A peer reviewed Journal of Glaucoma article featuring Specsavers’ data has reinforced what the company has known all along: that routine use of OCT – combined with innovative processes – is the pathway to more timely glaucoma detection and prevention of avoidable vision loss. Here, Specsavers ANZ director of clinical services DR BEN ASHBY and his team detail each component underpinning this transformative strategy.
The strategy – Dr Ben Ashby, Specsavers ANZ director of clinical services
Specsavers has placed significant emphasis on the early detection of glaucoma for close to a decade. In 1996, the Blue Mountains Eye Study revealed 50% of people with glaucoma had the condition undetected, even after appropriate eye testing, and in 2017 the National Eye Health Survey repeated this finding.
As optometrists who are passionate about providing patients with the opportunity to protect vision through early detection and access to diagnosis and treatment, we wanted to change the unfortunate statistic and enhance eye health outcomes for our patients.
While standard optometry obviously includes appropriate testing techniques for the condition resulting in detection and referral, Specsavers has constantly trialled and engaged in new processes and procedures, measuring their impact in the name of increased and earlier glaucoma detection.
This has led to our optometrists increasing our detection rates to approximately 90% of all patients with glaucoma among our patient base, including those previously undiagnosed. Since 2016 across Australia and New Zealand, we have detected glaucoma for more than 200,000 patients and sent more than 300,000 referrals to specialists for diagnosis and treatment. We’ve also been able to discover a lot of new insights into the condition, and how it is diagnosed in Australia and New Zealand. For instance, high intraocular pressure is the classic risk factor for glaucoma, but three quarters of patients we have referred for treatment have an IOP in the normal range.
We know the findings we’ve discovered on our journey are groundbreaking, so much so that Specsavers’ glaucoma detection data was globally celebrated in a recent peer-reviewed article in the Journal of Glaucoma and now we are receiving requests from around the world for more information as optometrists worldwide work to replicate what we are learning in Australia and New Zealand.
Our glaucoma strategy is multi-faceted and has come about over many years with a lot of determination from a dedicated team. This article sees just some of the people behind this strategy explaining its various aspects that they have contributed to and any data and learnings associated with each.
If you have any further questions or are a non-Specsavers optometrist and want to employ some of these strategies in your testing environment, please don’t hesitate to contact us. The more we can do as an industry to detect initial stages of glaucoma, the more likely we are to have a future without preventable vision loss from the condition.
Technology – Jeena Tan, Specsavers ANZ head of clinical systems
During the past decade, Specsavers’ clinical systems and technology have been redeveloped and refined to ensure that all patients are receiving gold standard clinical diagnostics, and that this information is seamlessly accessible for optometrists. The most tangible element of the strategy was in 2018 when we installed OCT machines in every practice in Australia and New Zealand. We found that when we systematically used OCT on every patient as a part of their standard eye test in addition to consistent structural and functional assessment as per the RANZCO Referral Pathway for Glaucoma Management, detection of glaucoma increased substantially. On top of this, there were minimal changes to corresponding false positive referral rates. This data has most recently been published in detail in the Journal of Glaucoma study.
Since the rollout of OCT, we have integrated OCTs with our practice management system, networked our visual field analysers and integrated with our electronic referral platform. We continue to focus on leveraging technology to make it easier for optometrists to care for their patients. We know that if optometrists have straight-forward access to data, imaging and reports captured by each of these machines in their consulting room, they can be used in everyday testing and results can easily be compared over time, all at the click of a button. A feature to write therapeutic prescriptions electronically has also made it easier to prescribe treatments for glaucoma patients as required.
This has enabled our optometrists to confidently and appropriately co-manage more patients with glaucoma, ensuring our ophthalmology colleagues aren’t being inundated with appointments for routine checks that could have been carried out by optometrists thus enabling them to focus on the patients who truly need their support. This has become valuable in regional and rural locations where access to ophthalmology is not as readily available.
This is supported by our data which shows that over time, reviews for patients with confirmed glaucoma are increasing, indicating that patients are being actively reviewed and co-managed in Specsavers practices.
Information and data knowledge – Dr Joseph Paul, Specsavers ANZ head of professional services
Constant monitoring of patient outcomes has been critical to ensuring Specsavers’ glaucoma strategy has had the necessary impact on detecting previously undiagnosed glaucoma. Interrogating this data and making changes to our approach as needed has kept us on the right course.
The high volume of patients seen across the Specsavers network means data is captured that can be analysed in a meaningful way to establish individual, practice-level, regional and national patterns in glaucoma detection rates. We empower our optometrists by feeding this information back to them through weekly reports, providing them with an understanding of how they are providing the right outcomes for their patients. This includes information on how each optometrist’s glaucoma (and other eye conditions) detection rates compare to expected population prevalence, as well as giving information on their referral patterns, inter-professional communications, and their use of diagnostic tests. These benchmarked reports allow optometrists to understand their own practice patterns and identify any opportunities where the optometrist could further enhance patient outcomes or work on their professional development.
One example of this is when we discovered through data insights that if it was clinically indicated that a patient required a visual fields test, patients who underwent the visual field test on the same day were more likely to have glaucoma detected and a referral made. Whereas patients who did not have the test on the same day were more likely to not receive the test at all, making them less likely to have glaucoma detected, to be referred or to receive a diagnosis or treatment. To improve eye health outcomes for our patients, we worked closely with optometrists and practices to identify and eliminate the reasons why visual fields tests weren’t occurring on the same day. This was achieved through improved efficiency of clinic processes, communication and agility of roles and responsibility across store teams. Now, same-day visual fields tests occur for most patients, helping ensure that all patients receive the care they need.
Clinical Support – Nick Gidas, Specsavers ANZ head of clinical performance
Equipping optometrists with the latest knowledge, skills and processes to detect glaucoma in early stages is crucial to enabling best health outcomes for our patients.
As a part of my role, I am responsible for a team of clinical performance consultants who work across each Australian state and in New Zealand, supporting optometrists and store partners to deliver best health and sight correcting outcomes through ongoing coaching and training. This includes working closely with store teams to enhance processes and communication techniques specific to their store, patients or technology. It also involves identifying opportunities for improvement as found in weekly benchmark reports.
Our team has been able to improve glaucoma detection rates and health outcomes for patients with glaucoma by focusing on processes such as increasing the occurrence of same-day visual fields, training clinical support staff in capturing high quality retinal imaging and even increasing patient support group referrals.
Ongoing Education – Cindy Nguyen, Specsavers ANZ head of professional development
Specsavers is committed to ensuring that our optometrists are supported in their clinical practice with local and national opportunities for formal and informal education, whether it be our flagship Specsavers Clinical Conference, local CPD events or online education. In addition to cutting edge clinical training, our optometrists have access to education on communication, leadership and development to help them become the best optometrists they can be.
By marrying gold-standard diagnostic equipment with focussed education to help optometrists get the most out of that equipment, we are able to help all our optometrists confidently diagnose and manage glaucoma.
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