STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile

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STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile
Australia & New Zealand
Eye Health Report 2018

STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile
© Specsavers Pty Ltd and Specsavers New Zealand Ltd. State of the Nation:
    Australia and New Zealand Eye Health Report 2018

    This work is copyright. The Copyright Act 1968 permits fair dealing for study,
    research, news reporting, criticism or review. Selected passages, tables or charts
    may be reproduced for such purposes provided acknowledgment of the source is
    included. Permission for any more extensive reproduction must be obtained from
    Specsavers Pty Ltd and/or Specsavers NZ Ltd through one of the contact officers
    listed for this report.

    While every effort has been made to ensure the accuracy of this document, the
    uncertain nature of data, forecasting and analysis means that Specsavers Pty
    Ltd and Specsavers NZ Ltd is unable to make any warranties in relation to the
    information contained herein. Specsavers Pty Ltd and Specsavers NZ Ltd, its
    employees and agents disclaim liability for any loss or damage which may arise
    as a consequence of any person relying on the information contained in this
    document and any attachments.

    Specsavers Pty Ltd
    ABN 82 097 147 932

    520 Graham Street
    Port Melbourne, VIC 3207
    T: +61 3 8645 0700

    New Zealand
    Unit A 26 Triton Dve, Mairangi Bay
    Auckland 0632
    T: +64 9 475 0250

    For information on this report please contact:
    Cathy Rennie Matos,
    Caitlin Carey,

    This report could not have been developed without the contribution of many people.
    A special thank you to the Specsavers’ Optometry Team who worked tirelessly to
    analyse the 6.3 million clinical records that were used to inform the research in this
    report, to the Specsavers’ Communications Team who spent hours researching
    and writing the report, and to Nature and Research NZ who conducted and
    analysed our consumer research studies. We are also grateful to our optometrists
    and their patients who shared their personal stories with us, as they bring a
    human face to our data and motivate us to play our role in reducing avoidable
    vision loss and blindness. Finally, a special thank you to our industry partners who
    have been invaluable in working together to Transforming Eye Health in Australia
    and New Zealand – RANZCO, Glaucoma Australia, Macular Disease Foundation
    Australia, Diabetes Australia.

STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile




14 Prevalence Rates of Eye Disease
21 Optometric Services
35 The Social and Economic Cost of Eye Health

36   The Public View of Eye Health
36   The Public’s Understanding of Eye Conditions and Diseases
37   Accessibility and Perceived Barriers
38   An Eye Test is More than a Sight Test
39   Eye Health – A Public Health Issue

41   Glaucoma
46   Age-Related Macular Degeneration
49   Diabetic Retinopathy
54   Cataract
56   Refractive Error

60   Optometric Services
61   The Nations’ Relationship with Children’s Eye Health
62   After Eight is Too Late
63   Prevalence of Children’s Eye Conditions
64   Children’s Eye Conditions and the Myopia Epidemic
65   Children’s Eye Screening Programs

67 Aboriginal and Torres Strait Islander Eye Health
70 Māori and Pacific Islander Eye Health
72 Supporting The Fred Hollows Foundation

75   Raising Public Awareness
77   Increasing Early Detection
78   Improving Communication and Collaboration Between Professions
81   Improving the Evidence Base


STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile

    21   Table 1.1:    Total optometric consultations by year
    22   Table 1.2:    Total optometric consultations forecast for FY25
    22   Table 1.3:    Referred comprehensive consultations by year
    23   Table 1.4:    Comprehensive initial consultations by another practitioner by year
    25   Table 1.5:    Comprehensive initial consultations by year
    25   Table 1.6:    Brief initial consultations by year
    26   Table 1.7:    Total initial consultations by year
    27   Table 1.8:    Other comprehensive consultations by year
    28   Table 1.9:    Diabetes mellitus consultations by year
    29   Table 1.10:   Subsequent consultations by year
    31   Table 1.11:   Visual fields by item number by year
    31   Table 1.12:   Visual fields by age range by year
    32   Table 1.13:   Total NZ optometric consultations forecasted to FY15

