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Collaborative Care – Specsavers Sets the Scene for a New Era

Lights, camera, action… If there was ever any doubt about the legitimacy of large scale optometry conferences, just look to Specsavers. Their annual conference gets bigger every year, in September attracting 500 delegates to Brisbane, over 100 of them from outside the organisation.

Themed ’Collaborative Care – A New Era in Eye Health’ the Specsavers conference was living proof that eye health providers from across the board are taking the concept of collaboration seriously. Among the audience and exhibitors were representatives from the Optometry Board of Australia, the Royal Australian New Zealand College of Ophthalmologists, the Australian College of Optometry, all divisions of Optometry Australia, various young optometrists associations, and Australian universities.

A line-up of seven well-known ophthalmologists from across Australia and New Zealand, presented to delegates at the full Sunday session, all providing useful take-home messages for everyday practice and encouraging optometrists to refer on and collaborate at every viable opportunity.

But it was Peter Larsen, Specsavers’ Optometry Director, who set the scene, describing the recent agreement with RANZCO to collaborate on new guidelines for the care of patients with glaucoma, diabetic eye disease and macular degeneration. Mr. Larsen said consistency of practice and collaboration were fundamental to success and better patient outcomes. Quoting troubling statistics related to glaucoma diagnosis and treatment, Mr. Larsen said 50 per cent of glaucoma cases were not detected; many of those who were detected were not referred on; 15 per cent of those who were referred on were not turning up for tertiary care and 40 per cent of patients prescribed treatment ceased taking their medication. He said the solution was to work together with systematic processes that ensured patients did not fall through the cracks.

With any relationship between optometry and ophthalmology, we’ve got to be cognitive of the risk that exists on both sides of the equation

Highlighting the recent case of Honey Rose, an optometrist from the United Kingdom charged with manslaughter having failed to detect a patient’s bilateral papilloedema, Mr. Larsen said optometrists had a responsibility of care which could not be shifted to the ophthalmologist.

The case of Honey Rose was referred to several times during the Specsavers conference, a clear indication of the “jitters” this had sent through the eye health profession. “With any relationship between optometry and ophthalmology, we’ve got to be cognitive of the risk that exists on both sides of the equation. Guidelines that exist must reduce the risks on both sides of the equation,” said Mr. Larsen. “Risks can’t be shifted from optometrists to ophthalmologists or from ophthalmologists to optometrists, it’s about reducing the risks with guidelines, consistent practice and collaboration,” he said.

Mr. Larsen said data collection and analysis was also critical to reducing risks and improving patient outcomes. To do this, he said Specsavers had made use of the Oculo system to produce new clinical reports across its stores, which painted a picture of the number of referrals made by its practices. These reports highlighted the disparity between practice referrals and over time would help identify whether practices were referring enough, too much or too little. This in turn, he said, would enable Specsavers to tailor education to ensure the best patient outcomes were achieved.

Diabetic Eye Disease Guidelines Launched

Following the August launch of guidelines for glaucoma, Mr. Larsen announced guidelines for the treatment and management of diabetic eye disease. He left the detail to be explained by Brisbane ophthalmologist Dr. Russell Bach, who developed them with Dr’s. John Downie, Andrew Chang, Alex Harper, Angus Turner, Peter Van Wijingaarden, Gerard Liew, Jim Runciman and Jenny Arnold on behalf of RANZCO in collaboration with Specsavers.

Dr. Bach explained the value of working to guidelines, and reiterated the importance of collaboration between optometrists, ophthalmologists, as well as general practitioners, endocrinologists and nutritionists in the effective management of patients with diabetes. “If the guidelines are used appropriately, health professionals will be able to collaboratively provide a uniformly high standard of care of patients with diabetic retinopathy that is both time efficient and low risk for members of the health team and cost effective for the community,” said Dr. Bach. Echoing Mr. Larsen’s focus on data collection and analysis, and citing examples from other areas of medicine, Dr. Bach said the prevention, detection and treatment of sight threatening diabetic eye retinopathy requires evidence based and efficient processes. Going forward, he said it would be necessary to provide education that will deliver consistent grading of diabetic retinopathy, develop software applications to aid the clinical decision making process and facilitate data collection looking at cost efficiencies and patient outcomes.

