Defining the Risk and Epidemiology of Aboriginal Australian Macular Disease: The DREAM Project
Understanding risk and protective factors for macular disease among Aboriginal Australians.
Diabetes can damage the small blood vessels of the eye, causing leakage of fluid at the macular, the part of the eye where you get the most detailed vision from. Aboriginal Australians experience high rates of this macula leaking and swelling, much higher than non-Aboriginal people. So far, we do not understand why this is, and what factors or causes are driving this. This study investigates all aspects of health and diabetes, including the social, clinical, and medical. We also plan to follow people with diabetes for four-to-five years to see if we can predict based on what we collect who will go on to suffer from blindness, and who will not. Ultimately, these findings of new factors and their ability to tell us who will do well (or poorly) is important to initiate steps in reducing the human and societal costs of blindness.
Wardliparingga Aboriginal Health Equity Research Unit
The global increasing prevalence of diabetes has meant that diabetic retinopathy (DR) and diabetic macular oedema (DMO) have become an increasingly important causes of vision impairment. Trends show an increase in diabetes-related blindness over two-decades except for in high-income regions, such as Australia. For Australia’s Indigenous people the story is inconsistent with these high-income trends, in that the prevalence of DR appears to have doubled over the same period, and diabetes-related vision loss is estimated to be approximately five times higher among Indigenous Australian people when compared to other Australians. These inequalities in disease burden have persisted despite national health investments and initiatives. Much of the research effort that has been achieved in relation to DR/DMO among Aboriginal Australians has focused on “surveying” ocular outcomes as standalone measures and lack comprehensive and systematic investigation into the underlying drivers of diabetes-related blindness. The DREAM Project will utilise a population-based biomedical cohort with baseline assessments and forthcoming longitudinal data (with 4-5 years of follow-up) with the aim to better understand the underlying social, psychological, environmental, behavioural, clinical, biological and metabolomic risk factors of DR/DMO among Aboriginal people. This will further our global understanding of DR/DMO among Indigenous Australian people and will allow for: 1) characterisation of baseline phenotypes in individuals with and without DR/DMO 2) unpacking the cross-sectional/temporal risk factors that contribute to DR/DMO progression. Ultimately, the identification of novel markers and their predictive capacity is important to initiate steps in reducing the human/societal costs of blindness.
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