Feature, Soapbox

2020 – The benefits of hindsight and foresight

After years of having 2020 as the milestone for so many vision initiatives, here we are! This makes it an especially good time to pause and take stock.

The latest figures from the World Health Organisation estimate that there are 2.2 billion people with vision impairment, of whom 1 billion have lost vision from something that could have been prevented or treated. There is a lot of work to do, but this is far better than it might have been without the rallying cry of Vision 2020: the Right to Sight as a movement.

Globally, between 1990 and 2015 the number of blind people rose from 30.6 million to 36 million, and those with moderate and severe visual impairment increased from 159.9 million to 216.6 million. This reflects that even while age-specific disease prevalence decreased (by about one-third for blindness and one-quarter for vision loss, respectively), increasing population growth and ageing had a greater impact.

Our most recent national data comes from the National Eye Health Survey, which estimated that more than 450,000 Australians are affected by visual impairment or blindness. Ninety percent of our vision loss and blindness is preventable or treatable and, astonishingly, about 60% of this is caused by uncorrected refractive error.

We must face up to a growing burden of disease, even when we are still not currently on top of Australia’s eye health. Areas of need include the 50% of Australians with glaucoma who are undiagnosed, and the similar figure of people with diabetes who don’t get recommended interval screening. This is a real problem when of the nearly 1.7 million Australians with diabetes, 29% over the age of 50 have diabetic retinopathy, and 4.5% have sight-threatening diabetic retinopathy.

There is a new opportunity to track down those people through the new national KeepSight programme, the success of which relies on the support of all eyecare providers.

The latest report from the University of Melbourne’s Indigenous Eye Health Unit (IEHU) shows a halving of the gap between the standards of mainstream and Indigenous eye health from 2008 to 2015. (Full disclosure, IEHU head Hugh Taylor is my father). It shows that a truly systems-level, integrated approach is making difference, even while relatively few other indicators of the wellbeing of Indigenous Australians do so.

What does this look like looking ahead? Well, firstly, finding a replacement catch cry for 2020 will be hard without sounding like we are losing acuity. Branding aside, greater acuity – in terms of efficiency and productivity, digital decision support and big data – is what we must expect.

The indications are already here. The growing demands of disease burden in ageing populations globally. The rise of teleophthalmology in the US, for which we should re-align the funding mechanisms here in Australia. The supplementation of our human workforce and diagnostic instrumentation with AI as seen in the UK and Singapore.

We should expect a confluence of trends, and it will give rise to the question of “Where?”. Will optometry assume a greater responsibility, expanding the role of primary eye care? Is the trend going to be in GP offices, reflecting the overriding global perception of optometry associated with spectacles rather than medical care? Is it going to be “one stop” scanning booths in pharmacies? Will we be advanced enough to take place in the patient’s home using mobile phone technology? I’ve heard arguments both ways that one of optometry or ophthalmology will become redundant – will this be true?

What doesn’t change is that eyecare will remain a “team sport”. Multi-disciplinary teams in which everyone works to the top of their scope – a scope potentially expanded by AI – will be essential for affordable, sustainable systems.

As we look to the exciting horizon of new, personalised immunologic and genetic therapies, the costs of treatment can only continue to rise. This means that it will be more critical than ever to ensure connected care corrects the gaps and systemic overlaps in care pathways.

Globally, this has many components. One is finally succeeding in eradicating the fax as a medical tool. A second is aligning the disjointed health funding systems, so that there are not perverse incentives creating inefficiencies between community-based and hospital care, between prevention and treatment, between the insured and the un- or under-insured. A third is critically reviewing care pathways so that cost-effective technologies are appropriately plugged into workflows to promote adoption. A final one is building data systems to amass the evidence base to inform our choices.

And as for Vision 2021 and beyond? There’s certainly lots of need, opportunities and tough choices. Solutions can only be as good as the people implementing them. Let’s get to work!

ABOUT THE AUTHOR:

Name: Kate Taylor

Qualifications: MBBS MPH GAICD

Workplace: Oculo

Position: CEO

Special interests: Innovation, sustainability, quality health outcomes

Location: Melbourne

Years in profession: 25