For the past two years, Specsavers has been measuring the impact of its progressive models for preventative eyecare, resulting in the country’s largest eye health data set. MYLES HUME analyses the company’s second annual report on its progress.
Specsavers’ latest snapshot into Australian eye health has revealed referrals for eye disease are soaring to new and unprecedented levels.
Thanks to the blanket use of imaging technology to inform the standard eye test, ophthalmology-led education and other clinical interventions to deliver timely and accessible care, the optical chain’s latest statistics show it is continuing to move the needle on disease detection rates.
The data, from its Specsavers Eye Health Report 2019-20, detailed the major inroads its optometrists are making, particularly in terms of earlier glaucoma detection and referral. The organisation is identifying more patients in their 40s with the disease, while also aligning actual detection rates with prevalence estimates.
Released late last year, the 88-page document is a follow up to the company’s inaugural 2018 State of the Nation Eye Health Report. Billed at the time as the most in-depth examination of Australian eye health, it established a yardstick to measure future reports and outcomes against.
In its latest report, Specsavers analysed data from 8.5 million patient journeys to quantify both the impact of its strategies and the Australian public’s attitude towards eye health. It is the largest publicly available data set of its kind in the region, increasing by an additional 3.5 million data points this year.
Asked about the significance of the updated report Mr Peter Larsen, Specsavers’ group eye health strategy director, explained: “Its purpose is to present our own data – collected systematically in every patient engagement – to demonstrate clearly that a systematic approach to patient care delivers improved health outcomes.
“We want all stakeholders within our broad profession to be able to access and use this report as a benchmarking tool in itself, against which they can test their own patient data.”
Glaucoma: Turning the tide
Specsavers’ most notable impact has been in the detection and referral of glaucoma and diabetic eye disease, underpinned by its initiative to include optical coherence tomography (OCT) as an element of every patient’s eye exam.
The figures show glaucoma referrals have almost tripled in two years. Between July and December 2017, when OCT was installed in just 3% of stores, Specsavers referred 10,562 patients to ophthalmology.
By 31 July last year glaucoma referral numbers had increased to 24,477. With OCT now available across all 334 Australian stores, referrals were projected to reach 42,000 by the end of 2019, an increase of 19% on 2018 (34,053) and 64% on 2017 (15,145).
Overall, sample statistics show 86% of referrals have been deemed appropriate by ophthalmologists, with 14% being false positives.
“The findings [also] indicate that more than half (53%) of the referrals to ophthalmology in 2019 were new referrals. This closely aligns with the findings of the Blue Mountains Eye Study from 1992-1994,” the report states.
“Furthermore, new glaucoma diagnoses made up the majority of referrals for those under the age of 49; 72.8% for people under the age of 40 and 68.7% for people 40 to 49.”
Tackling diabetic eye disease
The convergence of IT, data, training and collaboration strategies has allowed Specsavers to expand its focus on other causes of preventable vision loss.
One of those has been diabetic retinopathy. At 31 July 2019, 7,028 patients were referred to ophthalmology for the disease. Based on the current referral rates, this figure was projected to reach 12,000 patients by the end of 2019, an increase of 34% on 2018 (8,982) and 205% on 2017 (3,931).
“This year, following enhancements to Specsavers’ patient management system to enable optometrists to simply and consistently identify patients with diabetes, and the introduction of the KeepSight portal, for the first time we are able to properly start measuring eye health outcomes for this subset of the total population,” the report states.
“The ability to analyse data specifically for patients with diabetes opens up many opportunities to better understand eyecare for this at-risk group.”
Specsavers is currently registering 1,500 diabetes patients every week to the KeepSight database to ensure they receive regular eye test reminders. Total registrations were forecast to reach 36,000 by the end of 2019.
Additionally, the data reveals that in 2018 20.1% of diabetic eye referrals from practices using OCT identified macular oedema compared with 12.8% for non-OCT practices.
Specsavers’ OCT rollout means 1,000 optometrists will now use the technology on as many as four million patients a year, translating to one in six registered optometrists across Australasia.
While the systematic use of OCT has been the catalyst for significant change, other clinical interventions are also having a measurable impact.
This includes use of the RANZCO Referral Pathways, the Oculo e-referral platform and Optometry Benchmark Reporting. Increased use and same day performance of visual fields on at-risk patients is also helping minimise the number of patients lost to follow up.
Another major contributing factor has been the recently-introduced ophthalmology-led education workshops.
Called the Ophthalmologist Local Education and Engagement Program (OLEEP), the initiative is designed to improve optometrists’ decision making and ability to detect glaucoma suspects.
The face-to-face events have so far been held in 18 sites across Australia and New Zealand, reaching some 200 optometrists. Among those who have attended the events, glaucoma referrals have increased by 35%, further aligning with national prevalence rates.
This increase in referrals has also aligned with increased use of visual field testing – from 8.1% to 11.4% of patients.
Additionally, ophthalmological feedback has helped deliver greater consistency and a reduction in the number of false positive referrals, which are expected to continue to decline over time.
Eye disease awareness and understanding
Specsavers also uses the annual report as an opportunity to track public awareness and understanding of eye disease.
Of the three major sight-threatening eye diseases, diabetic retinopathy again had the lowest awareness levels. Only 34% of Australians have heard of the condition, with 78% not knowing anything about it.
Prompted awareness of glaucoma remained steady at 74%, with 53% admitting they aren’t aware of it. Awareness of macular degeneration remains low in Australia at 60%.
While the vast majority believe they should get their eyes tested regularly, 33% of Australians couldn’t recall having an eye test in the past two years.
The top three reasons were; not thinking there’s anything wrong (20%); cost concerns (20%); and don’t have time/haven’t gotten around to it (17%).
While the cost of standard comprehensive eye test is government funded in Australia, 41% did not know tests are bulk billed through Medicare.
As many as 30% of people (up from 22% in 2018) think they’ll be out of pocket between $20 and $100+, while 11% (down from 19% in 2018) don’t know whether they will be charged for an eye test or not.
“The confusion around costs in Australia could be as a result of some optometrists charging gap payments for diagnostic tests, such as retinal photographs, OCT and visual fields. Regardless, more education is required to inform Australians of their entitlements under Medicare,” the report states.