Ophthalmic Findings in Aboriginal Children with High Rates of Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder: The Lililwan Project

ABSTRACT

Purpose

To describe ophthalmic findings in an Indigenous paediatric population and the associations between fetal alcohol spectrum disorder (FASD), prenatal alcohol exposure (PAE), and eye anomalies.

Methods

Medical records were reviewed for eye problems, and eye assessments were conducted by an orthoptist or ophthalmologist in the Lililwan Project cohort, which comprised 108 (81%) of all children born between 2002 and 2003, and residing in the remote Fitzroy Valley, Western Australia in 2010. Values from ophthalmic assessments and prevalence of abnormalities were presented for the total cohort and stratified by group: FASD; PAE (no FASD); and No PAE.

Results

Of children, 55% had PAE and 19% FASD. Most (98%) had normal vision; 15.6% had keratometry cylinder values indicating astigmatism and potential for improved vision with glasses. Strabismus (22.3%), short palpebral fissure length (PFL; 21.3%), upslanting palpebral fissures (12.0%), follicular trachomatous inflammation (6.9%), abnormal slit lamp assessments (6.7%), retinal tortuosity (6.7%), and blepharoptosis (5.6%) were identified. Strabismus and trachoma rates were higher than in the general child population. Ophthalmic findings were similar between groups except for prevalence of short PFL (FASD > No PAE; p = 0.003); abnormal keratometry cylinder values (FASD [29.4%] and PAE (no FASD) [20.0%] > No PAE [5.3%]; p = 0.031) and blepharoptosis (FASD [9.5%] > other groups [0%]; p = 0.040).

Conclusion

Despite the small sample, some eye abnormalities were higher in children with PAE and/or FASD. Access to eye services or assessment of vision and structural eye anomalies is essential for Indigenous children, particularly those with PAE or FASD to allow early effective treatment.

KEYWORDS:

• Aboriginal Australian
• child
• eye
• fetal alcohol spectrum disorders
• Indigenous

Acknowledgments

The authors acknowledge the children and families involved in the Lililwan project, and members of the project team who were instrumental to the work presented in this article, including Sharon Eadie and Charlie Schmidt. We also thank Ms Aimee Leong (orthoptist) for her involvement in ophthalmic assessments.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval statement

Conduct of this research adhered to the guidelines of the Declaration of Helsinki. Ethics approval was obtained from The University of Sydney Human Research Ethics Committee (No. 12527), Western Australian Aboriginal Health Information and Ethics Committee (No. 271–01/10), Western Australian Country Health Service Board Research Ethics Committee (No. 2010:01) and the Kimberley Aboriginal Health Planning Forum Research Subcommittee (No. 2010–001). All participants provided written informed consent.

Submission statement

This submission has not been published anywhere previously and is not being considered simultaneously for any other publication.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09286586.2024.2331539.

Additional information

Funding

The Lililwan Project was supported by the National Health and Medical Research Council of Australia [Project Grant #1024474]; the Australian Government Department of Health and Ageing (DoHA) and the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA). Professor Elizabeth Elliott was supported by a National Health and Medical Research Council of Australia (NHMRC) Practitioner Fellowship [#457084] and a Medical Research Futures Fund Next Generation Fellowship [#1135959]; and is currently a NHMRC Leadership Fellow [#2026176]. Dr James Fitzpatrick was supported by a McCusker Clinical Research Fellowship.