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Report

Drilling down into Specsavers’ state of the nation report

03/12/2018By Myles Hume
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Tracking 6.3 million patients, Specsavers’ State of the Nation Report provides an unprecedented examination of eye health across Australasia. MYLES HUME takes a closer inspection to see what it discovered.

The overarching point hammered home in Specsavers’ State of the Nation Report is a need for further industry-wide collaboration.

Detection and treatment in isolation is no longer enough. This, the report says, is imperative if practitioners are to stem the 270,000 (one in 100) Australians expected to suffer preventable vision loss by 2020, costing the ageing nation $16.6 billion per year.

Tracking the experiences of 6.3 million Specsavers patients, the company has compiled and analysed unprecedented volumes of eyecare data for Australia and New Zealand, shining a spotlight on the impact of current strategies and interventions.

The report singled out the “overwhelmingly real and positive impact” that systematic use of optical coherence tomography (OCT), used alongside clinical benchmark reporting and RANZCO referral guidelines, has already had in tackling key causes of vision loss and blindness.

This has been most evident in glaucoma, where Specsavers’ referral rates have doubled in one year.

According to the report, Specsavers in 2017 referred around 15,000 patients for glaucoma. In 2018, an additional 7,300 patients were flagged largely due to implementation of the RANZCO referral pathway for glaucoma and benchmark reporting.

The report said factors contributing to this marked increase include; optometrists having a clearer understanding of when to refer using the RANZCO guidelines, and optometrists re-evaluating individual clinical practice and/or completing professional development activities in response to feedback via benchmark reports.

If all practitioners adopted these initiatives, along with OCT, then it is thought glaucoma would be detected in some 80,000 Australians next year alone. This is important considering 50% of people with glaucoma in Australia remain undiagnosed.

OCT

Incorporating OCT in standard patient care has been the other major driver in increased glaucoma referrals.

Across the 85 practices that systematically used OCT over the past 12 months, Specsavers is now referring an additional 9,900 glaucoma patients annually compared with 2017.

With the majority of glaucoma referrals having intraocular pressure (IOP) within the normal range, the systematic use of OCT proved superior for detecting low-tension glaucoma. These were patients with visible optic nerve change or other overt signs, without raised IOP.

“This suggests OCT is an effective tool in identifying more people in need of referral for glaucoma across all age groups. The 2018 OCT data also indicates that by using OCT on every patient, Specsavers is able to detect glaucoma at a rate close to population prevalence,” the report stated.

In medical retina cases, the majority of which are age-related macular degeneration (AMD) patients, practices systematically using OCT detected 69% more cases than non-OCT in 2018. Importantly, it detected 194% more cases compared with 2017.

In diabetic macular oedema, practices using OCT are referring 85% more cases than non-OCT.


Medicare

Optometric consultations across all Medicare Benefits Schedule (MBS) item numbers have increased 51% over the past 10 years, with 71.7 million in total.

That is expected to increase an average of 5% per year. As a result, optometric consultations are predicted to exceed 9.5 million by 2020 and 12.2 million by 2025.

In the 2018 financial year there were 8.7 million optometric consultations in Australia. Comprehensive initial consultations (MBS item numbers 10900, 10910, 10911, 10905 and 10907) accounted for 43%, followed by subsequent consultations (10918) at 25% and other comprehensive consultations (10912, 10913 and 10914) at 19%.

Breaking down initial consultation figures, there were 4.68 million in the 2018 financial year, of which 1.42 million (38.9%) were over 65.

“[This] suggests that as many as one in six older Australians aren’t taking advantage of the annual comprehensive eye test covered by Medicare,” the report said.

In the 45–64 age-bracket, there were 1.29 million consultations (22.1%), 1.44 million for 15–44-year-olds (15.2%), and 513,000 for children under 14 (11.8%).

Again, this suggests that the majority of Australians are not having their eyes tested as regularly as the industry recommends.

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Call for change

Based on its findings, Specsavers has called for changes to the Optometric Medical Benefits Scheme.

Interestingly, it called for the creation of a “new code”, allowing patients between 45–64 to access optometric consultations every 24 months, instead of every 36 months – a position supported by Optometry Australia.

“There is strong evidence to support a comprehensive eye examination every two years, even if asymptomatic, for adults aged 45–64 including the importance of early detection of asymptomatic conditions such as glaucoma and the lack of community understanding of the often insidious nature of vision loss,” the report stated.

In Item 10905 – a comprehensive initial consultation referred to an optometrist by another optometrist – the report called for inclusion of written referrals from “a medical practitioner” too, claiming it would lead to improved patient health outcomes as a result of enhanced intra-profession referrals and communication.

Despite there being 4.68 million initial consultations in the 2018 financial year, a mere 10,838 (0.2%) came under this item.

In items 10916 and 10918 (brief initial consultations), the report authors believed restrictions on billing of visual fields (10940 and 10941) should be removed. They claimed there were instances in which visual fields may be clinically indicated alongside a consultation that may be most appropriately billed to 10916 or 10918 (i.e. monitoring a patient with glaucoma requires both periodic review of visual fields and IOP measurement).

In Item 10914 (progressive disorders), the report said criteria should be amended to support early identification and intervention because there were several conditions, including glaucoma and AMD, where initial diagnosis at an early stage required detection of early progression.

Item 10915 (mydriatic, diabetes mellitus): Remove the requirement for dilation and ambiguity related to the billing of patients with diabetes mellitus to ensure patients with diabetes are accurately identified when examined by an optometrist.

10940 and 10941: Enable visual fields to be performed on behalf of, and by, an optometrist – and allow further visual fields examination in the same 12 month period in the presence of one of; established glaucoma in which there has been definite progression of damage over 12 months; established neurological disease which may be progressive and where a visual field is necessary for the management of the patient; or monitoring for ocular disease or disease of the visual pathways which may be caused by systemic reactions to certain drugs.





Patient awareness

One in three Australians are projected to be over 55 by 2032, and the government estimates vision impairment will be the most prevalent health condition among older people.

According to the report, the biggest barriers to people having their eyes tested regularly tie back to a general lack of awareness and understanding of eye health, the belief that nothing is wrong, a lack of time and perceived cost.

The majority of people in Australia (65%) don’t know the most common form of glaucoma has no symptoms and almost 43% couldn’t say whether glaucoma was an avoidable cause of blindness.

Furthermore, of those who said they had some awareness of glaucoma there was extremely high uncertainty around prevalence of the disease, the increased risk if a family member is diagnosed, and the age at which people should begin regular eye tests for it.

Of those who had heard of AMD, the majority were relatively unfamiliar with the condition, with most having a relatively poor understanding and 43% not knowing it’s the leading cause of blindness in their country.

While roughly 80% of people in both Australia and New Zealand are clear of the role that optometrists play in detecting AMD, nearly half aren’t aware lifestyle changes can help manage the disease.

Diabetic retinopathy had the least level of awareness of all the major eye diseases. Of the people who had heard of it, 89% said they had little knowledge about the disease or nothing at all.

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