Innovation and collaboration to meet remote eye-care needs

Sixty years ago, the revered ophthalmologist Fred Hollows saw first-hand the tragic extent of avoidable blindness in remote Aboriginal communities and decided he needed to do something about it. Unfortunately, it is not possible to say the rest is history.

The rate of preventable blindness among Indigenous Australians remains three times that of the broader population, with diabetes-related vision loss up to five times higher among Indigenous Australians. Our First Nations peoples also have significantly higher incidence of cataracts and are much less likely to receive timely treatment for a range of chronic eye-health conditions.

When it comes to eye health, more must be done to close the gap, particularly in remote communities. Collaborative care models that utilise digital technologies in a culturally sensitive way, to overcome the tyranny of distance, are increasingly likely to play a key role.

One model that is having considerable success is Lions Outback Vision in Western Australia. Established in 2010 with support from the Lions Eye Institute and the University of Western Australia, Lions Outback Vision is making a tangible difference in improving access, reducing wait times, increasing surgery efficiency, and boosting patient appointment attendance rates in remote communities in the Pilbara region.

Under the leadership of its founder, ophthalmologist Dr Angus Turner, Lions Outback Vision has developed and implemented a range of innovative and sustainable models of service delivery. It currently provides specialist eye-health services throughout the Pilbara, Kimberley, Goldfields, Midwest and Great Southern regions of Western Australia.

Before Lions Outback Vision, patients requiring surgery or urgent treatment had no choice but to travel to Perth, often without receiving the necessary prep work. Those requiring initial diagnosis or ongoing management of chronic eye conditions had to wait for extended periods for appointments with visiting ophthalmologists. The inevitable result was haphazard treatment with a lack of continuity of care. Many remote community members missed out altogether.

In all its services, Lions Outback Vision emphasises the importance of utilising technologies to link patients with eye-health professionals providing integrated treatment solutions. Services include the Lions Outback Vision Van, a specialist mobile eye-health clinic that visits 19 remote communities around Western Australia twice annually and showcases the protocols and principals developed by the Aboriginal Health Council of Western Australia for outback service delivery in Indigenous communities.

Teleophthalmology – including Medicare reimbursed, three-way, optometry-facilitated telehealth consultations with local optometrist Alex Craig from Karratha Eyecare – has played a central role in ensuring remote patients have timely access to specialist diagnosis and treatment. This is supported by the digital transmission of high-resolution eye-imaging technologies such as optical coherence tomography (OCT). The telehealth model includes on-call ophthalmologists who are immediately available when a patient first visits the local optometrist, so there is no need to schedule a further specialist appointment.

Peer reviews have shown that the telehealth model, including the introduction of on-call services, has resulted in a 10-fold increase in access for Aboriginal people, a halving of cataract surgery wait times and high levels of patient satisfaction. A systematic review showed patient outcomes were equal or better using telehealth compared to regular specialist care, surgeon efficiency was improved, and the need for pre- and post-op visits was reduced or eliminated.

The Lions Outback Vision team is also researching the use of various deep learning systems (DLS) for screening patients with diabetes for retinopathy and macular oedema. With their artificial intelligence partners – which include Google, the Centre for Eye Research Australia (CERA) and Eyetelligence, Topcon and Thirona – they have found that DLS seem to have the necessary sensitivity and specificity to become a potential point-of-care test that could be used in remote communities to improve screening rates.

The success of Lions Outback Vision shows that an integrated and collaborative approach to eye care, enabled through the intelligent use of digital technologies, can make a marked difference in the most remote and disadvantaged communities in Australia. With committed ophthalmology and optometry leadership and the buy-in of local health services, the model can be replicated in other underserved communities.