Vision and eye disorders account for 1.9% of Australian general practice consultations.1 Over 13 million Australians have one or more long-term eye condition(s) and more than 450,000 Australians are visually impaired or blind.2 Long-term vision disorders are more common in older people, with 93% of people aged 65 years and over affected, compared with 12% of people aged 0 to 14 years.1 As providers of comprehensive healthcare, general practitioners (GPs) need to be able to screen for, assess and manage vision and eye disorders, including eye emergencies, and refer to ophthalmologists and other eye care specialists as required. GPs also have an important role in the prevention of eye disease.
Approximately 90% of visual impairment and blindness is preventable and treatable. The main causes of visual impairment are uncorrected refractive errors and cataracts. These conditions and age-related macular degeneration, diabetic retinopathy and glaucoma are responsible for 80% of vision loss in Australia.2
The burden of vision and eye disorders in Australia is higher in Aboriginal and Torres Strait Islander peoples, and the prevalence of bilateral visual impairment and blindness is three times higher in this group compared to non-Indigenous Australians. Uncorrected refractive errors cause two thirds of visual impairment. Cataracts are the leading cause of blindness, as opposed to macular degeneration in non-Indigenous Australians, causing 40% of blindness.2-4
Vision loss can have profound negative impacts on health and wellbeing. In children, visual impairment can affect development and learning. In adults, visual loss can result in falls and injuries, social isolation, loss of independence and have a negative impact on emotional wellbeing. GPs play a major role in screening for and managing visual and other eye problems in vulnerable populations such as babies and children, Aboriginal and Torres Strait Islander peoples, people with diabetes and hypertension, and older adults. GPs also need to consider the legal, social and emotional implications of visual impairment, and address these aspects within the provision of comprehensive healthcare.
Prevention of avoidable vision loss is a health priority.2 GPs have the key role in discussing risk modification with patients to prevent eye disease. The main modifiable risk factors for chronic eye health conditions include smoking, poor nutrition, lack of physical exercise and excess alcohol consumption. Eye infection, lack of suitable eye protection, UV exposure and medications, including corticosteroids, are also risks for eye pathology.5 Promoting lifestyle change is important in preventing visual conditions and vision loss. This is particularly important in people at increased risk of vision loss, including patients with diabetes and hypertension, where appropriate management of their underlying medical condition will also prevent eye disease.
There is inequity in eye healthcare in Australia, with Aboriginal and Torres Strait Islander peoples and people living in rural and remote communities having less access to services including optometrists, correction of refractive errors, surgical management of cataracts and to have correctable causes of visual impairment treated.2 Equitable access to eye healthcare is a health priority in Australia.6 GPs therefore need to advocate for improved access to culturally appropriate and affordable eye health services, including cataract surgery and correction of refractive error.