Impact of rurality on optical health: review of the literature and relevant Australian Bureau of Statistics data.

CONTEXT: Rurality is associated with a number of direct and indirect causes of eye disease. The direct causes are best described as lifestyle factors, such as exposure to UV light and occupational risks. Indirect factors are those where the occurrence of a predisposition is magnified due to rural population distributions, for example gender and age. ISSUE: Research into rurality and optical health is limited, so definitive increases in the prevalence of vision disease are difficult to ascertain. Furthermore, establishing the need for additional optometrists in rural areas has been mixed in the literature. The current review addresses the relationship between rurality and optical health and suggests an increase in available optometrists in rural areas. LESSONS LEARNED: Age is the single largest correlate of vision disease, with an increase in age over 40 years correlating significantly with a range of vision diseases. Rural New South Wales (NSW) Australian areas contain a higher proportion of 'older' residents than urban equivalents. Gender is also a correlate of vision disease, although the phenomenon is more complex than for age. Rural NSW populations contain a higher ratio of men to women than do urban areas, which is significant. Rural residents are exposed to higher levels of UV radiation than their urban counterparts, increasing the prevalence of pterygium. Rural residents experience higher levels of occupational eye injury and may have less stringent eye safety standards. The interaction between vision and hearing loss can accentuate occupational safety vulnerability and general living difficulties. Rural communities experience higher levels of noise-induced hearing loss. Rural communities experience higher levels of certain eye disease and may be exposed to an increased risk from indirect factors such as age, gender and private health insurance ownership. Rural communities may have lower access to optometrists and this review suggests increasing the number of optometrists in rural Australia. The amount of research conducted on factors associated with rurality and optical health should be increased.