Models of Vision Care

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Program Leader: Ms Amanda Davis, Brien Holden Vision Institute Foundation

Program description

This program will build on the platform of the Vision Care Delivery projects in Vision CRC. The program is split into two key areas:

1. Models of vision care delivery for Indigenous communities
2. Models of vision care through the development of vision centres in developing countries.

Project 1: Aboriginal & Torres Strait Islander Education - Models of vision care delivery for Indigenous communities

This project will seek to develop and test a comprehensive model for the development of an effective workforce to deliver eye care in Australia to ensure that affordable, accessible and culturally appropriate eye care is delivered to Aboriginal people. It will identify appropriate skills required at different levels in the referral and health care chain. With the workforce defined, education will need to be developed and delivered to support the workforce. This model will include an element of flexibility to allow for differences in state and regional requirements. The model aims to be accepted, endorsed and implemented by Indigenous health services and the Commonwealth and State governments.

Project Participants: AH&MRC, Brien Holden Vision Institute Foundation, Lowitja Institute, Optometrists Association Australia, Professor Hugh Taylor, Vision 2020 Australia, Vision Care NSW.

Project 2: Model of vision care in remote locations - Vision centre model development

This project will review the vision centre model as an effective, affordable and accessible way to provide eye care in developing countries. It will look at areas of affordability, accessibility, demand, willingness to pay, patient satisfaction, monitoring and evaluation frameworks, procurement systems and financial sustainability. The project will identify success factors of vision centres, informing government and NGO policy on the most efficient means of providing sustainable eye care in developing countries in the Asia Pacific region.

Project Participants: African Vision Research Institute, CERA, Brien Holden Vision Institute Foundation, LVPEI, Professor Kevin Frick.

Statistics

The latest World Health Organization statistics show that 45 million people worldwide are blind.³ About 87 % of the world's visually impaired live in developing countries and globally, 85 % of all visual impairment and 75 % of blindness could be prevented or cured.³  Uncorrected refractive error (near-sightedness, far-sightedness or astigmatism), is the second highest cause of blindness globally.⁴

In 2008-2009, there were 158 million people globally with significant vision impairment as a result of uncorrected refractive error.^4,5 This figure includes at least eight million people with blindness due to uncorrected refractive errors.^4,5 In addition, there are an estimated 517 million people without adequate correction for functional presbyopia, making a total of 670 million suffering from unnecessary blindness and vision impairment.⁶ Correction of refractive errors could give normal vision to more than 12 million children aged 5 to 15.³

Avoidable blindness and impaired vision carry significant social and economic costs. In Australia, the costs of care and indirect costs for vision disorders are over $5 billion a year, with total costs to the Australian public of $9.85 billion in 2004.⁷ Strategic government policy interventions addressing vision impairment in Australia would cost $188.8 million, but would save over $650 million in present value terms over the lifetime of the populations impacted by the interventions.⁸

Benefits to Australia

The Program will provide a new framework that identifies and trains the workforce for providing eye health to Aboriginal people, with immense benefit for Australia. The development of an efficient and effective model of providing eye health services to Aboriginal people will:

• Contribute to the reduction in health care and social costs due to the improved vision in Aboriginal communities
• Train Aboriginal health workers & eye health coordinators
• Contribute to increased workforce participation
• Assist government in Aboriginal health policy development
• Have the potential to be used as a model for workforce development in other health sectors.

Understanding the success factors of providing vision care to disadvantaged communities in the Asia Pacific region will secure benefits for Australia through:

• Informing the Australian government’s investment in the Avoidable Blindness Initiative with a productivity improvement of 5 % estimated on investment
• Informing the investment of Australian NGOs in blindness prevention Programs in the Asia Pacific region with a productivity improvement of 5 % estimated on investment.

Program future 2015 and beyond

The establishment of a workforce framework for Aboriginal eye heath workers will seek to have a more cohesive approach of all stakeholders to the management of eye health in Australia. The aim of the program post-2015 is for the model to be developed and taken up at a national level. The framework will have a defined curriculum for the levels of workers with the intention for the creation of a national level training program that will be accredited and run through technical level colleges.

The framework would provide for a more streamlined and efficient approach to providing culturally appropriate eye health provision that interfaces with mainstream eye health care in Australia. The successful implementation of this model on a nation-wide basis would create an opportunity for government to assess this as a model for all aspects of indigenous health provision.

The development of a Vision Centre model that can provide affordable and accessible eye care to disadvantaged communities in the Asia Pacific region that is sustainable without aid assistance would provide a platform for eradicating avoidable blindness in the region. The key partner, Brien Holden Vision Institute Foundation (the Institute), is committed to utilising the model developed and learnings from the research to advocate to both Australian and recipient countries for model implementation. The Institute will also, through its education platform, teach in-country stakeholders and other INGOs on model implementation.

References

1. Taylor HR, Keeffe JE, Vu HT, et al. Vision loss in Australia. Med J Aust. Jun 6 2005;182(11):565-568.
2. National Indigenous Eye health Unit, Melbourne School of Population Health, University of Melbourne, National Indigenous Eye Health Survey, September, 2009; ISBN-9780 734 4109 8.
3. World Health Organization, Fact Sheet No. 282, May 2009. Accessed at: http://www.who.int/mediacentre/factsheets/fs282/en/index.html
4. Resnikoff S, Pascolinin D, Mariotti SP, Pokharel GP, 'Global magnitude of visual impairment caused by uncorrected refractive errors in 2004', Bulletin of the World Health Organization, January 2008, 86(1).
5. Smith TST, Frick KD, Holden BA, Fricke TR, Naidoo KS, ‘Potential lost productivity resulting from the global burden of uncorrected refractive error’ in Bulletin of the World Health Organisation, 2009; 87.
6. Holden BA, Fricke TR, May Ho S, Wong R, Schlenther G, Cronje S, Burnett A, Papas E, Naidoo KS, Frick KD, ‘Global vision impairment due to uncorrected presbyopia’, Archives of Ophthalmology, Vol 126 (No. 12), Dec 2008.
7. Access Economics. Clear Insight: The Economic Impact and Cost of Vision Loss in Australia:  A Report prepared by Access Economics Pty Ltd: Eye Research Australia; 2004
8. Access Economics. Investing in sight. Strategic interventions to prevent vision loss in Australia. Melbourne: Eye Research Australia; 2005.