Monday, September 01, 2014
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Models of Vision Care

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 three 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
  3. Intelligent retinal camera for rapid detection of blinding eye disease

 


 

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.


 

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, LV Prasad Eye Institute, Professor Kevin Frick.


 

Project 3: Intelligent retinal camera for rapid detection of blinding eye disease

The project is developing the most advanced technology for use in real-time detection and assessment of common blinding eye disease and general health disorders. The imaging technology of the breakthrough retinal camera is being developed with international partners in Australia, US, China, India and Africa.

The world's first intelligent retinal camera will accurately and rapidly detect and eventually diagnose sight-threatening conditions such as diabetic retinopathy and glaucoma. The camera is being designed for ease of use in the most extreme environments so that it can be used by technical support staff and in the most remote and under-served locations, especially to close the gap in eye health in Australian Aboriginal communities.

Project Participants: Aboriginal Health and Medical Research Council of NSW,  Brien Holden Vision Diagnostics Inc, Brien Holden Vision Institute, Brien Holden Vision Pty Ltd, Brien Holden Vision Technology Co Ltd, Brien Holden Vision Institute Foundation, Centre for Eye Research Australia, Fred Hollows Foundation,, L V Prasad Eye Institute, Ninti One Limited, Zhongshan Ophthalmic Centre.


Statistics

 

Refractive Error

In Australia 480 000 people have impaired vision with 62% due to refractive error.1 Aboriginal communities in Australia are particularly in need of effective eye care systems. It has recently been found that 94% of all vision loss in indigenous communities of Australia is preventable or treatable and that 35% of indigenous adults have never had an eye examination.2 The rate of blindness is 6 times higher and the rate of vision impairment is 2.8 times higher than the rate found in non-indigenous Australians.2

Refractive error has recently been found to be the leading cause of vision impairment and accounts for half of vision loss in indigenous adults and children. It has also been identified as one of the top 3 causes of blindness in these groups.2

There are currently 32 million people worldwide that 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.4 Uncorrected refractive error (near-sightedness, far-sightedness or astigmatism), is the second highest cause of blindness globally.3

In 2008-2009, there were 108 million people globally with significant vision impairment as a result of uncorrected refractive error for distance vision.3 This figure includes seven million people with blindness due to uncorrected refractive errors.3 In addition, there are an estimated 517 million people without adequate correction for functional presbyopia, making a total of 625 million suffering from unnecessary blindness and vision impairment.3,6 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

Glaucoma and diabetic retinopathy

Vision impairment can dramatically affect an individual’s ability to participate in society – resulting in poor health, economic loss and social isolation. Almost 50% of blindness and 70% of visual impairment is preventable or treatable.9 Early detection is essential to preventing unnecessary disability and can improve quality of life for hundreds of thousands of Australians and millions around the world. Unfortunately, many people are slipping through the cracks in the system and not being diagnosed. The major reasons are limited access to eye-health services (especially in remote areas), inadequate technology and lack of professional availability.

The problem is particularly acute in the Indigenous population, with 35% of adults never having had an eye exam.10 The most common reasons are cost, availability, accessibility and perceptions around the severity of the problem.  The social and economic costs are needlessly high as 94% vision loss in Indigenous peoples is either preventable or treatable.11

Diabetic retinopathy (DR) and glaucoma are two of the most important and difficult conditions to address. DR affects up to 80% of those with diabetes for 10 years or more,12 with blindness occurring at a 30 times higher rate in Indigenous populations.13 New cases could be reduced by 90% through vigilant detection14, monitoring and treatment. Glaucoma occurs in 2.5% of Australians over 40 years of age.15 Half of all glaucoma and diabetes cases in Australia are undiagnosed.16

  • 80% of Indigenous Australians with diabetes have not had an eye exam in the last 12 months; and
  • 94% of all indigenous vision loss is either preventable or treatable.17

Unnecessary blindness and vision impairment have significant costs to Australia, including a direct cost to government for eye care and rehabilitation services in excess of $1.8 billion per year and substantial indirect costs to individuals and the community.18 The most common reasons for not seeking eye-care services are cost, availability and accessibility.


 

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.

The retinal camera project will have a synergistic relationship with the other Models of Vision Care projects and will accelerate and broaden the impact of the program, by increasing the scope and accessibility of vision care and blindness prevention services for the most vulnerable and ‘at risk’ people in Australia (and the world).

In environments where there is a dearth of eye care professionals, the retinal camera system will guide the health worker by providing: (i) a permanent record of the state of the retina, optic nerve and some choroidal features; and (ii) an assessment of signs and ocular measurements that might indicate a serious threat to vision or health. For health care professionals, the retinal camera system would provide valuable, objective information, which, when taken with other signs, symptoms, and patient history, would help develop a more rapid and reliable diagnosis and patient management strategy.

Eventually, the functions of the system can be expanded to the detection and measurement of other ocular conditions (eg, refractive error, age-related maculopathy) and vascular and neurological conditions that would benefit from early detection and treatment.

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. Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990-2010: a systematic analysis. The Lancet Global Health [Internet]. 2013 13 November 2013. Available from: http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70113-X/fulltext.
  4. World Health Organization, Fact Sheet No. 282, May 2009. Accessed at: http://www.who.int/mediacentre/factsheets/fs282/en/index.html
  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.
  9. Taylor HR, Pezzullo ML, Keeffe JE, 'The economic impact and cost of visual impairment in Australia', Br J Ophthalmol. 2006 March; 90(3): 272–275. doi: 10.1136/bjo.2005.080986.
  10. Australian Institute of Health and Welfare 2011. Eye health in Aboriginal and Torres Strait Islander people. Cat. no. IHW 49. Canberra: AIHW.
  11. 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.
  12. Kertes PJ, Johnson TM, ed. (2007). Evidence Based Eye Care. Philadelphia, PA: Lippincott Williams & Wilkins. ISBN0-7817-6964-7
  13. Taylor HR, National Indigenous Eye Health Survey Team (2009).National Indigenous Eye Health Survey: minumbarreng (tracking eyes): full report. Melbourne: Indigenous Eye Health Unit, The University of Melbourne.
  14. Garg S & Davis RM, Diabetic retinopathy screening update, Clinical Diabetes, October 2, 2009 vol. 27 no. 4 140-145.
  15. The Economic Impact of Primary Open Angle Glaucoma - A Dynamic Economic Model Centre for Eye Research Australia, University of Melbourne, Australia, February 2008.
  16. Lancet. 1999 Nov 20;354(9192):1803-10
  17. AIHW 2011. Eye health in Aboriginal and Torres Strait Islander people. Cat. no. IHW 49. Canberra: AIHW
  18. “Clear Insight - The Economic Impact and Cost of Vision Loss in Australia” released in August 2004. Copies of this Report are available from <www.cera.org.au