Prevalence, Treatment, and Outcomes of Corneal Disease in Aboriginal and Torres Strait Islander Peoples in Australia: A Systematic Review

BACKGROUND: To synthesise available evidence on the prevalence, treatment strategies, and outcomes of corneal disease affecting Aboriginal and Torres Strait Islander peoples in Australia, and to identify gaps in the existing literature. METHODS: A systematic review with narrative synthesis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Scopus, and the Cochrane Library were searched from January 2010 to February 2025. Eligible studies reported epidemiology and/or treatment outcomes of corneal disease in Indigenous Australians. Due to heterogeneity, meta-analysis was not performed. RESULTS: Twenty-one studies met inclusion criteria. Active trachoma prevalence declined over the past decade from approximately 14%-15% (1-5) to 3%-4% (6-8), with most jurisdictions reporting prevalence below endemic thresholds by 2022, although pockets of higher prevalence persisted in some remote communities (8). Trachomatous trichiasis was higher among Indigenous Australian adults compared with non-Indigenous Australian adults (~0.4%-0.5% vs. ~0.03%-0.05%) (5, 8, 9). Evidence for non-trachomatous corneal disease was limited to clinic and hospital-based cohort studies. These data suggested that pterygium was common among Indigenous Australians, although lacked population-level prevalence estimates. Hospital-based keratitis cohorts demonstrated worse visual outcomes among Indigenous patients, with distinct risk factor profiles characterised by lower contact lens use and higher rates of trauma and delayed presentation. CONCLUSIONS: While available data suggest progress in some corneal conditions among Indigenous Australians, major evidence gaps limit reliable estimates for several pathologies. Priorities include strengthening Indigenous-specific population data and developing prevention and treatment approaches tailored to environmental exposures and access barriers in remote communities.