Specsavers annual clinical conference, this year presented as a series of online lectures and panel discussions, has provided an update on KeepSight, a national diabetes eye health program launched in 2019.
The program, led by Diabetes Australia, was established to reduce diabetes related vision loss by making it easier for people to have regular diabetes eye checks with their eye care practitioner.
Since the program’s launch, optometrists have registered 90,000 people with diabetes on the KeepSight portal database. While this is an impressive start, Specsavers Director of Optometry, Dr Ben Ashby, reported that Specsavers own goal is to register 200,000 people by the end of 2021 as part of a whole-of-optometry drive.
Dr Ashby, and almost 400 delegates who zoomed in to the presentation on KeepSight, heard from “three luminaries in the fight to beat diabetes”; Professor Greg Johnson, CEO of Diabetes Australia, Associate Professor Peter van Wijngaarden, Deputy Director Centre for Eye Research Australia, and Peter Larsen, Group Eye Health Strategy Director at Specsavers.
Professor Johnson and A/Prof van Wijngaarden commenced proceedings by presenting current diabetes-related statistics and describing the challenges associated with growing the number of people registered with KeepSight in the current COVID-19 environment. Professor Johnson said, “While we’re overwhelmed with the COVID pandemic, in fact the diabetes pandemic continues silently –during this time, significantly more people have been diagnosed with diabetes than diagnosed with COVID-19 and they will live with diabetes for the rest of their life”.
He said education is not enough to address the size and scale of the diabetes epidemic and its complications, including blindness. A systematic approach – such as that being delivered through KeepSight – is needed to ensure everyone with diabetes has regular eye checks, so the early signs of diabetic retinopathy can be identified, enabling early intervention, which will result in better outcomes.
A/Prof van Wijngaarden reminded the audience of the “huge burden of eye diseases that come with diabetes”.
Currently, half a billion people world-wide live with diabetes and over the next decade, 130 million more will be diagnosed. This is the fastest growing health problem in Australia with diabetic retinopathy being the most common diabetes related condition.
The recent National Eye Health Survey showed that about 30% of non-indigenous Australians over 50 years of age with diabetes had some degree of retinopathy, about 5% of which was sight threatening.
The prevalence of diabetes is about three to four times higher among Indigenous Australians, (and even higher in some communities). Complications, including retinopathy, tend to come on earlier – 40% of Indigenous Australians surveyed over the age of 40 had diabetic retinopathy and it was sight threatening in about 10%.
According to Professor Johnson, one third of all hospital admissions in Australia are diabetes-related, and of all diabetes types, gestational diabetes is increasing most quickly – this will drive diabetes prevalence in future generations.
A/Prof van Wijngaarden acknowledged the “remarkable achievements” of Specsavers and all optometrists in building the KeepSight database by registering people with diabetes or encouraging them to register their participation.
He said the objective is to have everyone with diabetes on the database. This will enable KeepSight to know whether people with diabetes are accessing eye checks, and how early they are accessing interventions and treatments.
“My message for tonight is ‘get everyone on KeepSight’. Please register every person you see with diabetes. KeepSight data is secure and registration will help to prevent vision loss. It’s the key to maximising sight,” said A/Prof van Wijngaarden.
Mr Larsen said KeepSight is the beginning of a journey to embed optometry in the holistic care team that will solve the problem of diabetic eye disease.
Pointing to the success of the diabetes screening program initiated and directed by Professor Peter Scanlon in the United Kingdom, Mr Larsen said the UK screening program has toppled diabetes as the leading cause of blindness. To maintain funding levels, the program to recall patients for regular eye examinations is expected to deliver eight out of every ten people with diabetes back to service providers to get their eyes checked – in other words it has to be measurable and accountable. He said similarly, Australian optometry needs to play its part in eliminating diabetes associated blindness, and the profession’s activities in this area need to be measurable and accountable.
Linkages identify Drivers
Data suggests that currently around half of the 1.4 million people with diabetes who are registered on the National Diabetes Services Scheme (NDSS) are not accessing eye services as required for many reasons – cultural diversity, language barriers, disadvantage – social, demographic, rural and regional.
According to A/Prof van Wijngaarden, this may also be because diabetes’ multiple manifestations makes the disease challenging to live with.
“Typically, a person with diabetes makes 180 diabetes-related decisions every day – that’s half a million decisions per decade. Within this context of competing health priorities, keeping up with retinal screening is understandably often not the top priority, particularly for the majority of people who are not experiencing problems with their vision.”
By linking the databases of NDSS and KeepSight it will be possible to identify and reach people who aren’t having their eyes examined and get them into the system.
A/Prof van Wijngaarden said people with diabetes who are not engaged in their eye care will gain the most benefit from KeepSight as they begin to receive regular communication about the importance of eye screening from Diabetes Australia, which is perceived to be the “trusted voice of diabetes”.
Additionally, he said clinicians will benefit from an increased number of patients attending for diabetes eye checks. “KeepSight aims to strengthen patient relationships and bring in people who are not currently engaged in eye care.” Although it may be hard for a clinician to see their impact on diabetes prevalence at an individual level, he said “together we are changing the face of the leading cause of avoidable blindness… the success of this program depends on each of us. We owe it to people with diabetes to do better.”
When speaking to patients Mr Larsen advised, “Simplicity of message is key – let them know KeepSight is a program from an independent body – it’s a safety check to make sure that people with diabetes are getting the best eye health.”