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HomemiophthalmologyKeepSight: Managing Diabetic Eye Disease

KeepSight: Managing Diabetic Eye Disease

KeepSight, launched in March 2019, is a coordinated and systematic approach to preventative and timely healthcare. The collaborative program aims to reduce avoidable vision impairment and blindness.

Too many Australians with diabetes are losing their sight because they aren’t having their eyes checked within recommended timeframes.

As an eye doctor I have the misfortune of seeing many people coming for their very first eye check with end stage eye disease.

KeepSight is the first national recall and reminder system introduced domestically to remind those with diabetes to have regular eye examinations

It’s an alarming reality, but one that we are now addressing through KeepSight, a new program to significantly reduce rates of diabetes-related vision loss and blindness in Australia.

The premise of KeepSight is simple. By encouraging people with diabetes to get their eyes checked more regularly, we can help them to keep their sight.

WHY KEEPSIGHT MATTERS

Approximately 1.7 million Australians are estimated to be living with diabetes, and with an additional 280 people developing diabetes every day, this figure is estimated to grow to 2.45 million by 2030.

The reality is that all Australians with diabetes are at risk of developing diabetic retinopathy (DR) and there are currently around 100,000 Australians with visionthreatening DR. Concerningly, this number is expected to double by 2030.

Further, on average, one in three people with diabetes will develop some form of diabetic eye disease which equals about 423,000 Australians – one third of those registered on the National Diabetes Services Scheme (NDSS).

From left: Graham Perrett MP, Dr. Peter van Wijngaarden, Dr. Amira Howari (optometrist and Diabetes Australia Ambassador), Peter Larsen (Executive Director Specsavers AUS and NZ), Dr Andrew Laming MP and Professor Greg Johnson (Diabetes Australia).

Diabetic retinopathy is often asymptomatic until it reaches an advanced stage and outcomes of late treatment are usually inferior to early intervention.

Evidence shows that early detection and timely treatment can prevent the majority of diabetes-related vision loss. The lack of a coordinated and systematic approach means a significant proportion of Australians with diabetes do not have an eye examination when required. This is despite ample existing capacity in optometry, ophthalmology and general medical practices to support early detection and treatment.

That is why Diabetes Australia, Vision 2020 Australia, Oculo and the Centre for Eye Research Australia worked with the Australian Government to develop a recall and reminder program which engages the 1.3 million current registrants on the NDSS to have regular eye examinations, using existing eye health and primary care practitioners and existing Medicare Benefits Schedule (MBS) item numbers.

In 2018, the program was born and in March 2019, it was officially launched to consumers. Since then, more than 2,500 people with diabetes have signed up for regular reminders.

KeepSight aims to demonstrate that a coordinated and systematic approach to preventative and timely eye healthcare will improve outcomes for people with diabetes.

The program will provide new opportunities to measure the burden of diabetes-related eye disease in Australia and will serve as a vehicle to reduce avoidable vision impairment and blindness.

HOW KEEPSIGHT WORKS

The logic behind KeepSight is not new. The eye health and diabetes sectors understand that too many Australians are experiencing diabetes-related vision loss and blindness because approximately half of those with diagnosed diabetes are not receiving eye examinations at the recommended frequency. As a result, retinopathy may progress and threaten sight if left unchecked.

KeepSight is the first national recall and reminder system introduced domestically to remind those with diabetes to have regular eye examinations. And we have firm evidence that the concept works.

The introduction of similar schemes in other countries has had tremendous success, in particular in England and Wales.

A recall and reminder system was established there in 2003 and by 2010 diabetic retinopathy was no longer the leading cause of preventable blindness. Yet, in the 50 preceding years, diabetes was the main cause of vision loss in the working aged.

We absolutely expect that this can be a similar story in Australia in years to come. KeepSight has the potential to be the missing link that will keep Australians with diabetes more engaged in their eye health care and dramatically reduce diabetes related vision loss and blindness in Australia.

Optometrists, orthoptists, ophthalmologists, Aboriginal health workers, and GPs who do diabetic retinopathy (DR) screening are really important for the KeepSight program.

As the professionals who work at the coalface of this health epidemic, it’s critical that we play our role in addressing this important issue. This is an extremely valuable community initiative that confirms the eye care sector’s role in the management of eye health for people with diabetes.

KeepSight aims to demonstrate that a coordinated and systematic approach to preventative and timely eye healthcare will improve outcomes for people with diabetes

By registering as a KeepSight provider, then registering and recording the results for patients with diabetes, we can ensure they are getting the right eye care, at the right time. We will also be helping the NDSS target people who are not getting recommended eye examinations to get checked.

