An entirely new approach to eye screening at Specsavers has doubled the detection of glaucoma and promises to make a significant impact on the 50 per cent of Australians living with glaucoma who are currently undiagnosed.
The approach combines education with technology and importantly, maximises information gathered through benchmarking the processes and outcomes of individual Specsavers optometrists across the country.
“We’re undertaking a disruption to optometry with an approach that has never happened before on such a large scale,” explained Peter Larsen, Optometry Director of Specsavers.
In essence, Specsavers is mid way through a national roll out, that will see optical coherence tomography (OCT) included as part of the screening process for every patient who has a Medicare funded eye test.
The power of benchmarking is to understand the impact you’re having on avoidable blindness within the community
“Our practices with OCT are now offering a new standard of quality in eye health screening – no one has ever done it before at this scale,” said Mr. Larsen, adding that 200 OCTs will be installed in practices by the end of 2018 and the roll out will be completed by the end of 2019.
OCTS ALREADY RETURNING RESULTS
“Tonometry only identifies patients with high intraocular pressure, which comprises less than half of those with glaucoma. By routinely assessing the structure with OCT and then, on indication, performing functional testing, we’ve been able to double the detection rates of this disease,” said Mr. Larsen.
He explained that Medicare statistics indicate a prevalence of visual field tests in Australia of just 6 – 7 per cent. “Considering the 50 per cent undiagnosed glaucoma and the published prevalence of people at risk of glaucoma, the number of visual fields performed will need to increase significantly… Collaboration is key and the research now being conducted with the Royal Australian and New Zealand College of Ophthalmology (RANZCO) will seek to examine the quality of the published pathways” said Mr Larsen. “Early results are positive and now the study will be expanded to optometrists and ophthalmologists across Australia and New Zealand.”
This is only part of the story.
IMPORTANCE OF BENCHMARKING
A powerful component of Specsavers’ new approach to screening for eye disease is the ability to benchmark processes and outcomes at a granular level, which paves the way for improved eye health right across the community. This is where Specsavers integration of its practice management system with the Oculo platform has an important role to play.
“The Oculo referral platform gives us a systematic way to communicate patient information to other relevant health professionals and for them to communicate with our optometrists,” said Mr. Larsen. “Importantly, it enables us to aggregate our data for feed back to stores and individual optometrists about the number of specific referrals they are initiating and how these compare against other Specsavers peers and stores, and how they are ultimately impacting disease detection and therefore, patient outcomes.”
Benchmarking clinical performance can be confronting for any individual, particularly in optometry, which has not traditionally worked in this way. Mr. Larsen said Specsavers has worked with its optometrists on the benefits of benchmarking to improve patient outcomes.
When an optometrist compares, for example, how many visual field tests they are completing, or how many cases of glaucoma they are diagnosing with their colleagues at a store or national level, they are able to gain an insight into the impact they are having as an individual on eye health. They’re also able to see whether they need to change the way they are doing things to improve their performance relative to others.
“Soon we’ll be able to provide optometrists, and the broader eye care community, with a link between the prevalence of visual field tests and the detection of glaucoma – we should be able to define a ratio – so that optometrists will know whether they are doing enough/too many/ or too few visual field tests to accurately detect glaucoma in the community,” said Mr. Larsen.
“The power of benchmarking is to understand the impact you’re having on avoidable blindness within the community,” he said. “We believe we now have Australia’s largest data set on optometry referral patterns across the most significant diseases in avoidable and treatable blindness. This will lead to a greater understanding of what the benchmarks should be in optometry. Using this information, combined with professional education and technology, we can intervene to improve the quality of health outcomes.”
Mr. Larsen said the information can also be used when liaising with Medicare, particularly when it comes to advocating for funding. By being able to provide real time statistics about prevalence of specific tests and the impact of those tests on disease detection, government is able to tangibly measure the value of funding the service.
THE FUTURE
Mr. Larsen said glaucoma is the first of many eye diseases that Specsavers will focus on. Macular degeneration and diabetic eye disease will soon be targeted in a similar way with the prevalence of specific screening processes and their impact on eye disease detection and outcomes measured, benchmarks for detection defined, and goals set for further improvement. Additionally, it will become possible to analyse data on patients, eye disease and treatment outcomes at an increasingly granular level, enabling an even greater understanding of eye disease in the community and more personalised, effective patient care.
Background on Blue Mountains Study statistics – and how the Specsavers OCT pilot is impacting detection rates.
