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Sunday / November 3.
HomemieyecareReframing Care for Macular Disease

Reframing Care for Macular Disease

For the past two years, Specsavers has worked with Macular Disease Foundation Australia (MDFA) to better understand and classify its neovascular age-related macular degeneration (nAMD) patient cohort through a pilot project involving 16 practices spread across Australia.

Early outcomes are already demonstrating the benefits of this collaborative model of care.

This collaboration with Specsavers has ensured we reinforce and build understanding of macular disease and treatment, as well as consider what it means to be living with the challenges of the disease

Treatment compliance and follow-up appointment attendance are long known as major contributors to preventable vision loss for patients with all forms of eye conditions.

Of the estimated 1.4 million1 Australians with evidence of age-related macular degeneration (AMD), it is estimated that over 160,000 currently have nAMD and require treatment. Historically, we know that about half of the patients who commence treatment with intravitreal injections stop treatment within five years and non-adherence rates increase over time as patients gradually drop out.2

This rate of drop out in treatment and appointment attendance rates for patients with diagnosed conditions is a challenge that the eye health sector needs to take on collaboratively to influence change in patient behaviour, Specsavers Optometry Director Dr Ben Ashby said. For this reason, Specsavers partnered with MDFA to commence a pilot project.

In the pilot, consenting patients with nAMD were referred, by participating Specsavers optometrists, to MDFA’s MyEyes program, where they received intensive and tailored support with MDFA’s clinical support team through phone calls, emails, text messages, and letters.

“When it comes to working synergistically to improve patient health outcomes, Specsavers has quite the track record,” Dr Ashby said. “We’ve worked alongside other industry leaders, such as Glaucoma Australia and Diabetes Australia, advocating for and providing support as part of a care management team for patients with glaucoma and diabetes, doing all we can to prevent them losing sight.

“For this project, we have been focussed on enabling and strengthening an extension of the care pathway to MDFA, so that our patients with macular disease can receive the best care at all stages of their journey. As a result of working closer with MDFA, we have seen some great individual successes for our patients referred from our participating practices.”

MDFA CEO Dr Kathy Chapman said working with Specsavers to achieve this level of care has been hugely beneficial for participants.

“Macular Disease Foundation Australia is very pleased to be collaborating with Specsavers, Australia’s largest optometry provider, to improve the visual outcomes of people living with macular disease.”

Dr Chapman continued, “Regular visits to an optometrist are vital for detecting macular disease early and getting onto the right treatment path. Our collaboration with Specsavers has been a great opportunity to bring our collective expertise together, centred on achieving better outcomes for patients.

“Specsavers’ optometrists play a vital role with the initial clinical support, while MDFA is here to provide complementary support through tailored information resources, psychosocial, and practical support. Our goal is to ultimately help more people live better with their macular conditions, as well as maintain their vision.”

Dr Chapman said the initial work has been focussed on supporting people with late stage nAMD and helping them to adhere to their intravitreal injections.

“Through this partnership and amplifying our organisational strengths, we have seen that a combined approach can help people persist with sight-saving injections. This collaboration with Specsavers has ensured we reinforce and build understanding of macular disease and treatment, as well as consider what it means to be living with the challenges of the disease,” she said.

Examples of Impact

Among patients referred by Specsavers optometrists to MDFA’s MyEyes program are Irene Cox from Victoria, Michael Gordon from Geelong in Victoria, and Elizabeth Watts from Hervey Bay in Queensland.*

All have been diagnosed with nAMD and have maintained treatment and kept up with appointments since they were referred.

Ms Cox appreciated the regular check-ins she’s received by being in the program and said that a conversation from one of the phone calls she had with MDFA’s clinical support team led to her joining an MDFA peer support group. This made her feel less alone and helped her 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 wet age-related macular degeneration and now, I have the opportunity to interact with people who deal with the same problems as I have,” she said.

“I am full of hope, as I know the support I’m receiving will improve my mental state and give me information, which would be most welcome.”

Similarly, Mr Gordon says he has greatly appreciated the regular phone call check-ins that he’s received from MDFA’s team. He said the information provided has helped him understand why it is so important to prioritise his eye health appointments.

“The information given when I was first referred to the program was very beneficial. Following on from that, on a month-to-month basis, the check-ins have been beneficial to help sift through what the health information means and help me not forget anything, like my appointments.

“I definitely intend to keep up treatment. I will do everything to subvert any vision loss.”

For Ms Watts, the biggest threat to maintaining her eye health appointments was transport – she can’t drive so depends on government transport to make hospital appointments. Ms Watts said that if it weren’t for the education and encouragement she received via the program, she might not have prioritised her eyes.

“The calls and text messages I receive from the Foundation are important and have taught me that it’s important to have the treatment and that the injections are working,” said Ms Watts.

“The emails underscore how important my appointments are and hold me to account. So long as I’m on treatment, I’m very happy.”

Referring to MDFA

Babara Vermeulen from Specsavers Victor Harbor in South Australia is the pilot program’s top referring optometrist and said working collaboratively with MDFA and local ophthalmologists has been invaluable to providing the best care for patients.

“As primary healthcare providers, optometrists take a lot of the load, comanaging and screening a lot of patients for different conditions. It’s important to work collaboratively with patient support bodies, such as MDFA, who have specially trained educators and clinicians on hand, peer support groups, and patient-friendly information at the ready for the different types of patients that we see.

“Their service is a true extension of our care and can make a real difference for patients.”

Ms Vermeulen said she has been a passionate advocate for the program; both because of the benefits she’s seen her patients gain, and more personally, because both of her grandparents live with AMD. Thanks to early intervention and support, they have been able to maintain their independence.

“This morning alone, I saw a patient with nAMD who had a recent diagnosis and was very anxious and stressed about his condition. I’d been working closely with his ophthalmologist and was able to talk him through his treatment and explain why it was so important.

“While he found this very reassuring, I knew that he would think of a lot of questions after he left the appointment. I referred him to MDFA and the MyEyes program and was able to tell him that someone would be in touch. This is just one example of how collaborative care is so important, both for patients, optometrists, and ophthalmologists in reinforcing the care we deliver.

“I had another patient who really benefitted from our partnership with MDFA. She wanted to stop injections and all treatment, and she was at real risk of losing her vision if this occurred.

“After agreeing to a referral to MDFA, and receiving their supportive phone calls for several weeks, the clinical support team were able to connect with the patient’s family. Here, they discovered that one of the main reasons why the patient wanted to drop out of care was because of anxiety and stress around transportation to appointments.

“MDFA organised for the patient’s daughter to drive her to appointments, and the patient was able to attend and receive treatment, saving her sight.”

Dr Ashby said working with patient support services such as MDFA would continue to be a priority for Specsavers in the coming years.

“As the market leader in the provision of eye care services to Australians, Specsavers has a responsibility to also be the leader in preventing vision loss and protecting sight. We have seen the evidence that patients have improved health outcomes if they receive additional support services between optometry and specialist appointments, so we are doing all we can to ensure as many patients as possible are granted the option to receive it. This is just one part of our mission to change lives through better sight,” he concluded.

*Patient names changed for anonymity

References
1. Deloitte Access Economics and Macular Degeneration Foundation (2011). Eyes on the future – A clear outlook on age-related macular degeneration. Available at mdfoundation.com.au/resources/eyes-on-the-future/ [accessed 15 March 2023].
2. 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.

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