Research

An opportunity to engage

Current data suggests that a quarter of all Australians with diabetes do not receive the National Health and Medical Research Council-recommended retinal examination every two years. For Aboriginal and Torres Strait Islander people with diabetes, only half receive the recommended annual retinal examinations. At any given time, approximately one third of those with diabetes will have diabetic retinopathy and one in 10 will have sight-threatening retinopathy requiring prompt treatment.We know that up to 98% of the blindness caused by diabetic retinopathy can be prevented by early detection and timely treatment and that all people with diabetes are at risk of developing diabetic retinopathy if they live long enough.{{quote-A:R-W:450-Q: The intention of the MBS its is not to replace existing optometry or ophthalmology care but rather support primary care practitioners undertaking regular eye assessments as part of comprehensive diabetes care. }}Getting primary care on board with these messages and actively contributing to screening for diabetic eye disease will ensure eye changes are found earlier, thereby avoiding severe retinopathy and preventing vision loss and blindness. On the other hand, many people with diabetes will have no retinopathy and without other visual probls they do not require additional comprehensive eye exams.The new Medicare its for non-mydriatic photography will enable easy and affordable eye screening within a primary care setting for those with diabetes. This will be important for both mainstream and Indigenous people with diabetes as providing this service in primary care means that a separate specialist (optometrist or ophthalmologist) appointment may not be required.However, the new its include a VA test and retinal photography. Those with abnormalities are to be referred for further assessment and treatment. If the vision is found to be impaired or a photograph cannot be obtained then the patient requires a comprehensive eye examination and should be referred, as they should be if signs of retinopathy are seen. This means all those with probls that need further attention will be referred for further assessment.The advantages of this for optometrists and ophthalmologists is that they will receive referrals for those people with diabetes who really need their care – those with retinopathy and vision loss – rather than screening a whole lot of people who are normal. One would also expect the overall number of people with diabetes being screened will increase and consequently deliver earlier and additional referral for specialist eye care.I suggest that optometry uses the new MBS its as a great opportunity to engage with local GPs. Many GPs will not have the space, inclination or sufficient patients with diabetes to justify the purchase of a camera. These GPs should be supported with clear and easy referral pathways and care protocols for their patients with diabetes.Those who do decide to purchase cameras will require a degree of support on how to use the cameras, as well as somewhere to refer patients who do not pass the screening. There is also an opportunity to support GPs in reading and grading photographs.The intention of the MBS its is not to replace existing optometry or ophthalmology care but rather support primary care practitioners undertaking regular eye assessments as part of comprehensive diabetes care.Optometrists providing care in Aboriginal and Torres Strait Islander communities should consider the advantages of opportunistic screening for Indigenous patients with diabetes and how this can complent and support their regular care. For patients who would otherwise not receive regular eye care due to access barriers, the initiative represents an important step forward to close the gap for vision.The introduction of new MBS its supporting GPs to provide retinal screening for patients with diabetes presents a new opportunity for optometry to engage with primary care. I encourage optometrists to brace this opportunity to improve public health by working with our medical colleagues and additionally contribute to increasing diabetic retinopathy screening rates for all Australians.


Name: Mitchell Anjou AMQualifications: MScOptom, BScOptom, FACOOrganisation: Indigenous Eye Health, The University of MelbournePosition: Acadic specialist, senior research fellowLocation: Melbourne, VictoriaYears in the profession: 34 years