Association between digital smart device use and myopia: a systematic review and meta-analysis.

BACKGROUND: Excessive use of digital smart devices, including smartphones and tablet computers, could be a risk factor for myopia. We aimed to review the literature on the association between digital smart device use and myopia. METHODS: In this systematic review and meta-analysis we searched MEDLINE and Embase, and manually searched reference lists for primary research articles investigating smart device (ie, smartphones and tablets) exposure and myopia in children and young adults (aged 3 months to 33 years) from database inception to June 2 (MEDLINE) and June 3 (Embase), 2020. We included studies that investigated myopia-related outcomes of prevalent or incident myopia, myopia progression rate, axial length, or spherical equivalent. Studies were excluded if they were reviews or case reports, did not investigate myopia-related outcomes, or did not investigate risk factors for myopia. Bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklists for analytical cross-sectional and cohort studies. We categorised studies as follows: category one studies investigated smart device use independently; category two studies investigated smart device use in combination with computer use; and category three studies investigated smart device use with other near-vision tasks that were not screen-based. We extracted unadjusted and adjusted odds ratios (ORs), ß coefficients, prevalence ratios, Spearman's correlation coefficients, and p values for associations between screen time and incident or prevalent myopia. We did a meta-analysis of the association between screen time and prevalent or incident myopia for category one articles alone and for category one and two articles combined. Random-effects models were used when study heterogeneity was high (I2>50%) and fixed-effects models were used when heterogeneity was low (I2≤50%). FINDINGS: 3325 articles were identified, of which 33 were included in the systematic review and 11 were included in the meta-analysis. Four (40%) of ten category one articles, eight (80%) of ten category two articles, and all 13 category three articles used objective measures to identify myopia (refraction), whereas the remaining studies used questionnaires to identify myopia. Screen exposure was measured by use of questionnaires in all studies, with one also measuring device-recorded network data consumption. Associations between screen exposure and prevalent or incident myopia, an increased myopic spherical equivalent, and longer axial length were reported in five (50%) category one and six (60%) category two articles. Smart device screen time alone (OR 1·26 [95% CI 1·00-1·60]; I2=77%) or in combination with computer use (1·77 [1·28-2·45]; I2=87%) was significantly associated with myopia. The most common sources of risk of bias were that all 33 studies did not include reliable measures of screen time, seven (21%) did not objectively measure myopia, and nine (27%) did not identify or adjust for confounders in the analysis. The high heterogeneity between studies included in the meta-analysis resulted from variability in sample size (range 155-19 934 participants), the mean age of participants (3-16 years), the standard error of the estimated odds of prevalent or incident myopia (0·02-2·21), and the use of continuous (six [55%] of 11) versus categorical (five [46%]) screen time variables INTERPRETATION: Smart device exposure might be associated with an increased risk of myopia. Research with objective measures of screen time and myopia-related outcomes that investigates smart device exposure as an independent risk factor is required. FUNDING: None.

Estimating malignancy risk of melanocytic choroidal tumours detected in the Australian National Eye Health Survey.

Clinical relevance: The malignant potential of choroidal melanocytic tumours detected incidentally in the community is thought to be low, but this has not been assessed using a validated screening tool. An accurate characterisation of the malignant potential of these lesions has implications for resource allocation, service provision, education, and training.Background: MOLES (Mushroom shape, Orange Pigment, Large size, Enlargement, and Subretinal fluid) categorises tumours as 'common naevus', 'low-risk naevus', 'high-risk naevus', and 'probable melanoma'. The MOLES system recommends that patients with common naevi (score = 0) undergo review by a community optometrist every two years, ideally with sequential colour photography. For the remaining patients (score ≥ 1), specialist imaging and assessment are recommended, with referral triaged as non-urgent for patients with low-risk (score = 1) or high-risk naevi (score = 2) and urgent for patients with probable melanoma (score > 2).Methods: Lesions flagged as choroidal melanocytic tumours on retinal photographs taken during the Australian National Eye Health Survey were retrospectively analysed by an ocular oncologist. Each lesion was assigned a MOLES score and categorised as common, low-risk, high-risk or probable melanoma.Results: Seventy-seven choroidal naevi were identified. Seventy-five (97%) of the choroidal naevi were categorised as common naevi, with a MOLES score of 0. Two (3%) choroidal naevi had a score of 1 and diagnosed as low-risk naevi due to their size. No naevi had a score of 2 or more.Conclusion: All choroidal naevi detected in this nationally representative population survey were innocuous. This suggests that the vast majority of choroidal melanocytic tumours that are incidentally detected in Australia can be managed in primary eye care settings without the need for specialist referral. MOLES provides a simple evidence-based method for choroidal naevi assessment in primary care.