Vitreoretinal Surgery

Queensland ophthalmologist Dr. Nathan Walker captured the attention of optometrists in the room with a presentation on the exciting and highly skilled area of vitreoretinal surgery. Having outlined the evolution of surgical instrumentation and techniques, Dr. Walker went on to describe and differentiate a number of ocular conditions most likely to be seen in day-to-day practice, including epiretinal membrane, macular hole, and proliferative diabetic retinopathy. However it was the detailed images of ocular trauma caused by octopus straps, nails and metal shards, followed by graphic videos of the surgery that ensued, that really caught the attention of optometrists in the room. In keeping with the conference theme ‘collaborative eye care – a new era in eye health’, Dr. Walker spoke on clinically relevant issues such as the urgency of referral, indications for surgery, differential diagnosis, post-operative care and problems that patients may encounter between specialist visits.

Glaucoma Management

As you’d expect, having just collaborated with RANZCO to develop new glaucoma guidelines, management of glaucoma was high on the Specsavers’ conference agenda. Sydney ophthalmologist and glaucoma expert Dr. Andrew White spoke to delegates on glaucoma care, outlining the difficulties in its management, beginning with the limitation of current models of detection and assessment. Dr. White also spoke about the collaborative approach to glaucoma management and the critical role of optometry. He discussed components of glaucoma examination and management today and reviewed developments and advances for the future. Professor Stuart Graham also spoke on glaucoma, talking to delegates about the important issues of assessing glaucoma for progression and rates of optic disc change, as well as the use of progression software on visual fields and OCT scans for these purposes.

Optic Nerve Swelling

Picking up on the danger of optic nerve swelling mentioned in association with the Honey Rose case, Dr. Jesse Gale from Wellington New Zealand spoke to delegates about triaging patients and the urgency of referral when faced with a swollen optic disc. He said differentiating disc oedema from other causes of an elevated disc can be complex and the appearance of the disc is less important that its clinical context. Dr. Gale emphasised that a range of investigations is often required for diagnosis and “the urgency and timing of tests depends very much on presentation, so a clear referral is essential”.

Melbourne’s Dr. Christolyn Raj spoke on a number of cases she has managed involving cataract/refractive conditions, retinal disease and paediatrics. Dr. Raj highlighted common traps and misconceptions in the assessment and management of each of these eye conditions, delivering pearls of wisdom aimed at assisting patient co-management.

Finally, Queensland’s Dr. Sunil Warrier delivered a broad lecture covering off the basics of ocular oncology, newer surgical techniques for glaucoma management and the skills required to accurately assess and refer life-threatening ocular lesions.

A smaller group of 340 optometrists attended a lower key Saturday education event where two lecture streams ran consecutively. One lecture series focussed on pathology management, presented by Michael Yapp (Centre for Eye Health), Alex Gentle (Deakin) and Richard Johnson (Greenlane Hospital, Auckland). The second lecture series concentrated on paediatric eye care and was presented by Daryl Guest (University of Melbourne), Shelley Hopkins (QUT) and Geoff Sampson (Deakin).

All speakers, sponsors, delegates and special guests were invited to attend a welcome cocktail party at the Queensland Gallery of Modern Art, where drinks flowed, band played and a selection of artworks was available to be viewed.

Across the day and a half of conference, there was a total of 31 CPD points, including nine therapeutic points, to be acquired for Australian optometrists and a total of 9.5 CD and three general points for New Zealand optometrists at the 2016 Specsavers annual conference. The 2017 conference is likely to move back to Melbourne, taking place on Saturday 9th and Sunday 10th September.