Report Demonstrates Power of Sustainable, Preventative Eye Care

Data from the report will be shared with optometry, government, key patient support and advocacy groups, as well as health funds, the Royal Australian and New Zealand College of Ophthalmology (RANZCO) and local ophthalmologists, “to increase transparency and encourage widespread adoption of approaches that have been proven to work sustainably”.

According to Specsavers, the report findings confirm the following key principles underpin a sustainable model for preventative eye care that will enhance outcomes for patients at an unprecedented level:

• Addition of optical coherence tomography (OCT) as part of standard care for all patients,
• Timely and accessible care,
• Electronic referrals and communications,
• The leveraging of technology to improve the patient experience, and
• Professional development to improve patient outcomes.

the implementation of OCT and the introduction of benchmark reporting and RANZCO Referral Pathways have significantly impacted glaucoma referrals across all age groups

KEY FINDINGS

Glaucoma 

• 300,000 Australians over the age of 40 have glaucoma.
• 50% of glaucoma is undiagnosed.

Specsavers reports that the implementation of OCT and the introduction of benchmark reporting and RANZCO Referral Pathways have significantly impacted glaucoma referrals across all age groups.

Having completed its OCT roll out, 1,000 optometrists in 378 practices across Australia and New Zealand (around one in six registered optometrists) now use OCT on around four million patients a year.

For Specsavers, this has resulted in glaucoma referrals increasing from 10,562 (0.68% of patients) from July – December 2017 when OCT was only being used by 3% of the network to 20,516 (1.3% of patients) from January – June 2019 when OCT network coverage was at 83%.

More than half of the network’s referrals to ophthalmology in 2019 were new referrals, closely aligning with findings of the Blue Mountains Eye Study (1992–1994), which found that 51% of patients were previously undiagnosed.

Additionally, detection rates in Australia by age group were closer to internationally published prevalence rates for the condition:

• 0.2% of patients under the age of 40 were referred for glaucoma in practices using OCT,
• 0.7% of patients aged between 40–49 were referred in OCT practices,
• 2.7% of patients aged over 49 were referred for glaucoma (compared to 1.5% in non- OCT practices), aligning with the Blue Mountains Eye Study prevalence rate of 2.4–3% of people over the age of 49.

Analysis of an initial data-set of 137 ophthalmology validations from the 24,447 classified glaucoma referrals showed 86% of referrals were classified by the attending ophthalmologist as appropriate, with only 14% being false positives.

Referrals to Glaucoma Australia have also increased since the introduction of the Glaucoma Australia referral response pathway in 2018. To date, Specsavers has referred 2,658 patients, representing 3.6% of glaucoma patients referred to ophthalmology.

Diabetic Eye Disease 

• 1.7 million Australians have diabetes.
• 28.5% of non-Indigenous Australians with diabetes over the age of 50 have diabetic retinopathy (DR). 4.5% have sightthreatening DR.
• 39.4% of Indigenous Australians with diabetes have DR. 9.5% have sight-threatening DR.

Specsavers data indicates that currently 7% of all patients attending for an eye test have diabetes. As at 31 July 2019, 7,028 patients had been referred to ophthalmology for DR in the prior 12 months, and Specsavers predicts this figure will reach 12,000 patients by the end of the year, an increase of 34% on 2018 (8,982) and 205% on 2017 (3,931).

Based on a data sub-set of 19,833 patients with diabetes with retinopathy referred to ophthalmology between 2017–2019, 60.05% of patients were referred with mid-moderate non prolific diabetic retinopathy (NPDR), 20.45% with minimal retinopathy, 11.9% with severe NPDR and 7.6% with proliferative DR.

The report found that practices using OCT were more likely to identify macular oedema, which can be present at all stages of diabetic eye disease; most commonly in patients aged 60–69 (30%), followed by patients aged 50–59 (27%) and patients aged 70–79 (17%).

AWARENESS OF EYE DISEASE

Awareness and knowledge of glaucoma, macular degeneration and DR was disappointingly steady across Australia (AU) and New Zealand (NZ), and in fact, 3–4% lower than indicated in the 2018 report. This despite significant investment in public awareness campaigns by both Specsavers and advocacy groups.

Specsavers reported that awareness of DR was the lowest with only 34% of Australians and 37% of New Zealanders having heard of it and more than 78% admitting they don’t know anything about it. 82% believed diabetes can affect your eyes, but only 67% of Australians and 71% of New Zealanders were aware it could cause irreversible vision loss. Most (76% AU and 77% NZ) were unaware of the likelihood of a person with diabetes developing diabetic eye disease in their lifetime.

Prompted awareness of glaucoma remained steady at 74% in Australia and 75% in New Zealand with more than half (53%) admitting they didn’t know anything about the condition.

Awareness of macular degeneration was 60% in Australia and 46% in New Zealand. 60% of people admitted to being unfamiliar with macular degeneration. Less than half were aware that macular degeneration can be hereditary (48% AU and 32%) or that making lifestyle changes can lower the risk of the disease getting worse (49% AU and 40% NZ).

Myopia, cataract and hyperopia were the eye conditions that people were most aware of and felt they knew most about: with awareness of myopia (82% AU and 83% NZ), cataract (76% AU and 74% NZ) and hyperopia (74% AU and 75% NZ).

NEED FOR EYE EXAMINATIONS

Although 93% of Australian and 88% of New Zealand participants recognised the need for regular eye examinations, as many as one in three Australians and two in five New Zealanders could not recall having an eye test in the past two years.

Their reasoning remained unchanged from 2018, with 20% of Australian participants saying they didn’t think there was anything wrong with their eyes, and another 20% expressing concern about cost. In New Zealand, 30% were concerned about cost (eye examinations are not subsided by the government) while 25% said they didn’t think there was anything wrong with their eyes.

Interestingly, 41% of Australians did not know eye tests are bulk-billed through Medicare. 30% of people (up from 22% in 2018) thought they would be out of pocket between AU$20 and $100+, while 11% (down from 19% in 2018) did not know whether they would be charged for an eye test or not.

The key triggers and drivers for people to go to the optometrist for an eye test were vision starting to go blurry (61% AU and 64% NZ), followed by struggling to read (52% AU and 64% NZ) and not being able to see properly to drive (44% AU and 64% NZ). A reminder letter from the optometrist (36%) was another significant trigger.

UNDERSTANDING OF OPTOMETRY

Specsavers reported that the majority of people (80% AU and 89% NZ) perceive the optometrist’s role as being to test vision, followed closely by supplying glasses and contact lenses (78% AU and 85% NZ) and to a lesser degree detecting eye diseases and other eye health problems (71% AU and 69% NZ).

Optometrists were best known for detecting glaucoma (77% AU and 78% NZ), followed by macular degeneration (69% AU and 63% NZ) and diabetic retinopathy (64% AU and 65% NZ). There was very little awareness (53% AU and 63% NZ) of the role optometrists play in treating and managing minor eye conditions and their ability to prescribe therapeutic eye drops.

Specsavers released its first State of the Nation Eye Health Report in 2018, sharing outcomes from 6.3 million patient journeys over two years. The 2019–20 Eye Health Report is available at Spectrum-anz.com.