It is estimated that over 13 million Australians had one or more chronic (long-term) eye conditions in 2017–18, with chronic eye conditions affecting 93% of people aged ≥65 years.¹ Conditions such as cataracts, macular degeneration, glaucoma and diabetic retinopathy can lead to blindness if left untreated.¹ Declining vision impacts the everyday quality of life of the patient² and contributes to injury and morbidity.³ Open-angle glaucoma prevalence increases with age after age 40 years and is more common in people of Caucasian, Asian and African ethnicity.

Aboriginal and Torres Strait Islander peoples aged >40 years have nearly three times the rate of vision loss of other Australians.^4,5

Vision screening: Children aged <3 years

Newborn vision screening in Australia is typically undertaken in hospitals, soon after the baby is born. However, there is insufficient evidence to recommend routine vision screening in primary care in children aged <3 years. Children aged <3 years are often unable to cooperate with some of the clinical screening tests performed in general practice, such as visual acuity testing, and therefore may lead to false positive results.⁶

Vision screening: Children aged 3–5 years

The purpose of vision screening between the ages of 3 and 5 years is to detect any vision problems, but primarily to detect amblyopia. Amblyopia is more commonly known as ‘lazy eye’. It typically only occurs in one eye, but occasionally occurs in both.

Optometry Australia guidelines recommend the following techniques to measure acuity in children aged 3–5 years. The Broken Wheel Test is a possible alternative if the below tests cannot be conducted:¹²

• Patti Pics or Lea Chart at 3 metres or 6 metres
• Snellen chart at 6 metres – use multiple-line presentation or crowding bars to increase sensitivity of detection of amblyopia. Single-line presentations with crowding bars can also be considered.

Glaucoma

Glaucomas are a group of relatively common optic neuropathies in which there is pathological loss of retinal ganglion cells, progressive loss of sight and associated alteration in the retinal nerve fibre layer and optic nerve head. While there is no evidence for population screening for primary open-angle glaucoma,⁹ GPs have an important role in identifying those at increased risk for glaucoma and advising them to attend regular, fully comprehensive eye examinations with an optometrist. Open-angle glaucoma can be identified with optimal coherence tonography (high sensitivity), automated visual field testing (high sensitivity), tonometry (lower sensitivity) and visualisation of the optic disc (lower sensitivity). Management to reduce intraoccular pressure slows progression of glaucoma. However, there are currently no tools available that can identify patients’ individual risk, or for whom screening may be more beneficial.⁹

Assessing fitness to drive

For specific recommendations for Aboriginal and Torres Strait Islander people, please refer to the following sections from Chapter 6: Eye health of the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people:

• Visual acuity
• Trachoma and trichiasis

People at greater risk of visual impairment and loss include:⁸

• older people
• people with diabetes
• people with family history of vision impairment
• smokers (current or previous).

Older people

It should be determined whether the patient is wearing up-to-date prescription spectacles. Also assess whether there is a possibility of falls, or if the patient is no longer capable of managing a bifocal, trifocal or multifocal prescription.

Screening guidelines for diabetes-related eye disease, such as diabetic retinopathy:
Microvascular complications: Diabetes-related eye disease, Management of type 2 diabetes: A handbook for general practice | RACGP
 
Guidelines for assessing fitness to drive:
Assessing fitness to drive | Austroads
 
The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) referral pathways for age-related macular degeneration, diabetic retinopathy and glaucoma management:
Collaborative care | RANZCO