Adult onset unilateral high myopia in a female patient: A case report.

PURPOSE: We report a rare case of unilateral progressive adult-onset myopia in a healthy 27 year old female patient. OBSERVATIONS: The patient presented to our clinic in 2014 with gradual decrease in vision in the right eye since one and a half years. Her uncorrected visual acuity (UCVA) in the right eye was 0.05, improving to 1.0 with -2.25 Diopter Sphere (DS). The left eye uncorrected visual acuity was 1.0 partial improving to 1.0 with -0.50 Diopter Cylinder (DC) at 10°. The myopia in her right eye continued to increase steadily until her last detailed ophthalmic examination in November 2018, at the age of 31 years, showed a refractive error of -6.75 Diopter Sphere with -0.5 Diopter Cylinder at 170°. Ocular biometry readings showed an axial length (AL) of 25.79mm in the right eye compared to 25.05mm in 2015. The ocular examination of both eyes including clinical examination of anterior and posterior segment, corneal topography, lens densitometry, ultrasound B scan all were within normal limits. Over the last two years she has gradually developed moderate constant esotropia in the right eye, currently +30 Prism Diopters. A short visit to the clinic in December 2019, showed a refraction of -6.75DS with -0.5DC at 170° in the right eye and -0.50DC at 10° in the left eye. CONCLUSIONS AND IMPORTANCE: The abrupt onset of myopia in one eye in a healthy individual in this case, the degree of myopia, the nature and rate of progression, absence of risk factors, and otherwise normal ocular examination except for progressive increase in axial length is unusual. Our case brings us to conjecture the role of powerful local factors in the intrinsic regulation of eyeball growth going askew. We believe more and more reporting of myopia cases deviating from natural history and their study might provide clues in a new direction about myopia pathogenesis and our understanding and tackling of one of the oldest eye disease with an ever increasing prevalence.

Prevalence and associations of non-retinopathy ocular conditions among older Australians with self-reported diabetes: The National Eye Health Survey.

AIM: To determine the prevalence and associations of non-retinopathy ocular conditions among older Australian adults with diabetes. METHODS: Multistage random-cluster sampling was used to select 3098 non-indigenous Australians aged 50y or older (46.4% male) and 1738 indigenous Australians aged 40y or older (41.1% male) from all levels of geographic remoteness in Australia. Participants underwent a standardised questionnaire to ascertain diabetes history, and a clinical examination to identify eye disease. We determined the prevalence of uncorrected refractive error, visually significant cataract, cataract surgery, age-related macular degeneration, glaucoma, ocular hypertension, retinal vein occlusion and epiretinal membrane among those with and without self-reported diabetes. RESULTS: Participants with self-reported diabetes had a higher prevalence of cataract surgery than those without diabetes (28.8% vs 16.9%, OR 1.78, 95%CI: 1.35-2.34 among non-indigenous Australians, and 11.3% vs 5.2%, OR 1.62, 95%CI: 1.22-2.14 among indigenous Australians). Diabetic retinopathy (DR) increased the odds of cataract surgery among self-reported diabetic indigenous and non-indigenous Australians (OR 1.89, P=0.004 and OR 2.33, P<0.001 respectively). Having diabetes for ≥20y and having vision-threatening DR increased the odds of cataract surgery among indigenous Australians with diabetes (OR 3.73, P=0.001 and 7.58, P<0.001, respectively). CONCLUSION: Most non-retinopathy ocular conditions are not associated with self-reported diabetes. However, to account for Australia's worsening diabetes epidemic, interventions to reduce the impact of diabetes-related blindness should include increased cataract surgery services.

