Foreman Joshua, Xie Jing, Keel Stuart, Taylor Hugh R, Dirani Mohamed
Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia.
Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia.
PLoS One. 2017 Apr 13;12(4):e0175353. doi: 10.1371/journal.pone.0175353. eCollection 2017.
To present treatment coverage rates and risk factors associated with uncorrected refractive error in Australia.
Thirty population clusters were randomly selected from all geographic remoteness strata in Australia to provide samples of 1738 Indigenous Australians aged 40 years and older and 3098 non-Indigenous Australians aged 50 years and older. Presenting visual acuity was measured and those with vision loss (worse than 6/12) underwent pinhole testing and hand-held auto-refraction. Participants whose corrected visual acuity improved to be 6/12 or better were assigned as having uncorrected refractive error as the main cause of vision loss. The treatment coverage rates of refractive error were calculated (proportion of participants with refractive error that had distance correction and presenting visual acuity better than 6/12), and risk factor analysis for refractive correction was performed.
The refractive error treatment coverage rate in Indigenous Australians of 82.2% (95% CI 78.6-85.3) was significantly lower than in non-Indigenous Australians (93.5%, 92.0-94.8) (Odds ratio [OR] 0.51, 0.35-0.75). In Indigenous participants, remoteness (OR 0.41, 0.19-0.89 and OR 0.55, 0.35-0.85 in Outer Regional and Very Remote areas, respectively), having never undergone an eye examination (OR 0.08, 0.02-0.43) and having consulted a health worker other than an optometrist or ophthalmologist (OR 0.30, 0.11-0.84) were risk factors for low coverage. On the other hand, speaking English was a protective factor (OR 2.72, 1.13-6.45) for treatment of refractive error. Compared to non-Indigenous Australians who had an eye examination within one year, participants who had not undergone an eye examination within the past five years (OR 0.08, 0.03-0.21) or had never been examined (OR 0.05, 0.10-0.23) had lower coverage.
Interventions that increase integrated optometry services in regional and remote Indigenous communities may improve the treatment coverage rate of refractive error. Increasing refractive error treatment coverage rates in both Indigenous and non-Indigenous Australians through at least five-yearly eye examinations and the provision of affordable spectacles will significantly reduce the national burden of vision loss in Australia.
呈现澳大利亚未矫正屈光不正的治疗覆盖率及相关风险因素。
从澳大利亚所有地理偏远程度分层中随机选取30个人口集群，以提供1738名40岁及以上的澳大利亚原住民和3098名50岁及以上的非澳大利亚原住民作为样本。测量就诊时的视力，视力下降（低于6/12）者接受针孔测试和手持自动验光。矫正视力提高到6/12或更好的参与者被认定为未矫正屈光不正是视力下降的主要原因。计算屈光不正的治疗覆盖率（屈光不正参与者中接受远距离矫正且就诊时视力优于6/12的比例），并进行屈光矫正的风险因素分析。
澳大利亚原住民的屈光不正治疗覆盖率为82.2%（95%置信区间78.6 - 85.3），显著低于非澳大利亚原住民（93.5%，92.0 - 94.8）（优势比[OR]0.51，0.35 - 0.75）。在原住民参与者中，居住偏远（在外围地区和极偏远地区的OR分别为0.41，0.19 - 0.89和OR 0.55，0.35 - 0.85）、从未接受过眼部检查（OR 0.08，0.02 - 0.43）以及咨询过验光师或眼科医生以外的卫生工作者（OR 0.30，0.11 - 0.84）是覆盖率低的风险因素。另一方面，说英语是屈光不正治疗的保护因素（OR 2.72，1.13 - 6.45）。与在一年内接受过眼部检查的非澳大利亚原住民相比，过去五年内未接受过眼部检查（OR 0.08，0.03 - 0.21）或从未接受过检查（OR 0.05，0.10 - 0.23）的参与者覆盖率较低。
在区域和偏远原住民社区增加综合验光服务的干预措施可能会提高屈光不正的治疗覆盖率。通过至少每五年进行一次眼部检查并提供价格合理的眼镜，提高澳大利亚原住民和非澳大利亚原住民的屈光不正治疗覆盖率，将显著减轻澳大利亚全国视力丧失的负担。
