People living in the east of Perth’s vast metropolitan area have little or no access to public eyecare services, resulting in dire consequences for some. Lions Eye Institute is hoping to fix this with an intriguing initiative.
Ms Gaela Hilditch’s battle with glaucoma began with a squash ball – the one that hit her in the eye.
That was more than 50 years ago, but the journey from there to now, as she recovers from eye surgery in her West Australia home, is sadly indicative of the long slog many people go through to have their eye issues recognised and fixed.
It’s a problem that WA’s Lions Eye Institute (LEI) is hoping to solve with a new glaucoma collaborative care initiative that gives patients faster, better access to eye care and preserves or improves their sight.
Hilditch’s problems didn’t seem too bad in the immediate aftermath of her scrape with the squash ball, but she then started having problems with her vision.
Opticians in her home country, Britain, were unable to detect any issues and simply prescribed eye drops.
Fast-forward 25 years to Perth, where ophthalmologist Professor Bill Morgan established that she had trauma-induced glaucoma.
Incredibly, Hilditch says that she’s one of the lucky ones.
Her surgery was covered by private health insurance and the 74-year-old is now on the road to recovery and improved vision.
That’s not possible for everyone in Perth, particularly people who are outside the central Perth area and quite some distance from the only public eyecare facility at Royal Perth Hospital. Added to this, most glaucoma sufferers are over 60.
Hilditch is involved in a Consumer Engagement Committee, in which people shared sometimes desperate stories of inequities in access to eyecare and glaucoma treatment in WA.
“They’re older, they’ve got disabilities, they are very vulnerable,” Hilditch says. “They’ve got to go all the way into Perth. They can’t find a park, and they can’t necessarily even drive, because they are partially blind.
“Some of them are waiting a whole year to be seen and, in the meantime, they’ve lost even more vision.
LEI is hoping to address many of these issues in its initiative.
It has teamed up with the University of Western Australia and Royal Perth Hospital (RPH) to bring top-quality glaucoma services combined with optometry services to sufferers in parts of the city with limited access to public and private eyecare.
Morgan, a professor of ophthalmology at the university and a consultant ophthalmologist at LEI and RPH, has seen how this poor access to timely services over many years has played out unhappily for patients.
“The biggest challenge has been the increasing division between, if you like, private eyecare provision and the public clinic provision,” he says.
“The metropolitan area is essentially divided, with the western area of the city facing the ocean having good access to services and then once you go east there are no public eye facilities whatsoever.
“People in the eastern parts of the city have really limited access to eyecare, particularly if they can’t afford private eyecare or are deterred by the lengthy bus ride into Royal Perth Hospital.”
He says the collaboration will help to address these long-standing access inequities.
The initiative has earned a $276,000 grant from the WA state government as part of its $4 million program of support for innovative projects to address health priorities.
“When we applied for the grant, which was about May or June of 2023, there were already large numbers of glaucoma patients who were ‘over boundary’, meaning they had gone past the recommended four- or six-month appointment time, and they hadn’t been seen,” Prof Morgan says.
To help fix this, students from the university’s Doctor of Optometry program – which opened in 2021 – will be part of the solution at the LEI clinic at Midland, in Perth’s eastern corridor.
Supervised by a senior lecturer experienced in glaucoma, they will process various scans and tests, with an initial focus on those patients who have been waiting the longest for their next appointments or who appear to have fallen out of focus.
“The senior lecturer and students will make a decision on the patients and prepare a report saying this patient’s got this type of glaucoma, consistent with the information they received, and it’s either stable or may have progressed, and then we recommend ‘X’ follow up, including at the Midland clinic,” Prof Morgan says.
The team will co-ordinate with RPH to provide more specialist follow-up treatment and ophthalmology services for those patients who need it. Patients return to Midland if their condition is stable and follow-up tests are needed.
“It’s a triaging process, if you like, filtering patients who genuinely require ophthalmology input and assessment, instead of trying to channel them all through a narrow funnel into Royal Perth Hospital, which struggles to cope with the volume.”
The state grant will help to cover the extra administrative support needed at Midland and RPH, and the extra time invested by the supervising senior lecturer and students involved. It will also help cover the role of a senior registrar, who will vet the work and ensure the right clinical decisions are being made.
The hope is that the collaboration, set to start in the next couple of months, will reduce the burden on the stretched health system and ease the journey for glaucoma sufferers.
But the optometry students will also benefit, Prof Morgan says.
“We will be supporting the optometry program while at the same time helping to improve eyecare services in Perth and introducing students into that demographic where the need is greatest.”
If the collaboration is successful and the funding continues, the plan is to move the focus from glaucoma to other eye conditions like macular degeneration and paediatric myopia.
Prof Morgan is confident the success will be the same as the C-Eye-C program in New South Wales, on which the Midland clinic is modelled.
“It’s an idea that originally came from England and was taken up by Professor Andrew White at Westmead Hospital in Sydney,” he says.
“Westmead, a western suburb of Sydney, is like a corollary to the eastern suburbs in Perth and the same problems of large numbers of over-boundary patients was occurring at Westmead Hospital.
“Professor White established the C-Eye-C program, with university optometry academics and hospital staff collaborating to create a new service. Patients with glaucoma who were thought to be relatively stable at Westmead Hospital had their follow-up visit at the C-Eye-C facility, taking pressure off the hospital.
“They found that the appointment times were much faster, the number of people waiting for an appointment plummeted, the cost of providing the service was significantly less and patient satisfaction was much higher, because they didn’t wait so long in the clinic to be seen when they were assessed.
“So it was a case of win, win, win.”
That is the kind of result Prof Morgan is keen to replicate and so reduce the burden of eye disease wherever people are disadvantaged in accessing services.
And it would be the kind of result celebrated by Gaela Hilditch and so many others struggling in their own glaucoma journey.
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