Future burden of vision loss in Australia: Projections from the National Eye Health Survey.

IMPORTANCE: Projections of Australia's future burden of vision loss will inform eye health service delivery. BACKGROUND: This study aimed to forecast bilateral vision loss in Australia from 2020 to 2050. DESIGN: Population-based survey. PARTICIPANTS: Indigenous and non-indigenous Australians (n = 4253) aged ≥50 years from the National Eye Health Survey (NEHS, 2015-2016). METHODS: Using the age-and-sex-stratified prevalence of vision loss (better eye visual acuity <6/12) from the NEHS, the prevalence of, and number of people aged ≥50 years with, vision loss were forecast to 2050 using Australian census projections. MAIN OUTCOME MEASURE: Prevalence of, and number of Australians with, vision loss from 2020 to 2050. RESULTS: The prevalence of vision loss is predicted to increase from 6.7% to 7.5% by 2050. Owing to population dynamics, the estimated number of Australians ≥50 years old with vision loss will nearly double from 532 386 in 2016 to 1 015 021 in 2050. The greatest increase in vision loss is expected to occur in those aged ≥80 years (2.6-fold, 2016 = 144 240; 2050 = 376 296). The number of people with uncorrected refractive error is projected to increase 1.7-fold, from 331 914 in 2016 to 578 969 in 2050. CONCLUSIONS AND RELEVANCE: Due to population growth and ageing, the future burden of vision loss in Australia is likely to increase, but the magnitude of this change is uncertain due to a lack of available data on some relevant input variables. Nonetheless, efforts are required to ensure early detection and treatment of major eye conditions, particularly treatable conditions such as uncorrected refractive error and cataract.

Prevalence, associations and characteristics of severe uncorrected refractive error in the Australian National Eye Health Survey.

IMPORTANCE: In Australia, nationally representative data of the burden and associations of severe uncorrected refractive error are scarce. BACKGROUND: To report the prevalence and characteristics of severe uncorrected refractive error in Indigenous and non-Indigenous Australians. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 3098 non-Indigenous Australians aged 50 to 98 and 1738 Indigenous Australians aged 40 to 92 living in 30 randomly selected Australian sites were examined. METHODS: Severe uncorrected refractive error was defined as an improvement of ≥2 lines on the logMAR chart in one or both eyes in participants with a presenting visual acuity <6/12. MAIN OUTCOME MEASURE: Severe uncorrected refractive error RESULTS: Prevalence of severe uncorrected refractive error was 11.0% (95% confidence interval 9.3-13.0) in non-Indigenous and 14.5% (12.5-16.7) in Indigenous Australians. Eighty-two percent of non-Indigenous and 77% of Indigenous participants had a spherical equivalent refraction between -2.00D and +2.00D. Indigenous Australians who were older (odds ratio [OR] for 70-79 years vs 40-49 years = 3.59), resided in outer regional areas (OR = 1.78) and did not have an eye examination in the previous 2-years (OR = 1.50) were associated with higher odds of severe uncorrected refractive error. Geographical remoteness (OR = .68 for inner regional), male gender (OR = 1.30), older age (OR for 70-79 years vs 50-59 years = 1.51) and failure to have an eye examination in the previous 2-years (OR = 2.06) were associated with severe uncorrected refractive error among non-Indigenous participants. CONCLUSIONS AND RELEVANCE: Increased public awareness of the importance of regular optometric examinations may be required in groups at high risk of severe uncorrected refractive error.

Non-invasive in vivo hyperspectral imaging of the retina for potential biomarker use in Alzheimer's disease.

Studies of rodent models of Alzheimer's disease (AD) and of human tissues suggest that the retinal changes that occur in AD, including the accumulation of amyloid beta (Aß), may serve as surrogate markers of brain Aß levels. As Aß has a wavelength-dependent effect on light scatter, we investigate the potential for in vivo retinal hyperspectral imaging to serve as a biomarker of brain Aß. Significant differences in the retinal reflectance spectra are found between individuals with high Aß burden on brain PET imaging and mild cognitive impairment (n = 15), and age-matched PET-negative controls (n = 20). Retinal imaging scores are correlated with brain Aß loads. The findings are validated in an independent cohort, using a second hyperspectral camera. A similar spectral difference is found between control and 5xFAD transgenic mice that accumulate Aß in the brain and retina. These findings indicate that retinal hyperspectral imaging may predict brain Aß load.

