Partners in Eye Care: MDFA & Specsavers Wet AMD Project

The newly formed partnership between Specsavers and MDFA is an opportunity to gain a true understanding of incidence and prevalence rates of nAMD across Australia for the first time, and work towards improving appointment attendance and treatment adherence rates for patients.

Our shared vision is that the successful measures determined through the partnership will be shared with the entire industry to further impact the nation’s eye health

Dee Hopkins, MDFA CEO, says the project is at the heart of the organisation, which was established with a vision to provide a patient-centric, trusted service to those living with, or at risk of, macular disease.

“Our purpose is to reduce the incidence and impact of macular disease through leadership in prevention and early detection, disease management, advocacy, and research. Every day we work collaboratively and in partnership with our community, health professionals, researchers, and government to minimise the impact of macular disease. For this project, we are thrilled to position ourselves alongside the nation’s largest optometry provider to determine how we can collaboratively improve the visual outcomes of our patients. Our shared vision is that the successful measures determined through the partnership will be shared with the entire industry to further impact the nation’s eye health,” said Ms Hopkins.

Dr Ben Ashby, Specsavers Director of Optometry, says the partnership is a natural progression for Specsavers, which has been delivering on a strategy in support of the National Eye Health Framework to reduce the incidence of preventable vision loss and blindness in the nation through improved prevention, early detection and co-management of eye diseases.

“Through the accessibility of our stores and the number of patients we see, we’re in a special position to positively impact the vision outcomes of our nation. We do this by utilising our anonymised patient data, by harnessing the latest in optometry technology in all of our clinics, and through inter-disciplinary collaboration.”

Dr Ashby continued, “For the past six years, we’ve implemented a strategy to detect every case of glaucoma within our patient base and believe we have far surpassed the industry benchmark and increased detection rates by at least 60%. We’ve also collaborated with Diabetes Australia, the Federal Government and wider industry to launch KeepSight, which is now seeing hundreds of thousands of patients at risk of vision loss to diabetic retinopathy, receiving reminders for diabetes eye checks. While these strategies continue, we are now looking at how we disrupt the current prevalence statistics of unnecessary vision loss for patients with age-related macular degeneration. As a first step into this, we are proud to begin work on this nAMD project in partnership with MDFA.”

NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Of the estimated 1.4 million¹ Australians with evidence of AMD, it is estimated 156,090² currently have nAMD and require treatment. Despite non-adherence to treatment leading to the development of severe vision loss or blindness,³ it is estimated 20–25%⁴ of patients don’t receive the required intravitreal injection treatment.

Through their partnership, Specsavers and MDFA have targeted this group within the AMD patient contingent due to the potential to significantly reduce the incidence of preventable blindness by focussing on:

1. Supporting nAMD suspects to attend their first ophthalmology appointment, and
2. Following this, supporting them to adhere to the treatment prescribed.

Unlike early and intermediate cases of AMD, which may require ongoing monitoring before a referral is made, nAMD patients receive a prompt referral from optometry to ophthalmology for assessment and potential initiation of treatment.⁵ By targeting nAMD patients in this project, measurement of interventions from Specsavers and MDFA is straight-forward, and it may be possible to see a shift from the current 22.2%⁴ of patients who are lost to follow-up and the mere 56,000⁶ who are estimated to receive treatment.

On top of this, research has found that after initiation of treatment, patients with nAMD may drop out of treatment due to a variety of non-clinical reasons, including treatment burden (e.g. perceived excessive treatment visits, difficulty in attending, and pain/discomfort), lack of perceived benefit, cost burden and the existence of other medical conditions that are more severe.⁷ The partnership aims to overcome barriers to ensure every consenting patient is supported to adhere to prescribed treatment, including attending subsequent treatment appointments.

THE PROJECT

The project has begun in pilot phase with 16 Specsavers practices from around the country currently involved.

Consenting patients with suspected nAMD, who have had an eye test at these practices, are being referred to MDFA via Oculo at the same time as their ophthalmologist referral.

MDFA then contacts the patient within three business days to check how they are feeling and to answer any questions that may have arisen from the referral. Here they encourage them to attend the appointment with the ophthalmologist and invite them to join the MDFA specialised treatment support program called My Eyes.⁸

Once the appointment has occurred, MDFA contacts the patient again to find out the diagnosis and prescribed treatment, as well as support them with answers to any questions or concerns they may have.

My Eyes then commences periodic check-ins with the patient, aligned with their treatment intervals, to support them through their treatment. All My Eyes patients also receive specifically tailored information and resources about nAMD every two months, are connected to other services such as peer support groups, and the free national helpline run by MDFA: (AUS) 1800 111 709.