    21   Chart 1.1:    Total optometric consultations by year
    21   Chart 1.2:    Total optometric consultation by age range, FY18
    22   Chart 1.3:    Total optometric consultations forecast to FY25
    22   Chart 1.4:    Optometric consultations by type, FY18
    22   Chart 1.5:    Optometric consultations by item number, FY18
    23   Chart 1.6:    Referred comprehensive consultations by year
    23   Chart 1.7:    Referred comprehensive consultations by age range, FY18
    23   Chart 1.8:    Comprehensive initial consultations by another practitioner by year
    23   Chart 1.9:    Comprehensive initial consultations by another practitioner by age range, FY18
    25   Chart 1.10:   Comprehensive initial consultations by year
    25   Chart 1:11:   Comprehensive initial consultations (10910 & 10911) by age range, FY18
    26   Chart 1.12:   Brief initial consultations by year
    26   Chart 1.13:   Brief initial consultations by age range, FY18
    27   Chart 1.14:   Other comprehensive consultations by year
    27   Chart 1.15:   Other comprehensive consultations by age range, FY18
    28   Chart 1.16:   Diabetes mellitus consultations by year
    28   Chart 1.17:   Diabetes mellitus consultations by age range, FY18
    29   Chart 1.18:   Subsequent consultations by year
    29   Chart 1.19:   Subsequent consultations by age range, FY18
    31   Chart 1.20:   Visual fields by year
    31   Chart 1.21:   Visual fields by age range, FY18
    32   Chart 1.22:   Total NZ optometric consultations forecast to FY25
    43   Chart 2.1:    Glaucoma referrals as a percentage of patients
    43   Chart 2.2:    Visual fields as a percentage of patients v glaucoma referrals as a percentage of patients
    43   Chart 2.3:    Glaucoma referrals where IOP is under 22mmHg
    47   Chart 2.4:    Medical retinal referrals as a percentage of patients
    47   Chart 2.5:    Classification of AMD referrals sent through Oculo
    50   Chart 2.6:    Diabetes GP eye reports as a percentage of all patients
    50   Chart 2.7:    Diabetic eye referrals as a percentage of patients
    50   Chart 2.8:    Percentage of diabetic eye referrals with macular oedema identified
    55   Chart 2.9:    Cataract referrals as a percentage of patients
    56   Chart 2.10:   Refractive error based on dispensed prescriptions
    57   Chart 2.11:   Distribution of dispensed prescriptions by spherical power
    57   Chart 2.12:   Distribution of spherical power of contact lens prescription
    60   Chart 3.1:    Children’s optometric consultations by year
    60   Chart 3.2:    Children’s vision assessments by year
    68   Chart 4.1:    State spectacles schemes and estimated need for Indigenous Australians, 2016-17
    68   Chart 4.2:    Prevalence of trachoma in at-risk Indigenous communities, 2009 to 2016

STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile

ABS      Australian Bureau of Statistics
AIHW     Australian Institute of Health and Welfare
AMD      Age-related macular degeneration
BMES     Blue Mountains Eye Study
DHB      District Health Board
DMO      Diabetic macular oedema
DR       Diabetic retinopathy
IOP      Intraocular pressure
MBS      Medicare Benefits Schedule
MVIP     Melbourne Visual Impairment Project
NDSS     National Diabetes Service Scheme
NEHS     National Eye Health Survey
NHMRC    National Health and Medical Research Council
NPDR     Non-proliferative diabetic retinopathy
OCT      Optical Coherence Tomography
OLEEP    Ophthalmologist Local Education and Engagement Program
OMBS     Optometric Medicare Benefits Schedule
POAG     Primary open-angle glaucoma
PR       Proliferative retinopathy
RANZCO   Royal Australian and New Zealand College of Ophthalmologists
RE       Refractive error
RPE      Retinal pigment epithelium
StEPS    Statewide Eyesight Preschooler Screening

STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile
    With an ageing population in both Australia and New Zealand, vision
    impairment is expected to emerge as the most prevalent health condition
    among older people over the coming years. As 90% of vision loss in Australia
    and New Zealand is preventable or treatable, early detection and intervention
    is paramount to preventing avoidable vision loss and blindness5.