The prevalence of visually significant cataract in the Australian National Eye Health Survey.

PURPOSE: To describe the prevalence of visually significant cataract in Indigenous and non-Indigenous Australians. METHODS: A total of 3098 non-Indigenous Australians aged 50 years and over and 1738 Indigenous Australians aged 40 years and over, residing in 30 randomly selected Australian sites, were examined as part of the population-based National Eye Health Survey (NEHS). For those with visual acuity worse than 6/12, photos of the anterior and posterior segment were taken with a nonmydriatic fundus camera and assessed for cataract. Visually significant cataract was assigned in eyes with best-corrected visual acuity worse than 6/12 and cataract that was determined to be the primary cause of vision loss in that eye. RESULTS: In total, 99.2% (4797/4836) participants had complete data for visual acuity and cataract assessment. The overall weighted prevalence of visually significant cataract was 2.7% (95% CI: 2.0, 3.5) in non-Indigenous Australians and 4.3% (95% CI: 3.1, 5.9) among Indigenous Australians. After adjusting for age and gender, the odds of visually significant cataract were almost three times higher among Indigenous participants compared to non-Indigenous participants (adjusted odds ratio (OR) 2.95, 95% CI: 2.03, 4.29). Only 54.8% of non-Indigenous Australians and 38.9% of Indigenous Australians with visually significant cataract self-reported a known history of cataract. CONCLUSIONS: Our results suggest that continued efforts are required to build sustainable cataract surgery services within Indigenous communities. Furthermore, given the significant ageing of the Australian population, maintaining high cataract surgery rates amongst the non-Indigenous population is critical to reduce cataract-related vision loss.

Prevalence of glaucoma in the Australian National Eye Health Survey.

AIM: To estimate the prevalence of glaucoma in Australia. METHODS: This was a population-based study of 3098 non-Indigenous Australians (50-98 years) and 1738 Indigenous Australians (40-92 years) stratified by remoteness. Each participant underwent a standard examination that included visual field assessment, tonometry and non-mydriatic fundus photography. Two fellowship-trained glaucoma specialists independently assessed relevant case notes (past ocular history, best-corrected visual acuity, frequency doubling technology visual fields, Van Herick grade, intraocular pressure and optic disc-centred photographs) and assigned a diagnosis ranked on a scale of certainty: none, possible, probable or definite glaucoma. RESULTS: A total of 4792 (99.1%, 3062 non-Indigenous and 1730 Indigenous) participants had retinal photographs in at least one eye that were gradable for glaucoma. The weighted prevalence of glaucoma (definite) in non-Indigenous Australians and Indigenous Australians was 1.5% (95% CI 1.0 to 2.2) and 0.6% (95% CI 0.4 to 1.1), respectively. When definite and probable cases of glaucoma were combined, rates were 3.4% (95% CI 2.7 to 4.3) among non-Indigenous and 1.6% (95% CI 1.1 to 2.3) in Indigenous Australians. Only 52.4% of non-Indigenous Australians and 28.0% of Indigenous Australians with glaucoma self-reported a known history of glaucoma. CONCLUSION: We estimate that 198 923 non-Indigenous Australians aged 50 years and over and 2139 Indigenous Australians aged 40 years and over have glaucoma. Given the high rates of undiagnosed glaucoma coupled with a significant ageing of the Australian population, improvements in case detection and access to low vision rehabilitation services may be required to cope with the growing burden of glaucoma.

Prevalence and characteristics of choroidal nevi: the Australian National Eye Health Survey.

