Telehealth support of trained Aboriginal Health Practitioners way forward in regional and remote eye care

Emma Dargin, an Aboriginal Health Practitioner (AHP), at Condobolin's Aboriginal Health Service helped to save the sight of a patient with diabetic eye disease using her skills in retinal photography triaging and primary care eye health, during recent COVID restrictions.

Condobolin Aboriginal Health Service (AHS) is 460 km (6.5 hours’ drive) north-west of Sydney in outer regional New South Wales. Condobolin has a population of approximately 3,500 people, with about 770 residents identifying as Aboriginal and Torres Strait Islander. COVID -19 restrictions resulted in a period of two months without optometry outreach clinics at most regional and remote NSW ACCHSs, including Condobolin AHS.

A new patient, with Type 2 diabetes, presented to Condobolin AHS in April 2020.  The patient had a history of uncontrolled blood sugar levels over the eight years since the diagnosis of diabetes and had not had an eye examination in five years. The patient complained about seeing black lines with both eyes. Emma took photos of the back of the patient's eye using a digital retinal camera.

The photos showed significant internal haemorrhaging in both eyes. Diabetic eye disease (diabetic retinopathy) is a leading cause of blindness in adults due to damage to the blood vessels of the retina (light-sensitive tissue).  Emma recognised that an urgent referral might be needed and flagged the images for priority review by Condobolin AHS's General Practitioner. The images were also assessed via telehealth by Condobolin AHS's Visiting Optometry Service Provider, Brien Holden Foundation, based in Sydney, and the Centre for Eye Health Retinal Photo Grading Service. All these practitioners recommended urgent assessment and treatment by an ophthalmologist.

Emma quickly arranged an appointment for the patient at an ophthalmology practice in Orange, a large regional centre two hours’ drive east from Condobolin. Emma collaborated with the Brien Holden Foundation Optometrist and the Western NSW Eye Health Partnership to access this urgent appointment. The patient received several sessions of laser treatment.

The need for a quick diagnosis and urgent referral of advanced diabetic retinopathy poses a challenge in an outer regional and remote settings with limited immediate access to eye care services. Emma developed her skills in triaging diabetic retinal photographs through the Australian Government Provision of Eye Health Equipment and Training Project. This project provides equipment including retinal cameras, primary health care training, mentoring and access to the Centre for Eye Health Retinal Photo Grading Service at Primary Health Care Services with a significant Aboriginal and Torres Strait Islander patient base.

The tele-optometry consultation Emma accessed was funded by the NSW Rural Doctors via the Visiting Optometry Scheme. The Australian Government funded Visiting Optometry Scheme payment for tele-optometry in NSW was a short term measure in the COVID-19 period to ensure continued access to outreach services where Medicare was not able to support this.

Emma's quick action helped saved this patient's sight, highlighting both the importance of primary health care involvement in diabetic eye screening and telehealth support for regional and remote health services.

Regional and remote AHPs, trained and equipped to screen for urgent eye conditions and supported via tele-optometry, can save patient sight.