KeepSight Uniting in the Fight Against Diabetes

Now in its fourth year, several major milestones have been achieved, but KeepSight Program Director Taryn Black says there is still more to do.

It’s the fastest growing chronic condition in Australia with an average of 120,000 new cases per year

Across Australia today, around 1.9 million people have diabetes. It’s the fastest growing chronic condition in Australia with an average of 120,000 new cases per year.¹

Diabetes can cause multiple complications, with some of the most common being eye related. In Australia, diabetes is the leading cause of preventable blindness. Almost everyone with type 1 diabetes and more than 60% of those with type 2 diabetes develop some form of diabetic eye disease within 20 years of diagnosis.^2,3

“Eye complications are often linked to diabetic retinopathy (DR) where blood vessels in the retina are damaged and, if left untreated, can cause vision loss or blindness,” explained Ms Black. “Yet, vision loss from diabetic retinopathy is preventable in up to 98% of cases with early detection and treatment.²

“KeepSight was launched in 2019 to support people with diabetes to attend their regular diabetes eye checks. If we can increase the number of people having regular checks, we can decrease the number of people losing their vision to diabetes,” she added.

Saving The Sight Of 1.9 Million Australians

KeepSight is a private-public partnership supported by the Australian Government, Specsavers, Bayer, Novartis, as well as key industry bodies including Vision 2020 Australia, Optometry Australia, RANZCO, the Australian Diabetes Society and the Australian Diabetes Educators Association. This one-of-a-kind program in Australia specifically focusses on supporting people with diabetes.

“Regular eye checks and early detection are key to minimising the number of people affected by diabetes-related vision loss,” Ms Black explained. “When a person with diabetes signs up to KeepSight, they receive personal diabetes eye check reminders if they don’t have their eyes tested in the recommended timeframe.

“Despite only being a few years old, the program has been positively received by the community and we are seeing its impact through an ongoing increase in people with diabetes presenting for eye checks.”

Already, there have been more than 600,000 visits for a diabetes eye check since the program commenced.

In Partnership With Eye Care

KeepSight is delivered in partnership with the eye care sector and optometrists play a crucial role in its success.

Specsavers is a founding partner and an early adopter of the program. In 2019, KeepSight partnered with iCare (formerly Oculo), which contributed to Specsavers optometrists increasing the rate of visits to 6,000 per month nationwide. The following year, Specsavers invested further into its systems and processes, enabling KeepSight registrations directly from its patient management software. This further streamlined the registration process and saw KeepSight visits increase to more than 20,000 visits per month.

It is unacceptable that diabetes is the leading cause of blindness and vision loss in Australia. We must unite in the fight against diabetes

Having been active in supporting KeepSight from day one, on average 80% of Specsavers’ patients consent to their appointment being registered on KeepSight.

More recently, other providers including Luxottica, The Optical Co and Bailey Nelson have partnered with KeepSight. With the recent integration of the patient management software Optomate, almost 80% of the sector is now able to seamlessly register patients for the program.

The Optometrist’s Role

The success of KeepSight to date is directly linked to the role optometrists play in providing regular eye examinations, monitoring the eye health of people with diabetes, and providing timely treatment or referral to an ophthalmologist if necessary.

“This helps to prevent or delay the progression of diabetic eye disease and reduces the risk of vision loss.

Optometrists’ professional expertise and ongoing support are essential to ensuring that people with diabetes receive the necessary eye care to manage their condition and prevent vision loss,” Ms Black said.

For optometrist Babara Vermeulen, co-owner at Specsavers Victor Harbor in South Australia, KeepSight is an example of optometrists putting patients first. She said the program enables her and her co-workers to continue doing all they can to prevent avoidable vision loss.

“As an optometrist who cares deeply about early intervention and looking after my patients, I am proud to support KeepSight and recommend it to all of my patients with diabetes,” said Ms Vermeulen.

Ms Black agreed. “Optometrists are trusted by their patients and are seen as professional and reliable sources of advice and support. They play a key role in educating people with diabetes about the importance of regular eye checks and provide advice on how to manage their eye health. Without the optometry sector’s support, KeepSight would not exist.

“The number of sign ups that have occurred via optometrists reflects the program’s focus on industry collaboration. While we still have a long way to go, we are pleased to see that a significant amount of people with diabetes are now receiving additional reminders to attend their diabetes eye checkups.

“Together we are working towards early detection and prevention. It is unacceptable that diabetes is the leading cause of blindness and vision loss in Australia. We must unite in the fight against diabetes,” she added.

How Keepsight Reminders Work

People with diabetes experience a multitude of stressors and challenges associated with their condition.

Additionally, they also need to meet with different health professionals over time to manage the many complications diabetes can cause. Since diabetic retinopathy is often unnoticeable to the person in the early stages, it is easy to de-prioritise regular eye checks.

Diabetic retinopathy screening rates are low in Australia, with only around 50% of people with diabetes having had an eye examination in the past year.⁴

Once a person is registered on KeepSight, they receive reminders that complement existing recalls from their optometrist. These reminders are KeepSight branded and sent as SMS, emails, or letters. The KeepSight reminder suggests the person book in for an appointment at the optometrist they last visited, while also giving the option to find a new provider, thanks to an integration with Health Direct.