IMPORTANCE: Choroidal nevi are a common incidental finding on fundus examination. The National Eye Health Survey (NEHS, 2015-2016) provides an up-to-date estimate of the prevalence of choroidal nevi in non-Indigenous and Indigenous Australian adults. BACKGROUND: To describe the prevalence and characteristics of choroidal nevi among non-Indigenous and Indigenous Australian adults. DESIGN: Population-based cross-sectional study. PARTICIPANTS: This study included 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected sites, stratified by remoteness. METHODS: Choroidal nevi were graded from retinal photographs using standard protocols. MAIN OUTCOME MEASURES: Prevalence of choroidal nevi. RESULTS: In the non-Indigenous population aged 50 years and over, the weighted prevalence of choroidal nevi was 2.1% (95% CI: 1.4, 3.3). Among Indigenous Australians aged 40 years and over, the weighted prevalence of choroidal nevi was 0.68% (95% CI: 0.4, 1.3). The average maximum diameter, surface area and distance from the disc of the choroidal nevi was 1730 µm, 2 766 800 µm2 and 3400 µm, respectively. After multivariate adjustments, Indigenous participants (OR = 0.28, P = 0.01) and those of older age (OR = 0.79 per 10 years, P = 0.02) were less likely to have choroidal nevi. Choroidal nevus was not the primary cause of vision loss in any participant. CONCLUSIONS AND RELEVANCE: Choroidal nevi were relatively infrequent among NEHS participants, however non-Indigenous Australians had a significantly higher prevalence than Indigenous Australians. Choroidal nevi did not affect visual acuity and the majority were small.

Prevalence and Causes of Visual Loss Among the Indigenous Peoples of the World: A Systematic Review.

Importance: Studies have documented a higher disease burden in indigenous compared with nonindigenous populations, but no global data on the epidemiology of visual loss in indigenous peoples are available. A systematic review of literature on visual loss in the world's indigenous populations could identify major gaps and inform interventions to reduce their burden of visual loss. Objective: To conduct a systematic review on the prevalence and causes of visual loss among the world's indigenous populations. Evidence Review: A search of databases and alternative sources identified literature on the prevalence and causes of visual loss (visual impairment and blindness) and eye diseases in indigenous populations. Studies from January 1, 1990, through August 1, 2017, that included clinical eye examinations of indigenous participants and, where possible, compared findings with those of nonindigenous populations were included. Methodologic quality of studies was evaluated to reveal gaps in the literature. Findings: Limited data were available worldwide. A total of 85 articles described 64 unique studies from 24 countries that examined 79 598 unique indigenous participants. Nineteen studies reported comparator data on 42 085 nonindigenous individuals. The prevalence of visual loss was reported in 13 countries, with visual impairment ranging from 0.6% in indigenous Australian children to 48.5% in native Tibetans 50 years or older. Uncorrected refractive error was the main cause of visual impairment (21.0%-65.1%) in 5 of 6 studies that measured presenting visual acuity. Cataract was the main cause of visual impairment in all 6 studies measuring best-corrected acuity (25.4%-72.2%). Cataract was the leading cause of blindness in 13 studies (32.0%-79.2%), followed by uncorrected refractive error in 2 studies (33.0% and 35.8%). Conclusions and Relevance: Most countries with indigenous peoples do not have data on the burden of visual loss in these populations. Although existing studies vary in methodologic quality and reliability, they suggest that most visual loss in indigenous populations is avoidable. Improvements in quality and frequency of research into the eye health of indigenous communities appear to be required, and coordinated eye care programs should be implemented to specifically target the indigenous peoples of the world.

Vision loss in Indigenous peoples of the world: a systematic review protocol.

REVIEW OBJECTIVE/QUESTION: The objectives of this review are.

Population-based assessment of visual acuity outcomes following cataract surgery in Australia: the National Eye Health Survey.

