Eye care in the outback

Lions Outback Vision has been providing teleophthalmology consultations to rural Western Australia since 2011. The telehealth clinics augment regular ophthalmology and optometry outreach clinics, and support resident local optometrists. The evolution of telehealth in Australia has moved the service from pilot studies and novelty projects, to an integrated daily service which reduces waiting times, enhances continuity of care, and improves the efficiency of outreach ophthalmology trips. All this leads to better outcomes for the patients and improved satisfaction with the services.

The impact of telehealth

For ophthalmology, the diagnostic imaging of the eye has improved with the increased availability of optical coherence tomography (OCT) which enables the detection of common pathology such as diabetic maculopathy and neovascular ‘wet’ macular degeneration. Functional tests such as visual fields also support imaging to manage glaucoma. After research and subsequent advocacy to government, Medicare rebates were introduced for optometrists to support telehealth in 2015. There are minimal further infrastructure costs, since ubiquitous platforms such as Skype are used for the video- consultation to consent patients for management and any planned procedures. 

Through telehealth, the direct booking to surgery for those patients in need has achieved three main outcomes:

1. It has eliminated the ‘wait for the waiting list’, which is the well-documented wait of up to one year for public service outpatients, prior to being placed on the waiting list for surgery.¹
2. The outreach trips ratio of surgery:clinic has reversed with more surgical management and therefore greater impact of the visiting team on visual outcomes.
3. The distillation of the pathology means a higher proportion of primary eye care is being appropriately managed by optometry with less duplication of patient assessment.

Attendance rates on the rise

A significant highlight of telehealth has been the extraordinary attendance rate with only 3% non- attendance. This is in stark contrast to the average of 50% in the community visits. Patients also demonstrated very high satisfaction, as highlighted in a study published in 2015.² “On call” telehealth was introduced in 2017 to improve the access for Aboriginal and Torres Strait Islander patients living in remote areas, since optometrists may only visit for one day and the online booking system was not appropriate. An evaluation of this service has seen the odds of Aboriginal patients accessing teleophthalmology significantly increase 11-fold.³

Engagement and uptake with optometry have been remarkable with 94% of optometrists in the regions visited by Lions Outback Vision participating in telehealth in the first year of the new MBS item numbers being introduced.

Looking to the future

The telehealth services will continue to evolve as videoconference technology becomes ubiquitous, in the form of smart phones/tablets, the use of OCT becomes standard and more available, and as cellular reception improves. New trials with hospital-based optometrists and registrars in the regions are underway. The use of artificial intelligence to assist primary care providers is currently being investigated in a research partnership with Google with an aim to improve access to eye care in remote areas and tackle the long-term workforce maldistribution.

References

1. Quang Do, Vet al. Are cataract surgery referrals to public hospital s in Australia poorly targeted. Clin Exp Ophthal 2017.
2. Host B, et al. Real-time teleophthalmology: an analysis of patient satisfaction in rural Western Australia. Clin Exp Optom Jan 2017 .
3. Nguyen, A., Baker, A., & Turner, A. (2018). Current state of Teleophthalmology in Western Australia. Clin Exp Ophthal, 46, 34-35. [S1010].

Dr Angus Turner is the Director of Lions Outback Vision