Diabetic retinopathy and the major causes of vision loss in Aboriginals from remote Western Australia

Purpose: To report on diabetic retinopathy (DR) and the major causes of vision loss and blindness in Aboriginals in the Eastern Goldfields region of Western Australia between 1995 and 2007. Methods: Aboriginals (>16 years old) diagnosed with diabetes or eye problems from 11 communities in the Eastern Goldfields region of Western Australia were examined annually from 1995 to 2007. Data collected from prospective clinical examination included; visual acuity (VA), causes of vision loss, and whether DR was present. Severity of DR was graded according to the Early Treatment of Diabetic Retinopathy Study modified Airlie House grading system. Results: A total of 920 Aboriginals underwent 1331 examinations over the study period. There were 246 eyes with vision loss (best‐corrected VA < 6/12) in 159 Aboriginals, of whom five were bilaterally blind. The four major known causes of vision loss were cataract (n = 53, 30.1%), DR (n = 44, 25.0%), uncorrected refractive error (n = 31, 17.6%) and trauma (n = 19, 10.8%). Aboriginals who had diabetes were far more likely to have vision loss (odds ratio = 8.5, 95% confidence interval 5.7–12.6, P < 0.0001). Of the 329 Aboriginals with diabetes, 82 (24.9%) had DR, and 32 (9.7%) had vision‐threatening retinopathy. Of those with diabetes, 94 (42.5%) returned for follow‐up examination on an average of 3.2 visits with a median time between visits of 2 years. Conclusion: The four major causes of vision loss in Aboriginals from the Eastern Goldfields are largely preventable and/or readily treated. DR and other diabetes‐related eye conditions are a major cause of vision loss in Aboriginals, representing a significant health challenge for health services and clinicians into the future.