AIM: To assess the visual outcomes of cataract surgery among a national sample of non-Indigenous and Indigenous Australians. METHODS: This was a population-based study of 3098 non-Indigenous Australians (50-98 years) and 1738 Indigenous Australians (40-92 years), stratified by remoteness. A poor postoperative outcome in an eye that had undergone cataract surgery was defined as presenting distance visual acuity (PVA) <6/12-6/60, and a very poor outcome was defined as PVA <6/60. Effective cataract surgery coverage (eCSC; operated cataract and a good outcome (PVA ≥6/12) as a proportion of operable plus operated cataract) was calculated. RESULTS: The sampling weight adjusted cataract surgery prevalence was 19.8% (95% CI 17.9 to 22.0) in non-Indigenous Australians and 8.2% (95% CI 6.0 to 9.6) in Indigenous Australians. Among the non-Indigenous population, poor and very poor PVA outcomes were present in 18.1% and 1.9% of eyes, respectively. For Indigenous Australians, these values were 27.8% and 6.3%, respectively. The main causes of poor vision were refractive error (non-Indigenous=41.8%; Indigenous=41.9%) and coincident disease (non-Indigenous=43.3%; Indigenous=40.3%). The eCSC rates in the non-Indigenous and Indigenous populations were 88.5% (95% CI 85.2 to 91.2) and 51.6% (95% CI 42.4 to 60.7), respectively. CONCLUSION: Approximately half of eyes with a poor visual outcome postcataract surgery could be readily avoided through the appropriate refractive correction. The finding of a lower eCSC rate among Indigenous Australians suggests that improvements in access and quality of cataract services may be warranted in order to reduce cataract-related vision loss in the Indigenous population.

Prevalence and Causes of Unilateral Vision Impairment and Unilateral Blindness in Australia: The National Eye Health Survey.

Importance: This study determines the prevalence of unilateral vision impairment (VI) and unilateral blindness to assist in policy formulation for eye health care services. Objective: To determine the prevalence and causes of unilateral VI and unilateral blindness in Australia. Design, Setting, and Participants: This cross-sectional population-based survey was conducted from March 2015 to April 2016 at 30 randomly selected sites across all strata of geographic remoteness in Australia. A total of 1738 indigenous Australians 40 years or older and 3098 nonindigenous Australians 50 years or older were included. Main Outcomes and Measures: The prevalence and causes of unilateral vision impairment and blindness, defined as presenting visual acuity worse than 6/12 and 6/60, respectively, in the worse eye, and 6/12 or better in the better eye. Results: Of the 1738 indigenous Australians, mean (SD) age was 55.0 (10.0) years, and 1024 participants (58.9%) were female. Among the 3098 nonindigenous Australians, mean (SD) age was 66.6 (9.7) years, and 1661 participants (53.6%) were female. The weighted prevalence of unilateral VI in indigenous Australians was 12.5% (95% CI, 11.0%-14.2%) and the prevalence of unilateral blindness was 2.4% (95% CI, 1.7%-3.3%), respectively. In nonindigenous Australians, the prevalence of unilateral VI was 14.6% (95% CI, 13.1%-16.3%) and unilateral blindness was found in 1.4% (95% CI, 1.0%-1.8%). The age-adjusted and sex-adjusted prevalence of unilateral vision loss was higher in indigenous Australians than nonindigenous Australians (VI: 18.7% vs 14.5%; P = .02; blindness: 2.9% vs 1.3%; P = .02). Risk factors for unilateral vision loss included older age (odds ratio [OR], 1.60 for each decade of age for indigenous Australians; 95% CI, 1.39-1.86; OR, 1.65 per decade for nonindigenous Australians; 95% CI, 1.38-1.96), very remote residence (OR, 1.65; 95% CI, 1.01-2.74) and self-reported diabetes (OR, 1.52; 95% CI, 1.12-2.07) for indigenous Australians, and having not undergone an eye examination in the past 2 years for nonindigenous Australians (OR, 1.54; 95% CI, 1.04-2.27). Uncorrected refractive error and cataract were leading causes of unilateral VI in both populations (70%-75%). Corneal pathology (16.7%) and cataract (13.9%) were leading causes of unilateral blindness in indigenous Australians, while amblyopia (18.8%), trauma (16.7%), and age-related macular degeneration (10.4%) were major causes of unilateral blindness in nonindigenous Australians. Conclusions and Relevance: Unilateral vision loss is prevalent in indigenous and nonindigenous Australians; however, most cases are avoidable. As those with unilateral vision loss caused by cataract and posterior segment diseases may be at great risk of progressing to bilateral blindness, national blindness prevention programs may benefit from prioritizing examination and treatment of those with unilateral vision loss.

