Beyond greater accessibility to eyecare for Australia’s under-served regional and remote patients, remote optometry represents a new era with greater flexibility for the workforce. Insight is taken through the OPSM remote optometry journey.
The delivery of optometry in Australia is well-regarded by global standards, but challenges remain. Chief among those is access to eyecare for the country’s regional and remote population, followed by a maldistributed workforce, and somewhat rigid working conditions for optometrists.
Remote optometry has emerged as a new care model that can overcome some of these longstanding barriers. Leveraging new technological developments by EssilorLuxottica, OPSM has been significantly investing time and resources to develop and customise local clinical protocols and “reimagine the patient journey”.
The result is a cohesive and elevated remote comprehensive eye exam where the patient is in a conveniently located practice, accompanied step-by-step by a trained technician, while the optometrist is located remotely – oftentimes in another state.
The remote optometry journey
As Insight editor, I was invited to go through the OPSM remote optometry journey in May 2024 at the showroom in OPSM Macquarie Centre Sydney.
For the demonstration, the network’s professional services manager for NSW/ACT, Ms Astha Rai, acted as the remote optometrist.
The appointment started with the technician performing pre-test procedures beginning with the Wave Analyser Medica 800 (WAM800), capturing autorefraction to 0.01 D, low and high order aberration assessment, topography, pupillometry, retro-illumination of the crystalline lens, pachymetry, and tonometry.
Next, I was taken to an ultra-wide digital retinal device that takes a 200-degree view of the retina, as well as OCT with the capability to perform scans of my macula and optic nerves.
It’s immediately clear how pivotal the technician is, in addition to linked and easy-to-operate technology.
The technician then took me into the consulting room that looked like any other in the OPSM network, minus an in-person optometrist. Instead, this is where I’m introduced to the optometrist over a video link. Rai, as the optometrist in this scenario, takes down a detailed history, and notes my high astigmatism and toxoplasmosis scar from the pre-test work up, and is then able to remotely control and perform the subjective refraction on the Essilor VR800. It’s a remarkable piece of technology capable of refining the refraction to 0.01 D, but what’s most fascinating is its novel liquid lens that can be adjusted with high precision. There’s no rotation of lenses in this phoropter.
Rai has the option to choose from my existing prescription or autorefraction as a starting point and performs the refraction.
A slit lamp examination is also performed with the Essilor SL650. During the diagnosis and management discussion, the optometrist can present scans and results on screen, demonstrate any changes to prescription at the touch of a button and present visualisations of common eye disorders. It’s also possible to show what my vision would look like with certain lens designs.
Having the information presented this way is simple to understand and I imagine would get the patient invested in their eye health.
In my case, the optometrist hands back to the technician and recommends a new pair of lenses to account for my changed prescription, as well as a discussion around polarised lenses as a second pair for golf and other outdoor activities.
Although an ophthalmology referral wasn’t required in this instance, if one was, it can be done securely using the Oculo platform.
Expanding access to eyecare
While remote optometry presents an opportunity to offer more flexibility into the optometry workforce in terms of working hours and location, its primary function is to reduce the wait time for routine eye examinations by increasing the availability of optometrists in under serviced communities.
In turn, this empowers patients to be proactive about their eye health.
OPSM’s remote optometry program is being rolled out following a highly successful pilot at its South Hedland, Albany, and Kalgoorlie locations in 2023. The network plans to expand its remote optometry service across a number of locations by the end of 2024.
Early career optometrist Ms Kim Nguyen was one of OPSM’s first remote optometrists. She is located in Doncaster, Melbourne, where she spends two days per week practising remote optometry, seeing patients who visit OPSM stores in South Hedland and Kalgoorlie, both in remote parts of Western Australia. During the other three working days, she is practising in-person optometry.
Despite only graduating from the University of Melbourne in 2022, Nguyen was keen to be part of this new way of providing optometric care. It made sense, given her interest in the topic.
During her university studies she published a paper demonstrating the lack of digital competencies among optometry students amid the increasing prevalence of digital health models. Another formative experience was time spent in the OPSM relief team where she visited regional Victorian areas and provided temporary optometry cover.
That experience alone provided first-hand exposure to some of the challenges regional patients have when accessing eyecare, motivating her to make a difference to communities as a remote optometrist.
“In the locations where we are providing remote optometry, the nearest ophthalmologist is sometimes five hours away and other times they are only getting face-to-face optometry one week every few months, so it’s a long wait time for an eye test,” she says.
“Many of these conditions are treatable, and when we think about the eye health gap experienced by some regional and remote patients in Australia, remote optometry is helping to bridge that.
“The major benefit is that everything’s on one platform, which is great given all the information we receive in the pre-test.”
Nguyen says one of most important factors is the technician.
“They provide in person support for the patient and ensure the remote eye exam runs smoothly, especially if there’s difficulty in communicating with the patient; for example, if they’re hard of hearing or there’s a language barrier,” she says. “The technician is a crucial part of the remote optometry model, and those involved in the program are very dedicated and proactive individuals.”
To aid communication, the remote optometrist can also access short videos that can be played during the consult to educate the patient on certain eye conditions. Plus, Nguyen says it’s been great to show the patient their own eyes through videos captured on the slit lamp and digital retinal scans.
As part of OPSM’s remote optometry journey, comprehensive triaging ensures that any ocular emergencies are referred appropriately prior to consultation.
Nguyen recalls seeing a variety of non-acute eye conditions as a remote optometrist, including a recent case where she diagnosed geographic atrophy. The patient had infrequent eye health checks due to extended wait times for in-person appointments.
“Through the remote consultation, I was able to educate the patient about their eye health, convey the management plan, and emphasise the importance of regular eye exams,” she says.
More reading
OPSM introduces remote optometry consultations
How EssilorLuxottica and OPSM are developing the myopia leaders of tomorrow
Optometrist opportunities beyond the consulting room at EssilorLuxottica ANZ
