Volume 183 - Issue 9
Vision loss in Australia
Authors: Jill E Keeffe and Hugh R Taylor
Med J Aust 2005; 183 (9): 494-496. || doi: 10.5694/j.1326-5377.2005.tb07142.x
Published online: 7 November 2005
Published online: 7 November 2005
Jill E Keeffe,* Hugh R Taylor†
* Director, Population Health Division, Department of Ophthalmology, University of Melbourne, and Royal Victorian Eye and Ear Hospital, Locked Bag 8, East Melbourne, VIC 8002; † Professor, Centre for Eye Research, University of Melbourne, VIC. jillekATunimelb.edu.au
In reply: Boffa and Pesudovs and Coster all correctly point out that a reduction in visual acuity does not always lead to dis-ability, and that not all people with impaired vision are disabled or report impaired quality of life. Large Australian and American population-based studies have shown that visual acuity below a critical level of 6/12 is associated with disability and affects participation in chosen activities and quality of life.1 When compared with people with normal vision (≥ 6/12), those with impaired vision have an increased risk of falls and hip fractures, depression, difficulties with activities of daily living and social functioning.1
Not all people with reduced visual acuity are affected in the same way at any vision threshold, even if there is a demonstrated statistically significant association between poor vision and visual function and quality of life. For example, not all people with severe visual impairment (visual acuity < 6/60) report an impact on their own visual functioning or quality of life. The impact of poor vision on functional ability is similar for conditions such as cataract or acute macular degeneration as for refractive error. The impact has been shown with both correctable and uncorrectable vision impairment.2
The VF-14 (Visual Function Index) can be used as a measure of visual disability, as suggested by Boffa. It was used in the Melbourne Visual Impairment Project and confirmed the functional implications of vision impairment (visual acuity < 6/12).3 Studies show unequivocally that vision impairment is a social3 and economic4 problem, and suggest the need for health promotion campaigns.
Pesudovs and Coster ask why, in a country such as Australia, with optometrists “in every major shopping centre”, do people with refractive error not have the correct spectacles? They suggest some barriers of access to care. The Brotherhood of St Laurence has shown that affordability of glasses and rural disadvantage are barriers to access and equity of use of eye care services.5
Our report highlighted the fact that catar-act is an important cause of vision loss that is highly amenable to surgical intervention.6 We did not discuss the relative risks and outcomes of cataract surgery, which is well documented to be highly successful, with low complication rates (< 2% for most complications),7 and very high cost-effectiveness.
References
- Taylor HR. Eye care for the future: the Weisenfeld Lecture. Invest Ophthalmol Vis Sci 2003; 44: 1413-1418. CBBGGGDE
- Chia EM, Wang JJ, Rochtchina E, et al. Impact of bilateral visual impairment on health-related quality of life: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 2004; 45: 71-76. i1091556
- Weih L, McCarty CA, Taylor HR. Functional implications of vision impairment. Clin Experiment Ophthalmol 2000; 28: 153-155. i1091558
- Access Economics. Investing in sight. Strategic interventions to prevent vision loss in Australia. Melbourne: Eye Research Australia, 2005. Available at: http://www.cera.org.au/new/clearinsight/clearinsight.html (accessed Aug 2005).
- Brotherhood of St Laurence. Seeing clearly. Access to affordable eyecare for low-income Victorians. In: Changing pressures. Bulletin no. 13. Melbourne: Brotherhood of St Laurence, 2004. Available at: http://www.bsl.org.au/main.asp?PageId=60 (accessed Sep 2005).
- Taylor HR, Keeffe JE, Vu HT, et al. Vision loss in Australia. Med J Aust 2005; 182: 565-568. i1091564
- Powe NR, Schein OD, Gieser SC, et al. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Arch Ophthalmol 1994; 112: 239-252. i1091566