Funding for OCT machines and the embedding of medical retina and injection clinics in two new locations in the Northern Territory’s Top End has helped turn around poor treatment attendance and compliance among the local Indigenous population.
Previously, patients in the region with diabetic macular oedema (DME) were required to travel long distances to the Royal Darwin Hospital (RDH) that housed the only OCT machine – a vital tool in determining whether patients would benefit from anti-VEGF therapy or to monitor outcomes.
According to Professor Peter McCluskey, director of the University of Sydney’s Save Sight Institute (SSI), 10 to 20 patients per week and their carers were flown to Darwin for assessment from communities located hundreds of kilometres away like Gove and Katherine.
But the transport and accommodation costs for the care was costing NT Health large sums of money, and many patients either did not attend or discontinued their treatment.
With the support of McCluskey and other visiting consultants from the SSI, Northern Territory-based ophthalmologists Dr Tharmalingam Mahendrarajah and Dr Nishantha Wijesinghe realised that by funding OCT machines in remote communities they could radically improve the situation and save the health system significant expenditure.
Careful negotiation and lobbying with RDH and NT Health lead to the purchase of an OCT machine for Katherine.
McCluskey and his colleague conducted an audit 12 months after the purchase and showed that within six months the OCT scanner had paid for itself from savings in patient travel. It also demonstrated that patient attendance and treatment outcomes improved significantly.
A second OCT was then purchased for the Gove community. OCTs for other remote communities are now being considered.
Subsequently, McCluskey said monthly medical retina and injection clinics with a consultant and registrar from RDH have been running in Gove and Katherine, with few patients needing to travel to RDH and vastly improved patient compliance and treatment outcomes.
“What we did with this project was come up with a collaborative solution for an area of unmet need, that was causing avoidable blindness,” McCluskey said.
“There is a high prevalence of vision-threatening diabetic retinopathy and a need to take treatment to the community rather than have the patients make frequent trips to Darwin.”
In 2020, McCluskey said the COVID-19 pandemic highlighted the success of the community-based model of care, with regular visiting registrar clinics able to continue in both Gove and Katherine, with back-up telehealth consultant support from Darwin.
“There has been minimal disruption to intravitreal therapy for patients in these communities,” he said.