Abstract
BACKGROUND: In the last two decades, over 250 000 refugees and asylum seekers have arrived in Australia, many of whom experience significant health problems. Information about their eye health is scarce, particularly for those detained offshore. This is the first study to explore the eye health and services available to this population, helping inform future service planning. METHODS: A mixed-methods design was employed, incorporating a multicentre audit of an ophthalmology service in Nauru and Manus Island detention centres (2015-2016) and a comparative analysis of this service against established standards of public eye care in mainland Australia. Outcomes included prevalence and causes of vision impairment, management required, and service performance using the Australian Health Performance Framework. RESULTS: Eighty patients from 14 countries were included (3-57 years, 84% male). There were high rates of bilateral and unilateral vision impairment (19% and 25%, respectively) and bilateral and unilateral blindness (1% and 12%). Bilateral vision impairment was mostly avoidable (80%), with the commonest causes being refractive error and cataract. Ocular trauma accounted for 67% of unilateral blindness. Compared to mainland services, offshore eye care was sub-standard across all performance domains, including governance, information, workforce, safety, and effectiveness. CONCLUSIONS: Refugees and asylum seekers held in Australia's offshore detention centres had a high burden of eye disease and inadequate access to services. Ceasing offshore detention in favour of onshore processing, as recommended by numerous medical colleges, may help ensure people seeking asylum have access to appropriate eye care in Australia.