Prevalence of retinal vein occlusion in the Australian National Eye Health Survey.

IMPORTANCE: In Australia, knowledge of the epidemiology of retinal vein occlusion remains scarce because of a paucity of recent population-based data. The National Eye Health Survey (2015-2016) provides an up-to-date estimate of the prevalence of retinal vein occlusion in non-Indigenous and Indigenous Australian adults. BACKGROUND: To determine the prevalence and associations of retinal vein occlusion in a national sample of Indigenous and non-Indigenous Australian adults. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected sites, stratified by remoteness. METHODS: Retinal vein occlusions were graded from retinal photographs using standardized protocols and recorded as central retinal vein occlusion or branch retinal vein occlusion. MAIN OUTCOME MEASURE: Prevalence of retinal vein occlusion. RESULTS: In the non-Indigenous population, the sampling weight adjusted prevalence of any retinal vein occlusion was 0.96% (95% confidence interval: 0.59, 1.6), with branch retinal vein occlusion observed in 0.72% (95% confidence interval: 0.41, 1.2) and central retinal vein occlusion in 0.24% (95% confidence interval: 0.13, 0.47). Any retinal vein occlusion was found in 0.91% (95% confidence interval: 0.47, 1.7) of Indigenous Australians aged 40 years and over, with branch retinal vein occlusion observed in 0.83% (95% confidence interval: 0.40, 1.7) and central retinal vein occlusion in 0.07% (95% confidence interval: 0.02, 0.32). Older age (odds ratio = 1.64 per 10 years, P = 0.006) and the presence of self-reported diabetes (odds ratio = 3.24, P = 0.006) were associated with any retinal vein occlusion after multivariable adjustments. Retinal vein occlusion was attributed as the cause of monocular vision loss (<6/12) in seven (0.25%) non-Indigenous and six (0.36%) Indigenous participants. CONCLUSIONS AND RELEVANCE: These data suggest that retinal vein occlusion is relatively uncommon in the non-Indigenous Australians aged 50 years and over and Indigenous Australians aged 40 years and over. Similar to previous Australian and international reports, the prevalence of retinal vein occlusion rose sharply with age.

Utilization of eye health-care services in Australia: the National Eye Health Survey.

IMPORTANCE: National data on eye health-care service utilization will inform Australia's eye health policy. BACKGROUND: To investigate the utilization of eye health-care services by Australians. DESIGN: Cross-sectional survey. PARTICIPANTS: Indigenous Australians aged 40 years and older and non-Indigenous Australians aged 50 years and older. METHODS: One thousand seven hundred thirty-eight Indigenous Australians and 3098 non-Indigenous Australians were recruited from 30 randomly selected sites, stratified by remoteness. Sociodemographic, ocular history and eye health-care service utilization data were collected, and an eye examination was conducted. MAIN OUTCOME MEASURES: Recentness of eye examinations, types of providers used and associated risk factors. RESULTS: Approximately 67.0% of Indigenous Australians and 82.5% of non-Indigenous Australians underwent an eye examination within the previous 2 years. Indigenous status (P < 0.001), male gender (P < 0.001), Outer Regional (P < 0.001) and Very Remote (P < 0.001) residence were associated with less recent examinations. Participants with >self-reported eye disease or diabetes were most likely to have been examined within the past year (P < 0.001). For Indigenous Australians, older age was associated with recent eye testing (P = 0.001). Those with retinal disease and cataract were more likely to see an ophthalmologist (P < 0.001), and those with refractive error were more likely to see an optometrist (P < 0.001). In Regional Australia, non-Indigenouspeople were more likely to see optometrists (P < 0.001), and Indigenous Australians were more likely to utilize other, non-specialistservices (P < 0.001). CONCLUSIONS AND RELEVANCE: Eye examination frequency has improved in Indigenous and non-Indigenous Australians compared with previous population-based research. Further improvements are required in risk groups including Indigenous Australians and those living in Regional and Remote areas.