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Gender and Ethnic Differences in Pterygium Prevalence: an Audit of Remote Australian Clinics

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Gender and Ethnic Differences in Pterygium Prevalence: an Audit of Remote Australian Clinics CLINICAL AND EXPERIMENTAL RESEARCH Gender and ethnic differences in pterygium prevalence: an audit of remote Australian clinics Clin Exp Optom 2020 DOI:10.1111/cxo.13081 Aisling B McGlacken-Byrne* MB BCh Clinical relevance: Developing an accurate picture of the demographic profile and refrac- BAO tive status of Aboriginal and non-Aboriginal individuals with pterygium will facilitate health † Jocelyn J Drinkwater MPH planning and appropriate deployment of health-care resources in rural Australia. ‡ David A Mackey* MD FRANZCO Background: To date, there is a paucity of reports in the literature regarding Aboriginal ‡ Angus W Turner* MSc FRANZCO ocular health and refractive error. This study examines clinical data from a rural ophthal- *Lions Outback Vision, Lions Eye Institute, Perth, mology outreach clinic – a predominantly Aboriginal population. Australia Methods: An assessment was undertaken of data of 293 patients noted to have pterygium † School of Medicine, The University of Western present in at least one eye, from a sample of 2,072 individuals seen in rural northern West- Australia, Perth, Australia ern Australia in 2017 by the Lions Outback Vision Visiting Optometry Service. ‡ Centre of Ophthalmology and Visual Science, The Results: Pterygium was found in 14.1 per cent (n = 293) of patients using the Lions Outback University of Western Australia, Perth, Australia Vision service. The mean age of those with pterygium (n = 293) was 57.1 Æ 11.9 years E-mail: [email protected] (mean Æ standard deviation); 188 were female (64.1 per cent); 260 identified as Aboriginal (88.7 per cent), 22 identified as non-Aboriginal (7.5 per cent) and 11 did not specify (3.8 per cent). There were more males than females with pterygium in the non-Aboriginal group (18.0 per cent versus 6.4 per cent); however, the reverse was true in the Aboriginal group (11.7 per cent versus 17.0 per cent). Analysis of the subjective refractive data in those with pterygium revealed an overall mean spherical equivalent value of +0.66 Æ 1.28 DS. The median (interquartile range) best-corrected visual acuity was 0.0 (−0.1 to 0.0) logMAR (6/6 Snellen equivalent). Submitted: 15 January 2020 Conclusions: This paper increases our knowledge of ocular health in a remote Australian Revised: 11 March 2020 population, with an emphasis on the differences between Aboriginal and non-Aboriginal Accepted for publication: 31 March 2020 individuals, males and females. Key words: Aboriginal, indigenous, myopia, pterygium Pterygium is a triangular growth of fibrovas- Methods allagesfromrurallocationsinWestern cular tissue, extending from the limbus to Australia. Attending patients included 1 those from diabetic screening as well as involve the cornea. This condition is more Clinical data was reviewed of 2,072 patients new referrals and review patients. Demo- prevalent in regions on or around the equa- seen by the Visiting Optometry Service in 2 graphic details such as age, gender and tor, where sun exposure is more intense. 2017, as part of the Lions Outback Vision – a ethnicity were recorded. Ethnicity was self- The sample population investigated here part of the Lions Eye Institute, which pro- reported by patients at the time of clinic was from a near equatorial region with vides visiting ophthalmology outreach ser- registration as either ‘Aboriginal’ or ‘non- intense sun exposure. Refractive error is vices for residents in rural areas of Western Aboriginal’. also linked to sun exposure; myopia is asso- Australia. This program aims to tackle the ‘Pterygium’ was documented by the exam- ciated with indoor occupations and lower inequity of access to surgery for Indigenous ining optometrist in the clinical details or exposure to sunlight and hyperopia is more Australians. ‘diagnosis’ section of the patient record in common in people who spend more time The study was granted exemption for 3–6 293 of 2,072 patients (14.1 per cent). Further outdoors. ethics application by the University of West- There is a paucity in the literature dis- ern Australia given the retrospective and de- descriptive details such as side, unilateral/ cussing Aboriginal refractive errors. Evi- identified nature of the data. bilateral, site or severity, were not included dence from various countries and ethnicities Information was analysed from the elec- in this analysis. Those with pterygium pre- indicates that the global prevalence of myo- tronic patient database of the optometry sent in either eye were included in the pia is increasing.7 The hypothesised inverse section using FileMaker