COVID-19 particularly affects the elderly and those with underlying health conditions or chronic diseases. Communities are at higher risk when housing is poor and overcrowding is prevalent. Similarly, people with diabetes are at increased risk and have been advised to observe stringent social distancing measures.
At the beginning of 2020, the National Aboriginal Community Controlled Health Organisation (NACCHO) and other Aboriginal and Torres Strait Islander leaders and organisations acted quickly to prevent the spread of COVID-19 within their communities.
With the Australian Government, they worked to restrict travel in and out of remote communities. All non-essential visiting health services, including those delivering eye care, were suspended. Some biosecurity restrictions have now been lifted, while some inter-state and territory borders remain closed.
During remote community closures, only urgent ophthalmology care was available, and often with a number of guidelines and provisos, such as the ‘COVID-19 Primary Healthcare Guidance’ outlined by NACCHO.
One health provider facing these challenges was Associate Professor Dr Angus Turner, Director of Lions Outback Vision, and his team in Western Australia.
This program, proudly supported by Specsavers through their partnership with The Fred Hollows Foundation, has been able to navigate these complexities to ensure patients are receiving the best care possible while keeping everybody safe.
How Lions Outback Vision tackled diabetic eye disease in COVID-19 conditions
On average, 29 people are diagnosed every day in Western Australia – more than one every hour. There are more than 123,000 people living with all types of diabetes in the state.
Aboriginal and Torres Strait Islander Peoples are over-represented in diabetic health figures – being 14 times more likely to have diabetes-related blindness, with 10% of adults having diabetes, and one in three with diabetic retinopathy. Those living in remote and under-serviced communities experience even higher rates. Yet, they have significantly less access to screening and treatment services than other Australians.
Lions Outback Vision have been delivering eye care, including diabetic eye care, in Western Australia for over a decade. They work to address the unique challenges of delivering specialist eye health care to regional, remote and Indigenous communities through innovative and sustainable models of service delivery.
During a challenging year, juggling the delivery of eye care during the COVID-19 pandemic, the Lions Outback Vision team were unable to conduct outreach-screening clinics or travel between regions in Western Australia. The Vision Van was parked for almost four months, while training and community education sessions in diabetes and diabetic eye care were put on hold. From April to June 2020, a total of 10 screening clinics and seven regional surgical lists were cancelled.
Yet, Lions Outback Vision were determined to continue caring for their patients, particularly those with progressive conditions, such as diabetic eye disease.
Lions Outback Vision managed to continue delivering high quality and culturally appropriate eye health care to patients across Western Australia in the following ways:
Lions Outback Vision has surpassed 3,000 telehealth consultations to date, delivering quality eye health services to patients often hundreds of kilometres away. While many physical clinics and appointments were unable to go ahead this year, telehealth consultations drastically increased.
Telehealth optometry services were not included in the Australian Government’s temporary Medicare extension during the COVID-19 pandemic, however Lions Outback Vision continued to effectively use technology that was already in place within their health service, and reach patients all over Western Australia with critical eye care support.
During the April-May period of intra-regional travel restrictions, Lions Outback Vision conducted 440 telehealth consultations, which was a 100% increase on the same period the previous year.
Regionally based optometrists were able to see urgent cases and facilitate telehealth safely and with appropriate diagnostic imaging.
Dr Angus Turner says, “Telehealth has been thrown into centre-stage during this pandemic, but thanks to the many years of prior work in this realm, the systems were in place to enable access for patients to sight-saving eye care in high numbers’.
Continued treatment where possible
Even at the peak of COVID-19 restrictions in Western Australia, a number of procedures and treatments were categorised as essential. Many of these, such as diabetic retinopathy injections and treatments, needed to continue to ensure people would not go permanently and needlessly blind.
In fact, from January to September 2020, Lions Outback Vision was able to complete 220 diabetic retinopathy related patient screenings and 805 treatments. Also during this time, 225 people underwent training for slit lamp and diabetic retinopathy camera use, image grading, referral of retinal images and patients, and diabetic eye care. This training was conducted for health workers, Aboriginal Health Workers, General Practitioners, and students.
Adapting treatment and reducing travel
In an effort to reduce patient movement, Lions Outback Vision changed a number of ways they worked, including patient treatment regimens and intervals.
Dr Angus Turner says, ‘Patients where extensions of treatment interval were imminently vision-threatening were attended to in more sparse clinics with a reduced team, and few patients to enable adequate cleaning and distancing policies.’
Patients were grouped into communities for transport and screened for any COVID-19 patients symptoms prior to travel together.
Throughout this time, Lions Outback Vision also continued to progress the renovation and opening phase one of their new Broome clinic. This clinic has already been delivering eye health services, including diabetic retinopathy injections, to patients in the Pilbara and Kimberley regions. This was vital to reaching these people and reducing unnecessary travel.
Lions Outback Vision expresses their thanks and appreciation for supporters and partners like The Fred Hollows Foundation and Specsavers that enable them to continue delivering essential eye care to patients across Western Australia, even during a global pandemic.