2021 marks five years since Specsavers first piloted the use of Optical Coherence Tomography (OCT) in its optometric practices.
Beginning with a pilot
The pilot had the specific objective of targeting the 50% of patients with undiagnosed glaucoma as reported in the Blue Mountains Eye Study and the National Eye Health Survey. Despite progress in the understanding of glaucoma pathophysiology, clinical technology, and optometrists’ training and scope as primary eyecare providers, 50% of Australians with glaucoma remained undiagnosed – a rate that has remained relatively unchanged for the past three decades (see references here, here and here). This was primarily due to the nature of glaucoma, with a lack of overt signs and symptoms in early stages and with functional deficits often preceded by extensive structural damage before they manifest in a way the patient can notice.
By harnessing OCT technology in a consistent manner across all practices, every patient received the same high standard of care and optometrists were able to adapt their practice to a new uniform approach. The results from the first phase pilot, in conjunction with other systematically practiced tests and assessments, showed that this approach led to enhanced detection of glaucoma.
Detecting glaucoma in a patient is complicated and requires multiple assessments coupled with professional judgement to accurately determine an individual’s risk. Before the Specsavers pilot even began, it was determined that while there was clinical value in the OCT providing detailed structural analysis, in many cases prior to functional deficits being evident, but that OCT should never be used in isolation to assess a patient for glaucoma.
Instead, use of the technology would be followed by RANZCO guideline-directed investigation by the optometrist; meaning it must be used in conjunction with knowledge of the patient’s history, intra ocular pressures, assessment of the optic nerve and retina, anterior eye examination, angle examination and visual fields.
Five years on
Following the $40million rollout of OCT and associated training across the Specsavers network which began in 2017, OCT is now being used by 1,500 optometrists on more than 4 million patients per year, the impact on detection rates of glaucoma is irrefutable.
Consistent application of OCT within an optometric consultation, together with Optometry Benchmark Reporting and RANZCO Referral Pathways, result in improved glaucoma detection rates to a level that is now approaching internationally published prevalence rates for the condition.
With the benefit to patients clear, OCT has been officially incorporated in the standard Specsavers patient journey and made available to all patients, at no additional cost. This model has also been adopted by several other optometry practices in Australia.
The adoption of OCT is currently the only scaled, evidence-based solution proven to impact the detection of undiagnosed glaucoma within an optometric patient base.
Although OCT has been a catalyst for significant changes to patient care, it is just one of several fundamental elements that form part of the Specsavers Transforming Eye Health strategy.
Consistent application of OCT as part of the optometric consultation, together with Optometry Benchmark Reporting, clinician education and adherence to the RANZCO Referral Pathways has been effective in increasing the rate of glaucoma detection in line with published prevalence rates for the condition. The graph below shows glaucoma detection rates as measured in 2019.