Pro (v17, study, irrespective of nasal/temporal loca- relationship between myopia and pterygium Filemaker Inc., Santa Clara, CA, USA). Clini- tion or whether they presented with monoc- will be discussed. cal notes were reviewed from patients of ular versus binocular pterygia. Both eyes © 2020 Optometry Australia Clinical and Experimental Optometry 2020 1 Pterygium prevalence: an audit of remote Australian clinics McGlacken-Byrne, Drinkwater, Mackey et al. from these patients were included in refrac- female(58.9percent,n=1,221)and Astigmatism was present in 66.9 per cent tive examination. Best-corrected visual acu- Aboriginal (84.7 per cent, n = 1,754). (n = 176) of patients in at least one eye and ities were converted to logMAR scales for Pterygium was found in 14.1 per cent 35.0 per cent (n = 92) had bilateral astigma- calculating means and were reported as (n = 293) of patients using the Lions Outback tism. The median (interquartile range) best- Snellen equivalents. Vision service. The mean age of those with corrected visual acuity for patients was 0.0 Æ − Refractive data of the participants were pterygium (n = 293) was 57.1 11.9 years ( 0.1 to 0.0) logMAR (6/6 Snellen Æ – collected using subjective refraction, reti- (mean standard deviation) (range 27 90); equivalent). noscopy and corrective lens measure- 188 were female (64.1 per cent); 260 identi- fi ment. Emmetropia was defined as mean ed as Aboriginal (88.7 per cent), 22 identi- fi spherical equivalent (MSE) between −0.50 ed as non-Aboriginal (7.5 per cent) and Discussion DS and +0.50 DS.8,9 Myopia was defined 11 did not specify (3.8 per cent). There were as MSE < −0.50 DS and MSE < −6.00 DS more males than females with pterygium in The prevalence of pterygium varies greatly was classified as high myopia. Hyperopia the non-Aboriginal group (18.0 per cent, between and sometimes even within 2 was defined as MSE > +0.50 DS. Anisome- n = 14 versus 6.4 per cent, n = 8); however, populations. Pterygium is associated with tropia was defined at two levels; differ- the reverse was true in the Aboriginal group living at equatorial latitudes and with expo- ence in spherical equivalent between eyes (11.7 per cent, n = 85 versus 17.0 per cent, sure to ultraviolet radiation; therefore, geo- being > 0.50 DS and > 1.00 DS. Astigma- n = 175) (p = 0.002). In this sample, preva- graphical location and amount of time spent fl tism was defined as a cylindrical error lence was higher in Aboriginal compared to outdoors in uence the rate of pteryg- 10,11 ≥ −0.50 DC. non-Aboriginal individuals (14.8 per cent, ium. This sample population was mainly Statistical analyses were conducted using n = 260 versus 10.8 per cent, n = 22) from the Kimberley region (69.02 per cent, 0 IBM SPSS Statistics for Windows (Version (p = 0.005) (Table 1). n = 1,430), nearest the equator at 17.34 S, 25.0, IBM Corp., Armonk, NY, USA). Data are The spherical equivalent was +0.71 with the remaining patients from the Pilbara Æ fi presented as proportions: mean Æ standard DS 1.18 for the right eye and (28.14 per cent, n = 583) and Gold elds Æ deviation, or median (interquartile range). +0.56 DS 1.32 for the left eye, with an regions (2.85 per cent, n = 59), with latitudes 0 0 fi For two-way comparisons for independent overall MSE in this sample of +0.66 of 21.59 S and 30.74 S, respectively. This ts Æ Æ ‘ ’ samples, categorical variables were by Fish- DS 1.28. MSE was +0.64 DS 1.30 for within in the so-called pterygium belt , Æ 0 er’s exact test, using a two-tailed significance Aboriginal and +0.53 DS 0.89 for non- located 37 north and south of the 2 level of p < 0.05. Aboriginal individuals. Prevalence rates of equator. myopia, high myopia, emmetropia and The prevalence of pterygium varies hyperopia in individuals with pterygium greatly between countries: 0.7 per cent in Results were 8.9 per cent (n = 26), zero per cent Denmark, 18.4 per cent in Brazil, 23.4 per (n = 0), 38.6 per cent (n = 113) and 42.3 per cent in Barbados and 30.8 per cent in the – The population of 2,072 clinic attendees cent (n = 124), respectively. In Aboriginal south-westerly islands of Japan.12 14 In in 2017 was distributed mainly in the people, the respective rates were 10.5 per Australia, the Blue Mountains Eye Study north-west of rural Western Australia, cent (n = 25), zero per cent (n = 0), 43.5 per found a rate of 7.3 per cent in those with 69.0 per cent (n = 1,430) from the cent (n = 103) and 46.0 per cent (n = 109). 50 years and older and the Vision Impair- Kimberley region, 28.1 per cent (n = 583) Anisometropia of > 1.0 DS was found in 12.6 ment Project reported a rate of 2.8 per cent from the Pilbara region and 2.9 per cent per cent (n = 31) of patients and anisome- in those 40 years and older in Victoria.15,16 (n = 59) from the Goldfields region.
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