KeepSight subscriber Idwer Jajju says the program is a valuable asset for people with diabetes as it helps remind them when they are due for a diabetes eye exam. Mr Jajju has had bleeding and other symptoms in his eyes since 2010 and has undergone various treatments since the changes to his eyes were first picked up in an eye check.

“Preventive eye care is very important, and I personally never take my eyesight for granted.”

For the optometrist, the additional reminder means the patient is encouraged to come back for an eye check. The person also receives communication that addresses diabetes and eye health.

Since its launch KeepSight has sent more than 450,000 reminders to people in the system. These additional reminders are as reassuring for practitioners as they are for patients, according to Specsavers optometrist Suren Naidoo in Dapto, New South Wales.

“Having an initiative like KeepSight at my disposal gives me a lot more peace of mind that my patients will receive timely reminders to keep up their regular appointments. It also provides a reliable educational diabetes resource for them. In my opinion, this pushes us several steps forward in the fight to eliminate diabetes as the leading cause of preventable vision loss in Australia.”

How to join KeepSight as an optometrist

If you would like to use KeepSight in your practice or learn more about the program. Please contact [email protected]

 

References
1. diabetesaustralia.com.au/about-diabetes/diabetes-in-australia[accessed 22 May 2023].
2. The Case for an Australian Diabetes Prevention Initiative: Vision 2020, Diabetes Australia, and the Centre for Eye Research Australia, available at diabetesaustralia.com.au/wp-content/uploads/Case-for-an-Australian-Diabetes-Blindness-Prevention-Initiative.pdf [accessed 22 May 2023].
3. Dirani, M., Out of sight: A report into diabetic eye disease in Australia. Melbourne: Baker IDI, Heart and Diabetes Institute, and the Centre for Eye Research Australia, 2013.
4. medicine.uq.edu.au/article/2020/10/we-could-be-doing-more-prevent-vision-loss-people-diabetes [accessed 22 May 2023].

Why Specsavers Supports KeepSight

Specsavers’ AU$5m investment in KeepSight, plus hundreds of thousands of additional dollars in the development of technology, optometrist education and support, has been critical to the program’s success. According to Specsavers’ Optometry Director Dr Ben Ashby the company’s rationale in providing this significant support goes all the way back to 2007 when Specsavers entered the Australian market. Back then, as it is today, there was a goal to ensure “the optometry profession was doing all it could do to enhance eye health outcomes for Australians and prevent vision loss that could have been avoided”. “Specsavers is in a unique position, having done a lot of the hard yards over many years to successfully develop and support measures that lead to improved eye health outcomes for patients. “We see more than four million patients for eye tests each year in Australia and monitor the trends and patterns in referral rates, visual acuity, and return rates among others to develop evidence-based strategies to improve patient outcomes. “We know that no man is an island though, so we work closely in well-formed strategic partnerships with many players in the sector to collaboratively develop models of care that are sustainable and lead to true change.” Dr Ashby said Specsavers’ partnership with KeepSight is an example of this, and the five-year trends seen in patients with diabetes accessing eyecare – both those returning and those accessing care for the first time – are encouraging. “We’re also thrilled to see that the wider optometric industry recognises the importance of this initiative, with 80% of the sector now able to seamlessly register patients to KeepSight,” he said. Making a Difference To date, Specsavers optometrists have sent more than 600,000 patient registrations to KeepSight – flagging both initial appointments and follow-up appointments for the ~80% of patients with diabetes who give consent for the registration to occur. And, interestingly, he said Specsavers is beginning to see differences in outcomes for around 20% of patients who are not registered for KeepSight compared to those who are. “For example, since 2019, a comparison of those who were registered to KeepSight versus those who weren’t, for a representative sample of patients from across Australia, saw that the average number of appointments per patient since 2019 was 2.6 for non-registered patients with diabetes and three for KeepSight registered patients. “On top of that, recall response rates for our KeepSight-registered patients with diabetes have shown to be markedly higher than those who opted out of registration. This shows that patients registered with KeepSight access eye care in a more timely and regular manner than other patients with diabetes. “Meanwhile, since January 2019, specialist referral rates have been in line with industry standards, with our optometrists referring 8% of patients with diabetes for specialist care. Despite our volume of comprehensive eye tests for patients with diabetes increasing, these rates have remained steady, showing that our optometrists are detecting abnormalities and referring for treatment as clinically indicated, giving us a baseline.” Looking Down the Road KeepSight was designed with long-term aims, and the full benefits of the program will be seen in the coming five to10 years. As patients in the program continue to access eye care more regularly, we will see improvements in their long-term vision outcomes. It seems obvious, however, that the program is already having success in ensuring high rates of recall adherence and review appointment attendance by patients with diabetes, laying the groundwork for clinical success for the future. “Changing behaviours and improving long-term health outcomes for this cohort of patients is not something that will happen overnight, but we are proud to partner with Diabetes Australia and be at the forefront of this once-in-a-generation opportunity to end avoidable blindness to diabetes,” Dr Ashby said.