Three years ago, the optometric industry began a once-in-a generation journey to increase the rates of eye examinations and reduce the rates of diabetes-related blindness by detecting problems early when they are treatable. KeepSight is a private public partnership, setting aside commercial competitiveness and focussing on industry-wide collaboration and cooperation to enhance patient health outcomes at rates never achieved before.
To mark the program’s third anniversary, we review its progress.
When Specsavers committed AU$1million per year to fund the first five years of KeepSight, in partnership with the Department of Health, Diabetes Australia and Vision 2020, as well as Bayer and Novartis, we knew that we’d have an opportunity to make a profound difference for Australians with diabetes. In its first three years, KeepSight has made incremental progress toward its goals in improving timely access to eye care, introducing collaborative patient engagement strategies, and leveraging technology to support best practice care and appropriate referral. We’ve been pleased to see the importance of this initiative recognised across the industry, with 60% of the optometric industry now registering patients with KeepSight.
Together as an industry and with support from the Government, KeepSight is our chance to prevent unnecessary vision loss to diabetes through regular checks and early treatment
Figure 1. ‘Registrations’ include initial registrations, when a patient is first signed up to KeepSight; and also appointment registrations, where the optometrist notifies KeepSight when a patient attends a follow-up appointment.
As the program is still in its infancy, with the majority of patients involved having received at most one reminder to date, we expect to see trends in eye health outcomes attributable to KeepSight continue to develop over the next few years. By monitoring outcomes for patients with diabetes, we can see these trends beginning to emerge in our patient data, providing evidence of the program’s early successes. To achieve the below insights, Specsavers has analysed more than three years of its patient data to reveal ‘the three Rs of KeepSight’:
- Registration trends and learnings from its practices nationwide,
- Recall and attendance information, and
- Referral trends of diabetic maculopathy and diabetic retinopathy to date.
REGISTRATIONS
One of the first steps of the KeepSight strategy has been to build a large database of patients with diabetes who have consented to be part of the program. Without these patients, there would be no way for KeepSight to make the impact it has set out to achieve.
While initial conversations to establish KeepSight were underway in December 2018, Specsavers made alterations to its patient management software to enable them to capture baseline data for the prevalence of diabetes and diabetic eye disease among its patients, and to understand certain behaviour trends exhibited by this patient group, to highlight the need to remediate health outcomes for Australians with diabetes. Specsavers also used this information to enhance its internal recall strategy specific to patients with diabetes, which now works in conjunction with KeepSight reminders.
As seen in Figure 1, when KeepSight launched in 2019, Specsavers optometrists manually registered patients to the program through its website. As this was not a viable long-term or scalable solution, Specsavers invested in the development and adoption of a range of systems and processes across its network of practices to make the registration process as simple as possible for optometrists.
Integration with Oculo to enable KeepSight registration directly, which is now available for the entire industry to use, was completed in July 2019. Following this, registration rates from Specsavers optometrists rapidly increased to more than 6,000 per month nationwide. In early 2020, Specsavers and the entire optometric industry experienced a significant restriction on our ability to provide eye care for patients due to COVID-19. This caused a backlog of patients and, as services began to open again in different parts of the country, Specsavers saw the potential to strengthen its support of patients with diabetes by investing further into its systems and processes, and enabling KeepSight registrations directly from its patient management software. This further streamlined the registration process and saw KeepSight registrations increase to more than 20,000 registrations per month, representing two thirds of all patients with diabetes.
Between January 2019 and April 2022, Specsavers has registered more than 395,000 eye check appointments (initial and follow-up) to KeepSight.
RECALL
KeepSight’s recall strategy is the key enabler to achieving the program’s ambitions of reducing the rates of preventable diabetes-related blindness in Australia.
As explained by Diabetes Australia, for many patients with diabetes, the sheer volume of health appointments required to manage the disease means it can be easy to lose track. On top of this, while many patients know they need an annual eye check, having no noticeable changes to vision can often mean an eye test is de-prioritised.
KeepSight has been developed to complement the existing recall and reminder systems used by optometrists. For Specsavers, the value of collaborating with KeepSight is in ensuring that those patients with diabetes who did not return following a Specsavers recall message now also receive KeepSight reminders and are less likely to fall through the cracks when it comes to their eye health.
Before KeepSight was introduced, patients with diabetes responded to recalls more frequently than patients without diabetes (patients with diabetes were, on average, 11% more likely to respond to a recall). With some disruption due to COVID restrictions, adherence to recall among patients with diabetes has continued to improve after the introduction of KeepSight. In 2021, patients with diabetes were 16% more likely to respond to a recall communication than other patients, demonstrating a growing positive adherence to recall among patients with diabetes.
The number of patients with diabetes seen across the Specsavers practice network also increased from 5.2% of patients in January 2019 to 9.2% in February 2022. In March 2022 alone, more than 11,000 patients who were already registered to KeepSight returned for an eye test, making up more than 50% of KeepSight registrations for the month and showing that Specsavers and KeepSight reminders are helping to ensure patients with diabetes are receiving eye checks within the timeframe recommended by their optometrist.
REFERRAL TRENDS
While not all patients with diabetes receive referrals for specialist care following an eye test, it is important that Specsavers and KeepSight begin to capture and monitor specific referral information about patients with diabetes registered with KeepSight through Oculo. This includes information on visual acuity, grading of diabetic retinopathy and macular oedema.
Specsavers is working closely with KeepSight to establish a digital infrastructure to mobilise and monitor this at a national level so that, as an industry, we can understand diabetes eye disease in near-real time.
In the long-term, we will use this to assist KeepSight as it tracks successes, moving towards its long-term ambitions of improving eye health outcomes for patients with diabetes.
THE NEXT TWO YEARS
Diabetes doesn’t have to be the leading cause of blindness in Australia. Together as an industry and with support from the Government, KeepSight is our chance to prevent unnecessary vision loss to diabetes through regular checks and early treatment.
With the three Rs of KeepSight set up and on track, Specsavers is dedicated to making a real-life impact for people with diabetes in Australia. It is committed to maintaining its registration rates of consenting patients, to improving and measuring patient attendance rates following recall from both Specsavers and KeepSight reminders, and to enhancing the referral data it shares with KeepSight through Oculo.
By sharing Specsavers’ data and experiences, we hope to encourage other optometrists to start registering their consenting patients with diabetes to KeepSight. This can be done by filling out the online registration form at www. keepsight.org.au. Alternatively, to discuss integration with KeepSight through Oculo, or your preferred method, contact Taryn Black at Diabetes Australia ([email protected]).
Dr Ben Ashby is the Director of Optometry for Specsavers and is actively involved in research, development and implementation of sustainable models of eye care delivery to improve patient outcomes and reduce avoidable blindness. He is a Board Member and Vice President of Glaucoma Australia, Deakin University Optometry Advisory Board, is an Adjunct Lecturer at UNSW and an Honorary Teaching Fellow at the University of Auckland.
