many areas in comparison to other international studies as our participants had a much lower percentage of correctly answered questions relative to many international studies. 19,25 Data from our study shows that relying only on media to increase the knowledge of eye donation among medical students is not enough.…”

“…25 Overall, our study participant demonstrated a decreased level of knowledge in many areas in comparison to other international studies as our participants had a much lower percentage of correctly answered questions relative to many international studies. 19,25 Data from our study shows that relying only on media to increase the knowledge of eye donation among medical students is not enough. Therefore, employing different curative and preventative features of corneal blindness with basic eye health care in the curriculum is greatly needed.…”

Working Towards Eye Health Equity for Indigenous Australians with Diabetes

“…The earliest reports from 1996, albeit from a specific region of Australia, found that 20.9% of the population had any DR. By comparison, the most recent national level estimates were 39.4% in 2017 among Indigenous Australians over the age of 40 [14][15][16]. Furthermore, the prevalence of diabetes-related vision impairment, although varying widely between 5.2% to as high as 26.5% depending on the study context, sampling methodology and region, is consistently reported to be higher among Indigenous Australians [14][15][16]. Among non-Indigenous Australians, diabetic complications contribute only 1.7% of the total burden of vision impairment and these rates have remained largely unchanged over a twenty-year timespan [12,17].…”

Prevalence, associations and characteristics of severe uncorrected refractive error in the Australian National Eye Health Survey

“…Decades on, our recent report from Australia's National Eye Health Survey (NEHS) found that refractive error remains the leading cause of visual impairment among Indigenous and non‐Indigenous Australian adults, accounting for 63.5% and 61.7% of cases, respectively . In the present study, we aim to undertake further analysis to elucidate prevalence and factors associated with severe uncorrected refractive error (≥2 lines improvement in subjects with a presenting vision <6/12).…”