KeepSight's key optometry for diabetic eye disease

Diabetic retinopathy is the leading cause of vision loss and avoidable blindness in working-age Australians.

It is now three years since the launch of KeepSight, Australia’s diabetes eye disease screening initiative that is turning attention to diabetes-related vision loss. In Part 2 of National Diabetes Week (10-16 July), Outlook check with some of the program’s key stakeholders.

Black Taryn, Diabetes Australia – national program and policy director

The daily burden of living with diabetes can be significant. It is estimated that people with diabetes face up to 180 diabetes-related decisions every day – that’s more than 65,000 extra decisions a year.

Combined with busy personal and professional lives, remembering and scheduling regular eye exams can be ignored or put on a priority ‘list’. Add to that the global pandemic and significant disruption to routine health care over the past two years, and it’s no surprise that people’s regular eye exams may have fallen by the wayside.

With around 1.5 million Australians living with diabetes, and an estimated 50% of those not having regular eye exams, coupled with the stress and distractions of COVID-19, there is a large number of Australians at risk of preventable vision loss simply because they do not see an eye care provider on a regular basis. As we know, diabetic retinopathy is often asymptomatic until it reaches an advanced stage and the outcome of late treatment is usually lower than early intervention.

This means KeepSight is becoming more important than ever in its role of ensuring people with diabetes don’t fall through the cracks when it comes to routine eye exams. At the end of March there were 240,000 people with diabetes enrolled in the program.

That’s a fantastic breakthrough, but we still have a way of making sure everyone at risk gets regular checkups. Currently around 60% of the optometry sector have KeepSight integrated into their patient management system, making program registration quick and easy. Diabetes Australia is committed to working with other providers to increase that number.

Integration with this eye care sector is key – it keeps the process simple for patients, streamlined for practitioners, and keeps people with diabetes returning to their providers, building trust and rapport. Continuity of care is associated with optimal outcomes for diabetic complications, including diabetic retinopathy and KeepSight aims to facilitate this.

This is a unique public-private partnership that is making a real impact on the burden of diabetes-related eye disease on our health system and the well-being of Australians with diabetes.

Peter Van Wijngaarden, KeepSight clinical director & professor of ophthalmology, Australian Center for Eye Research (CERA)

Image: Anna Carlile.

CERA has been involved in advocating for KeepSight since its inception because we believe the scheme can make a real difference to the eye health of people with diabetes and prevent avoidable blindness.

I know, from direct experience in the UK, that a national screening program for diabetic retinopathy can be very effective in preventing avoidable blindness. I also know that treatment of late-stage diabetic retinopathy is often more difficult and prolonged, and often has worse outcomes than treatment in the early stages. I believe that we can do better for Australians with diabetes by providing support to ensure that diabetic eye screening appointments are not forgotten. That’s the core purpose of KeepSight.

CERA researchers are committed to making a real impact on patients and developing new and innovative ways to deliver eye health care – so supporting KeepSight is a natural extension of our work.

To date our energy has been devoted to the design, integration and promotion of KeepSight, but we are now focused on measuring program impact. We are also looking at ways to integrate KeepSight into the ophthalmology workflow and will do so in a pilot program supported by Bayer.

Key impact indicators would include the proportion of reminders that result in return visits to the eye care provider; number of registrants; impact of health messages (both targeted, via NDSS, and mass market messages) on diabetes eye screening activities.

Having built the digital infrastructure to mobilize people with diabetes and to monitor diabetes eye screening activity at the national level, we will be well placed to understand the burden of disease in the near future. In addition, we will have the opportunity to target health messages to people who do not currently have regular diabetic eye exams. This will be a very powerful tool to provide targeted support to Australians with diabetes who are at risk of vision loss from the disease.

Dr Benjamin Ashby, Specsavers – Australia & New Zealand director of optometry

The burden of avoidable vision loss and blindness from diabetes primarily affects the 50% of patients with the disease who do not receive regular eye exams. The fact that more than 90% of vision loss due to diabetes can be avoided through regular eye exams is the reason why Specsavers has been a staunch supporter of KeepSight since its inception.

Committed to funding $1 million per year for the first five years of the program, Specsavers has also invested in developing and adopting systems and processes across our network of practices. This has helped our Specsavers optometrists to register approximately 400,000 appointments (initial and follow-up), making us the largest referrers to date.

Looking to the years ahead, Specsavers’ commitment remains steadfast and will focus on:

• Continue to seamlessly connect all consenting patients and appointments to the program;
• Support Diabetes Australia to improve KeepSight’s withdrawal strategy, ensure that the program is coordinated with other recall messages and is as effective as possible in engaging patients, resulting in
  in an increase in patients attending timely follow-up optometric care;
• Support the development of a digital system that measures KeepSight’s progress against key program goals. While reporting on changes in eye health outcomes is not yet practical given that it is still preliminary, Specsavers shares data it has identified to assist in reporting program use among people with diabetes. Specsaver’s progress with KeepSight and our other Transforming Eye Health strategies, is regularly updated on our optometric data website (www.healthhub-anz.com).

KeepSight is an example of a public and private organization collaborating to address a major public health issue. KeepSight’s success to date demonstrates the potential for such public-private collaboration and similar solutions could benefit many Australians, addressing other public health concerns in the future.

Peter Murphy, Luxottica (OPSM, Laubman & Pank) – director of eye care and community

For Luxottica, integrating KeepSight registrations into its clinical workflow nearly 12 months ago was simply the ‘right thing to do’. Optometry has a very important role in tackling this serious public health problem, by providing the best eye care for people with diabetes.

The number of people with diabetes, or at risk of developing diabetes, in Australia is at epidemic proportions and we know the risk of some of these people, up to 100,000 per year, developing serious eye problems is very real. But most of this can be avoided simply by making sure people are checked regularly.

Given the number of patients we see, we recognize that we have a responsibility to be involved in addressing this national health issue.

And our diabetes patients appreciate that we are proactive in supporting them to manage their condition.

We know that these patients have many health appointments to attend to and that more acute problems can sometimes take the front place.

Vision, however, can deteriorate over time and promises can be put behind the burner. It is our role to ensure that does not happen, and that any changes, however small, are taken in a timely manner so that any visual impairment can be addressed quickly and effectively, before it is too late. We all take our vision for granted. But vision loss has an impact on quality of life.

Integrating KeepSight registration into our workflow means the process is seamless for our practitioners and ‘brainless’ for our patients. We have received great feedback from our practitioners and their patients that KeepSight makes a difference

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