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HomemieyecareThe Power of OCT Evidence in Glaucoma Management

The Power of OCT Evidence in Glaucoma Management

After many years of scrutiny and refinement, a peer reviewed article featuring Specsavers’ glaucoma data has been published in the Journal of Glaucoma, 1 a renowned scientific journal for glaucoma research.

The data – a retrospective review of routinelycollected electronic medical records of patients from 331 Specsavers practices in Australia – shows that when optometrists use optical coherence tomography (OCT) as a routine clinical tool, they are more likely to refer patients for specialist glaucoma management than those optometrists not using OCT.

These findings have been known and shared by Specsavers ever since the company made the decision to roll out OCTs into each of its practices in 2016, but for the first time, the data has been peer reviewed.

THE SPECSAVERS ROLLOUT

Specsavers started with a pilot that had the specific objective of targeting the 50% of patients with undiagnosed glaucoma as reported in the Blue Mountains Eye Study and the National Eye Health Survey.

This rate had remained relatively unchanged for the past three decades, primarily due to the nature of glaucoma with a lack of overt signs and symptoms in early stages, and with functional deficits often preceded by extensive structural damage before they manifest in a way that the patient can notice.

When we started using OCT technology consistently, in conjunction with the Royal Australian and New Zealand College of Ophthalmology (RANZCO) Referral Pathway for Glaucoma Management and the other assessments included in an eye test, we saw an enhanced detection of glaucoma and were able to refer patients at earlier stages than before.

We’ve been utilising the technology in this way with every patient in Australia and New Zealand ever since.

The Journal of Glaucoma article, which reviewed the deidentified records for every patient aged 18–99 years who attended an included Specsavers practice in Australia between 1 January and 31 July 2019, confirmed that those practices that used OCT consistently in their practice referred 1.1% of their patients for glaucoma, compared to practices without OCT who referred 0.8% of patients.

Ophthalmologist feedback found 41% of the referred patients were diagnosed with glaucoma, 38% were considered to be glaucoma suspects, and no sign of glaucoma was detected in 21%.

ADVOCATING FOR INDUSTRY TO FOLLOW

While this peer-reviewed article showcases a proud moment in time, a lot more has happened since 2019, when the data was collected. Specsavers practices in Australia and New Zealand follow the methods outlined in the article alongside other processes and strategies we’ve implemented, and have detected glaucoma in more than 200,000 patients since 2015.

It is hoped that by sharing this data, other practitioners will follow the lead and employ the same glaucoma detection techniques, leading to earlier detection rates for patients everywhere.

IMPROVING DETECTION

The implementation of OCT was just the beginning of our journey. Specsavers has implemented a number of other initiatives and processes that have led to further detection improvements.

The in- and out-of-store processes help optometrists detect glaucoma and include same-day visual field processes, integrating OCT directly with the practice management system, networking visual field analysers and other equipment, glaucoma-specific recalls, and electronic therapeutic prescribing. Every practice receives weekly glaucoma outcome reporting to drive continuous individual improvement. Specsavers has a team of clinical performance consultants to support optometrists to improve glaucoma diagnosis and management. We even cover the topics thoroughly in optometrist inductions, as well as in our ongoing local and national continuing professional development programs.

With these measures in place, even with COVID-19 restrictions leading to decreased patient volume numbers, the percentage of patients that we’ve referred to ophthalmologists for glaucoma has continued to increase year on year.

With a focus on glaucoma detection for eight years now, Specsavers has developed a large database of patients with the condition. Since 2016, Specsavers has made more than 300,000 total referrals for glaucoma, looking after more than 200,000 unique patients.

Over time, the percentage of first-time referrals compared to re-referrals has begun to slightly decrease.

We believe that as we are detecting more of the population, there are less people with undiagnosed glaucoma, making it less common to detect for the first time. This is heartening, as our obvious aim through all our work is to find all undiagnosed glaucoma and detect it as early as possible so that all Australians have the chance to manage or treat this sight-threatening disease and protect their vision.

Finally, something that wasn’t mentioned in the peer reviewed article is that the average age of first-time referrals decreased significantly when we implemented systematic use of OCT.

Straight away, we found that as we were detecting the disease earlier, the amount of 40 to 64-year-olds who were being referred increased. Many of these younger patients had normal range intraocular pressures and would not have had any clinical indication for an OCT prior to us standardising the scan.

The OCT roll out was completed in 2018 and since the initial referral rate boosts, rates haven’t grown as significantly but slight increases have occurred, reaching up to 1.5%.

This shows that we’ve reached a new benchmark of glaucoma referral for this patient age group and that due to our consistent utilisation of OCT in conjunction with our other processes, we’re detecting the condition earlier for patients, well before it affects vision.

CONNECTING PATIENTS TO GLAUCOMA AUSTRALIA

Alongside the increase in glaucoma detection and referrals to ophthalmology, Specsavers is now looking at ways to increase referrals of glaucoma patients to Glaucoma Australia.

Glaucoma Australia’s Sightwise patient support and education program is like an extension of care for optometrists and can really make a difference once a patient has left the testing room.

The team at Glaucoma Australia works closely with patients to understand their situation and to eliminate any concerns or factors that might impact on the patient receiving future care or treatment.

A recent survey into the effectiveness of the program showed that 84% of patients who take part adhere to their prescribed treatments, and 91% of patients in the program attend their recommended appointments2 – both important indicators for management success.

In addition, the number of patients surveyed who rated their knowledge of glaucoma and how it is treated as ‘above average’ or ‘excellent’ increased from 37% to 51% after receiving education and support through Sightwise, while those who rated their knowledge as below average, or poor fell from 22% to 6%.

JUST THE BEGINNING

While Specsavers has committed a great deal of time and resource into enhancing eye health outcomes for people with glaucoma, we are also committed to protecting vision from other eye conditions and supporting patients at all levels of their eye health journey.

Our work as a co-founder of KeepSight has now seen Specsavers optometrists refer more than 700,000 appointments to the program, which has increased the likelihood of patients with diabetes returning for eye tests in a timely manner by 20%.

Our work with Macular Disease Foundation Australia, in a recent pilot, helped to formulate its My Eyes patient support program, which will be formally launched in May. We’re also working more holistically with all patient support bodies and have created a network that has a shared ambition of working together to collaboratively develop patient-centered solutions to address shared problems.

While significant in-roads have been made, there are still 10 million people across Australia and New Zealand not accessing regular eye care.

With the breadth of our network and passion of our optometrists, we can make a real difference in helping those people access eye care through our practices as we continue in our commitment to change lives through better sight for all.

Dr Ben Ashby is the Director of Optometry Australia and New Zealand at Specsavers. He has responsibility for clinical performance, optometry professional development, professional services, and the development of clinical systems. He is actively involved in the research, development, and implementation of sustainable models of eye care delivery that improve patient outcomes and reduce avoidable blindness.

References

  1. Paul, J. P., McGuinness, M.B., Ashby, B.D., Larsen, P.D., et al., Increased glaucoma case-finding through routine optical coherence tomography in optometry practice. Journal of Glaucoma 28 November 2023. DOI: 10.1097/IJG.0000000000002339.
  2. Glaucoma Australia Patient Impact Measurement Survey 2023