The Vision Initiative

In October 2002, the Victorian government granted $1.8 million over three years to Vision 2020 Australia for The Vision Initiative. The Vision Initiative, which will begin in Victoria, is a new public health program being implemented by Vision 2020 Australia in collaboration with partner organisations in the eye health field. It allows ophthalmologists, optometrists, GPs, pharmacists, and other vision specialists to promote a consistent message to their patients and customers regarding eye care. The Vision Initiative is the first large scale public eye health program in Victoria committed to improving professional practice and the availability of, and access to, quality eye care services. It aims to raise awareness of the importance of eye health among the general public, health professionals and government and encourage those at risk to have regular eye tests. The ultimate goal is to prevent avoidable vision loss and reduce the impact of vision impairment - health, social and economic - on individuals and the community.

The Vision Initiative has evolved from recent Australian research showing that more than 400,000 people have a significant degree of vision impairment. At least 50% of the vision loss is correctable, 25% is preventable and that most vision loss occurs after 50 years of age, and increases threefold with each decade.

In Australia 80% of vision impairment is caused by five main eye conditions - under-corrected refractive error, cataract, diabetic retinopathy, glaucoma and age-related macular degeneration (AMD). Therefore, The Vision Initiative focuses on these conditions.

The public campaign will promote correction and early detection of the main causes of vision loss through its slogan of 'save your sight - get tested'. The target groups for The Vision Initiative are those most at risk of eye disease and vision loss which includes people aged over 50 years, with diabetes, a family history of glaucoma or AMD and those who have noticed a change in their vision. The key messages are:

• Get your eyes tested right away if you notice a change in your vision
• People with diabetes should get their eyes tested at least every 2 years.
• Have regular eye tests if you are over 50 years or have a family history of glaucoma or AMD.

Secondary populations being targeted include people who smoke, people who don't protect their eyes from the sun and people at risk of eye injury. Later in the program, priority will be given to people from culturally and linguistically diverse backgrounds and Aboriginal and Torres Strait Islander people, to attempt to overcome the many barriers to accessing eye care services that exist within these groups. Other target groups include local, state and federal governments, eye health and other health professionals and their organisations, relevant non-government organisations and service providers, media and community based health, and welfare organisations.

The Vision Initiative will focus efforts in five strategic action areas: public information and education, professional development, clinical and support services, policy, advocacy and legislation, and research, evaluation and monitoring.

The Centre for Eye Research Australia (CERA) has been contracted to conduct the research and evaluation component of The Vision Initiative program. CERA is the only WHO Collaborating Centre for the Prevention of Blindness in Australia, has published extensive research on vision impairment in Australia and it has the expertise and ability to provide high quality and continuing research to evaluate the effectiveness of The Vision Initiative.

Specifically, CERA currently conducts research to measure the change in the prevalence of vision loss as a result of the expected increased rate of eye examinations and eye health awareness generated through The Vision Initiative. A highly specific and targeted cross-sectional baseline evaluation of an older Victorian population was undertaken in 2003. Following the public launch in July 2003 and baseline evaluation, the study is repeated every two years to assess changes as a result of The Vision Initiative. The first follow-up assessment was completed in November 2005.

Follow-up evaluations apply the same methodology as used for the baseline assessment, allowing the assessment of any change. A random cluster sample of 1700 people aged between 70-79 years of age is obtained. This age group was chosen as they are relatively active and independent, and have a high prevalence of eye disease. The Victorian Department of Human Services manages the Seniors Card Program that is available to any permanent resident of Victoria, who is aged 60 years and over, who is retired and not working more than 35 hours per week. The program currently covers approximately 90% of eligible Victorians. In order to recruit 1700 people, a number of geographical areas (postcodes) have been randomly selected within metropolitan Victoria. Randomly chosen postcode areas differ for each evaluation. All holders of a Seniors Card who are aged between 70-79 years and reside in these areas are sent a letter inviting them to participate in this research.

The research is divided into two components, a questionnaire and an eye examination. The self-administered questionnaire is posted to the consenting participants. It obtains demographic details, relevant medical history and family eye health history. Attitudes and knowledge of eye health and perceived barriers to accessing eye care services are addressed. Awareness of protective eye health practices and low vision services are also questioned. Knowledge of appropriate follow-up intervals for chronic eye disorders and when and where to seek help if a change in vision occurs is also investigated. The majority of the questions have been taken from previously validated instruments. For example, the questions that investigate the impact of vision impairment on activities of daily living have been taken from the Impact of Visual Impairment questionnaire, which has been validated by CERA.

The participants are then required to attend a central and easily accessible location for an eye examination. The examination uses rapid assessment techniques and should take no more than 30 minutes. It includes visual acuity, auto-refraction, visual field testing, and lens and retinal assessment using a non-mydriatic fundus camera. A pilot study has been performed by CERA demonstrating good sensitivity, specificity and inter-observer reliability in assessing the presence and absence of cataract using a non-mydriatic fundus camera.

The self-administered questionnaire has also been given to approximately 500 participants, 49 years of age and older, who are follow-up participants of the Blue Mountains Eye Study (BMES). The BMES is a large population based study of vision and the causes of vision impairment and blindness in New South Wales. The questionnaire have also been given to participants over the age of 50 years who attend the Cancer Council Victoria's Health 2000 project and these results were used as a comparison with the main study.

A new Co-operative Research Centre, the Vision CRC, run by Professor Brien Holden incorporates a vision care delivery program. The Vision Initiative evaluation will also form part of this 7-year research collaboration.

For further information about The Vision Initiative, visit www.saveyoursight.org.au or call Vision 2020 Australia on +61 3 9656 2020. For information on the Research and Evaluation component of The Vision Initiative, contact CERA on +61 3 9929 8377.

The author acknowledges the assistance of Associate Professor Jill Keeffe and Georgina Downey in the preparation of this article.

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