Through this methodology, MDFA is able to report on patient consent/participation rates, anonymised patient diagnoses, false positive ophthalmology referral rates, and patient sentiment. This is shared with participating Specsavers optometrists who can also feedback on the process in monthly project meetings. Any patient trends or opportunities for development are identified and the project can morph to ensure the most effective visual outcomes for patients.

EARLY FINDINGS

While the project is still in infancy, early trends are encouraging, with 75% of participating patients joining My Eyes and early figures showing the first patients adhering to treatment.

A better picture of the state of nAMD in Australia is also beginning to emerge as data from the project is captured.

Optometrist, Yavani Mudaly co-owns two participating Specsavers practices in New South Wales and said that while the project has had a slower start due to COVID interruptions and lockdowns, her team of optometrists are looking forward to being at the forefront of this opportunity to make a positive difference for patients with nAMD.

“So far patients have been very willing and even grateful for the opportunity to participate and be better informed about their disease. If this project means that even one of my patients attends their ophthalmology appointment or adheres to treatment when they otherwise wouldn’t, it is worth it for me. It’s exciting to be on a journey that will incrementally change the visual outcomes for Australians with AMD,” she said.

Irene, who is an nAMD patient, said being involved in the project, especially the peer support group inclusion, has made her feel less alone and more supported to take her nAMD diagnosis seriously.

“I am just so grateful to my optometrist for getting me involved in this, as I don’t know anyone with nAMD and now I have the opportunity to interact with people who deal with the same problems as I have. I am full of hope, as I know this will improve my mental state and give me information, which would be most welcome,” she said.

NEXT STEPS

Dr Ben Ashby expects the project will take several years to test and slowly grow as key trends and data emerge from the pilot phase and the impact of the coordinated collaboration starts to develop.

“Eliminating loss to follow-up and increasing treatment adherence rates within our patient base would significantly reduce the unfortunately high amount of Australians who lose vision to nAMD every year. As always, we’re committed to sharing the blueprints to any success in patient health outcomes as we work closely with MDFA to formulate a strategy that could eventually impact all Specsavers patients with AMD nationwide. As we receive key learnings and data, we’ll be sharing it on our industry data website HealthHub (www.healthhub-anz.com), which interested parties can subscribe to.”

mivision will also follow the project and will report on key milestones and data as it is shared.

Duchesne Markham is the Stakeholder and Professional Communications Manager for Specsavers in Australia New Zealand. 

References 

1. Deloitte Access Economics and Macular Degeneration Foundation (2011). Eyes on the future – A clear outlook on age-related macular degeneration. Accessed at mdfa-s3fs-prod.s3-ap-southeast-2. amazonaws.com/s3fs-public/Deloitte_Eyes_on_the_ Future_Report_web.pdf 
2. Deloitte Access Economics and Macular Degeneration Foundation (2011). Eyes on the future – A clear outlook on age-related macular degeneration. Accessed at mdfa-s3fs-prod.s3-ap-southeast-2.amazonaws.com/s3fspublic/ Deloitte_Eyes_on_the_Future_Report_web.pdf. (2022 prevalence estimates are derived from a straightline extrapolation between 2020 and 2025 estimates in this report.) 
3. Wong T et al. (2007). The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology. 2008 Jan;115(1):116-26. doi: 10.1016/j. ophtha.2007.03.008. Accessed at pubmed.ncbi.nlm.nih. gov/17675159/. 
4. Obeid A et al (2018). Loss to follow-up among patients with neovascular age-related macular degeneration who received intravitreal anti-vascular endothelial growth factor injections. JAMA Ophthalmol. 2018;136(11):1251-1259. 
5. RANZCO Referral Pathway for AMD Management. Accessed at ranzco.edu/home/health-professionals/ referral-pathway-for-amd-management. 
6. Extrapolated to 2022 from: Ranibizumab and aflibercept: analysis of use for AMD, DMO, BRVO and CRVO. (2018) Accessed at www.pbs.gov.au/pbs/industry/listing/ participants/public-release-docs/2018-05/ranibizumab_ and_aflibercept__analysis_of_use_for_amd%2C_ dmo%2C_b 
7. Vaze et al (2014). Reasons for discontinuation of intravitreal vascular endothelial growth factor inhibitors in neovascular age-related macular degeneration. 
8. MDFA’s My Eyes pilot project is supported by Roche, Apellis and Novartis.