Prevalence of refractive error in Indigenous and non-Indigenous Australians: a systematic review and meta-analysis

Aims This study aimed to compare the prevalence of (1) presenting vision loss from refractive error, (2) subtypes of refractive error and (3) rates of spectacle coverage and use between Indigenous and non-Indigenous Australians in urban and rural locations. Methods Joanna Briggs Institute guidance for systematic reviews of prevalence studies was followed. Medline, Embase, Web of Science and relevant grey literature were searched. All studies reporting refractive error prevalence in Australian populations were included. Pooled prevalence estimates were derived using meta-analyses with a random-effects model. Results 17 studies were included (22 450 adults and 13 493 children). Pooled prevalence of bilateral distance vision loss from refractive error was 7.5% (95% CI, 4.6% to 11.1%) and 4.5% (95% CI, 2.7% to 6.8%) among Indigenous and non-Indigenous adults, respectively (p=0.126). Bilateral blindness occurred in 0.19% (95% CI, 0.00% to 0.75%) and 0.01% (95% CI, 0.00% to 0.09%) of Indigenous and non-Indigenous adults, respectively (p=0.265). Myopia, astigmatism and anisometropia were similar among Indigenous and non-Indigenous children (6.2% vs 5.3% (p=0.750), 5.2% vs 5.6% (p=0.928) and 4.1% vs 5.0% (p=0.661), respectively). Narrative synthesis of studies suggested Indigenous people had lower spectacle coverage and lower use of the spectacles they owned. Conclusions Vision loss from refractive error is common in Australia, with Indigenous people particularly affected by lower spectacle coverage and use. National strategies for addressing this should be considered, such as the national spectacle subsidy scheme. PROSPERO registration number CRD42022340197.