Further, by registering to be involved, it will be easier for people with diabetes who do not currently have regular eye checks, to find you. Once you and your patients are registered with the KeepSight program, the recall and reminder notices you may already send to your patients will be supplemented by reminders from Diabetes Australia.

HOW TO REGISTER AS A PROVIDER

Registering as a provider is quick and easy. It takes only a minute.

Eye care providers who already use the Oculo system can log on to Oculo, select a patient and follow the prompts for KeepSight registration.

Practices which don’t use Oculo can register through the KeepSight web portal, www.keepsight.org.au with three easy steps:

  1. Visit www.keepsight.org.au and select ‘For health professionals’ at the right of the screen. On the next screen, click ‘Register today’.
  2. Provide your email address and create a password, then receive a confirmation email.

Click on the link in the confirmation email, and then login with the password you have just created. Follow the prompts to enter your information – please note you will need your AHPRA number as part of the registration, or an Orthoptics Australia membership number for orthoptist staff.

You only need to do this once, but you do need to be registered with the system before you can register patients.

HOW TO REGISTER PATIENTS WITH KEEPSIGHT
  1. Login to the KeepSight website using your email and password created at registration.
  2. Follow the prompts to record a patient visit.
  3. You’ll need to record your patient’s name, some basic information about the eye check provided, and when they will need a follow up eye check. If possible, their NDSS number should also be recorded if the patient can provide it.

Practices using Oculo will be prompted to register patients with diabetes to KeepSight when managing referrals and clinical correspondence.

PATIENT DATA SECURITY

Patient information will be strictly managed in accordance with industry best practice to safeguard data security and patient privacy. Identifiable patient information will only be available to Diabetes Australia, as the KeepSight lead partner, to remind the patient when eye examinations are due in the future. The data will not be released or shared.

The KeepSight program is not intended to disrupt existing arrangements between eye care providers and their patients, rather it will reinforce this with an additional recall and reminder system.

KeepSight presents a once-in-a-generation opportunity to significantly boost the number of eye examinations for people with diabetes and in doing so, reduce the number of people who lose their sight. As a sector, we can lead the charge to improve the quality of life for the 1.7 million Australians living with diabetes by supporting this national initiative.

FIND OUT MORE

Associate Professor Peter van Wijngaarden is a Principal Investigator at CERA and a consultant ophthalmologist in the medical retina clinic at the Royal Victorian Eye and Ear Hospital. He has been a Deputy Director at CERA since 2017. 

He is a Clinical Director and a founding member of Preserve Sight – a Commonwealth Government-funded national approach to diabetic retinopathy screening in Australia. A/Prof van Wijngaarden is also a member of the medical and research committees of the Macular Disease Foundation Australia and is the Royal Australia and New Zealand College of Ophthalmologists’ representative on the Vision 2020 Vision Initiative, a public health program seeking to reduce avoidable blindness in Victoria. He is a board member of the Ophthalmic Research Institute of Australia. 

The English Experience

The English NHS Diabetic Eye Screening Program was established in 2003 to offer two-field mydriatic digital photographic screening annually to all people aged 12 years and over, with diabetes. By 2008, the program had reached the whole population with over 2.14 million people with diabetes screened.

By 2010, for the first time in 50 years, diabetic retinopathy and maculopathy was no longer the leading cause of blindness registration for working age people in England.

Oculo: Helping to Facilitate KeepSight

Oculo is the technology provider for KeepSight – eye care providers who currently use Oculo are able to access a streamlined process within Oculo to register patients to receive eye examination recalls and reminders.

Oculo is a cloud-based clinical communications platform that facilitates collaborative patient care with the secure, instant transfer of clinical imaging, referrals, and other clinical correspondence between health care professionals. This platform centralises patient medical histories, ocular examination results and clinical imagery, moving health care decision making from one snapshot in time to longitudinal, cloud-based, collaborative and integrated patient care.

Data held on Oculo is encrypted in transit and in storage, at security standards that exceed Medicare’s standards for public key infrastructure and comply with global standards.

Contact: Oculo (AUS) 03 8592 7079 or (NZ) 09 888 0719 

A Collaborative Effort 

KeepSight is a partnership between the Australian Government, Diabetes Australia and other corporate and sector partners.

Partners include Specsavers, Vision 2020 Australia, Oculo, Centre for Eye Research Australia, Bayer and Novartis. Other eye and diabetes sector partners are being encouraged to get involved.