Adelaide now has a dedicated bulk-billing clinic for anti-vascular endothelial growth factor (anti-VEGF) eye injections, the only service of its kind in the city, giving patients with macular disease access to sight-saving treatment with no out-of-pocket costs.
The clinic, Adelaide Macular, has been established by ophthalmologist Dr Paul Athanasiov, who splits his working week between Vision Eye Institute, where he spends three days on cataract surgery and general eye care, and the two days he has carved out for his own venture treating patients with neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO), and retinal vein occlusion (RVO).
“We’ve been getting quite a lot of interest in the clinic,” Dr Athanasiov said. “It’s been really, really nice to be able to offer this to the Adelaide community.”
Wait times for ophthalmology in South Australia’s public hospitals stretch anywhere from one month to five years
In Response to Barriers
The idea grew out of what he was seeing in his own referrals to the public system. Wait times for ophthalmology in South Australia’s public hospitals stretch anywhere from one month to five years, he said.
“I’ve had a number of patients say that they’ve waited more than 12 months, and that’s my experience in referring a patient to public with wet AMD,” he said. “They’ll wait at least a year and that can be devastating for their vision if they aren’t being seen in private clinics.”
That gap between diagnosis and the public system’s capacity to act was, in Dr Athanasiov’s view, exactly the problem a dedicated bulk-billing clinic could solve. “You want to get them in to have an injection within days,” he said. “But the public hospital just doesn’t have the capacity to take people on that quickly, both in terms of their administrative processes and in terms of the number of doctors they’ve got.
“In one day, a public hospital registrar could do maybe 20 injections, whereas in a specialised private clinic, you can do 80 or more if you’ve set it up correctly.”
Lean By Design
As a single-purpose operation, Dr Athanasiov said it is entirely possible for Adelaide Macular to be financially sustainable, despite bulk-billing for every service.
The clinic runs lean by design, and that is central to how the model pays for itself. There is no receptionist; patients check themselves in on an iPad, and the clinical assistant simply comes out to collect them for testing. Booking the next round of visits and sending the appointment reminders takes moments. “We’re saving around AU$80,000 a year on a staff member, and the space required for that staff member to sit behind a desk,” Dr Athanasiov said.
Much of the equipment was acquired second-hand. All patients receive a high-resolution optical coherence tomography (OCT) scan, a vision check, a pressure reading, and their injection(s).
“We’re only here to do the macular injection,” Dr Athanasiov said. “I don’t mind if they’re rich, poor, or in between: if they’ve got a Medicare card, they are welcome. If, however, they’ve got a range of other complaints about their eyes, they will need to be seen somewhere else.” That said, the experienced clinical optometrist in their team ensures that all patients are being seen at least once per year to screen for glaucoma.
The clinic does not use the orthoptist-led triage model common in larger ophthalmology practices. In South Australia, Dr Athanasiov relies on a smaller team: one staff member runs the OCT, vision test, and pressure check before bringing the patient through, and he reviews the images himself immediately before giving the injection. Most patients arrive with an established diagnosis and a long history of treatment, he said, so the visit is “not so much a diagnostic issue, it’s just treatment”.
Better Experience All Round
Dr Athanasiov said bringing patients into a dedicated injecting clinic is “better for the patient, both financially and logistically”. And, he said, his own general clinic runs more smoothly now that injections are no longer disrupting the flow.
“When patients come [to Adelaide Macular], everyone knows why they’re there, and we do the same process repeatedly, so patients are out within 15 to 20 minutes,” he said. “Even if they have to travel for an hour to get here, it’s often faster than attending a general clinic.”
The response from patients has been, by his account, overwhelming. Some are still adjusting to how simple the process is. “Some of them look at me after I’ve done the injection and go, ‘So I just walk out?’ I’m like, ‘Yeah, just walk out’. They can’t believe it.”
Dr Athanasiov hopes his Adelaide experience will encourage other ophthalmologists, in South Australia and elsewhere, to consider something similar. He has since been approached about applying the model in regional and remote settings elsewhere in Australia.
“I think it’ll gradually become more accepted as a way to go,” he said. “The key is not that you don’t charge, it’s that you have a dedicated clinic set up for one thing, even if it’s just adjacent to your normal clinic or on a separate day.”