    Optometry plays a critical role in the early detection of eye disease,   • The systematic use of
    appropriate referrals, and ongoing patient co-management. For the          OCT as a screening
    past year, Specsavers’ has been focused on outcome-led optometry
    which has involved the development of consistent approaches to
    disease assessment and management, measuring improvement
                                                                               tool for every patient
                                                                               plus benchmarking
                                                                               effectively increases
                                                                                                                    of vision loss
    of clinical interventions, and benchmarking this against peers and         glaucoma detection
    published data.                                                            rates across all age               in Australia and
                                                                               groups, to near                    New Zealand is
    The introduction and systematic use of Optical                             population prevalence
                                                                                                                   preventable or
    Coherence Tomography (OCT) technology to                                   as per Blue Mountains
    screen all patients for eye diseases has led                               Eye Study (BMES) (50%                 treatable5
    to overwhelming data that shows the validity                               more cases detected in
                                                                               patients 40+ compared to
    of this approach in improving detection and
                                                                               non-OCT practices in 2018 and
    diagnosis rates of not only glaucoma, but also                             169% more compared to 2017).
    diabetic retinopathy and medical retinal disease,
    namely age-related macular degeneration.                                 • The majority of patients referred for glaucoma
                                                                               have intraocular pressure (IOP) within the normal range (ie.
    Comparing this data to major eye health studies is designed to             less than 22mmHg). The systematic use of OCT is proving to be
    assist optometrists in applying evidence-based benchmarks                  superior for detecting low tension glaucoma - these are patients
    to their care of the typical patient presenting to a primary eye           with evidence of structural change presenting on OCT, without
    health professional, and coupled with increased collaboration              raised IOP, visible optic nerve changes or other overt signs of
    with ophthalmologists, GPs and patient support groups will                 glaucoma. Optometry practices using OCT in this manner are
    continue to improve patient outcomes and prevent avoidable                 detecting and referring 49% more patients for low tension
    vision loss and blindness in Australia and New Zealand.                    glaucoma in patients 40+ compared to non-OCT practices.

                                                                             • A significantly higher proportion of medical retina cases, the
    Transforming Eye Health                                                    majority of which are age-related macular degeneration (AMD),
                                                                               are being detected in practices using OCT systematically
    An analysis of clinical data from 6.3 million Specsavers’ patients in      (69% more cases in patients 50+ compared to non-OCT
    Australia has shown overwhelmingly the real and positive impact            practices in 2018 and 194% more cases compared to 2017).
    that the systematic use of OCT technology on every patient as part         34.5% of patients are being referred for early AMD, 34.9% for
    of a standard comprehensive eye examination, combined with clinical        intermediate AMD and 30.6% for late AMD.
    benchmark reporting and collaboration with medicine through the
    RANZCO referral guidelines, is having on patient outcomes in relation    • The diagnostic sensitivity of OCT combined with the
    to some of the key causes of avoidable vision loss and blindness.          additional clinical information it provides, has assisted
                                                                               optometrists who use OCT on every patient to improve
    • Current national Medicare utilisation data indicates that                their detection of diabetic macular oedema (DMO) cases.
      Australian optometrists perform visual fields on 8% of                   These practices are identifying and referring 85% more
      all patients. To detect glaucoma at currently established                cases of DMO compared to non-OCT practices.
      population prevalence rates, visual fields should be performed
      on at least 10% of all patients presenting to optometry.

STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile
Optometric consultations
The Need for More                                   currently experiencing some degree
Research and Data                                   of diabetic retinopathy. By 2020, the
                                                                                                        are predicted to exceed
                                                    projected number of people experiencing           12.2 million in Australia and
Ongoing high quality research and clinical          vision loss or blindness from diabetic
data is needed in both Australia and New            retinopathy is 13,440 in Australia and
                                                                                                       1.2 million in New Zealand
Zealand to better understand prevalence of          2,682 in New Zealand4,8.                                     by 2025
eye conditions and diseases and the impact
of clinical interventions on patient outcomes.    • Cataract: as many as 1.5 million Australians
                                                    over the age of 55 are believed to have
At present it is not possible with the research     cataract6. By 2020, the projected number
and data available to gauge the impact we           of people experiencing vision loss or            in risk factors being identified through
are having on reducing avoidable blindness          blindness from cataract is 126,400 in            OCT results and the subsequent need to
in the region. As an industry, we need to           Australia and 24,800 in New Zealand4,8.          comprehensively assess these patients
coordinate our efforts to capture high quality                                                       for ocular disease.
data, aggregate it, analyse it effectively and    • Refractive Error: Approximately 2.4 million
share it so that we produce a growing data-         Australians and 480,000 New Zealanders         • The true number of comprehensive
set across the profession and government.           over the age of 40 have some form of             consultations for patients with diabetes
Only then will we be able to prove the              refractive error22 (22% of that age group)       mellitus in Australia is unknown due
validity of interventions to improve detection      and based on self-reported data another          to ambiguity related to the billing of
and diagnosis rates and subsequently the            1.3 million Australians over the age of 55       patients with diabetes, however 244,000
impact on improving patient outcomes and            suffer from presbyopia6. By 2020, the            consultations were performed under Item
reducing avoidable vision loss and blindness.       projected number of people experiencing          10915 in FY18, representing just 20% of
                                                    vision impairment from refractive error,         the 1.2 million Australians with diabetes
                                                    excluding presbyopia, is 423,793 in              registered on the National Diabetes
The Current State of                                Australia and 92,936 in New Zealand4,8.          Services Scheme.
Eye Health in Australia
and New Zealand                                                                                    • The number of visual fields procedures
                                                  Demand for                                         in Australia has been increasing steadily
Current prevalence of vision loss and blindness   Optometric Services                                with bilateral visual fields increasing
in Australia is estimated at between 453,0005                                                        68% over the past 10 years. The number
and 822,0004, and in New Zealand around           • In Australia, optometric consultations,          of visual fields performed annually is
175,0008. In the 2014-15 National Health            across all Medicare Benefits Schedule            expected to continue growing as more
Survey, over 12 million Australians (55% of the     (MBS) item numbers, have increased 51%           people are identified with glaucoma
population) self-reported having at least           over the past 10 years and are expected          risk factors through the use of OCT
one long term vision disorder7.                     to continue growing at an average of 5%          technology. Currently, the majority of
                                                    per year. It is predicted that optometric        procedures (63%) are performed on
Approximately 90% of vision                         consultations will exceed 9.5 million by         patients within the 55-64 and 65+ age
loss and blindness in Australia                     2020 and 12.2 million by 2025.                   range with the biggest growth coming
and New Zealand is caused                                                                            from people aged 65-74.
by one of the five major eye                      • In FY18 a total of 8.7 optometric
                                                    consultations in Australia were                • Several changes to the OMBS in Australia
conditions: uncorrected or
                                                    performed, with the highest volume               are recommended to reflect connected,
under-corrected refractive                          coming from Item 10910 at 2.23 million           contemporary practice and the impact that
error, glaucoma, AMD, diabetic                      (25.7%), followed by Item 10918 at 2.15          technology and data is having on improving
retinopathy and cataract4:                          million (24.8%) and Item 10911 at 1.23           the management of patients with diabetes
                                                    million (14.2%).                                 mellitus and progressive disorders such as
• Glaucoma: 300,000 Australians and                                                                  glaucoma and AMD. The key one being the
  115,000 New Zealanders over the age             • Initial consultations performed by               introduction of a new item for people aged
  of 40 are estimated to have glaucoma,             optometrists in Australia in FY18 totalled       45-64 entitling them to a comprehensive
  although as many as 50% of these are              4.68 million of which 1.42 million were for      eye examination once every 24 months,
  undiagnosed9,10. By 2020, the projected           people 65+ (representing 38.9% of the            rather than every 36 months.
  number of people experiencing vision loss         age range); 1.29 million were for people
  or blindness from glaucoma is 41,900 in           aged 45-64 (representing 22.1% of the          • In New Zealand, there is no systematic
  Australia and 7,287 in New Zealand4,8.            age range); 1.44 million were for people         means of capturing and reporting
                                                    age 15-44 (representing 15.2% of the age         on optometric services performed
• AMD: 1 in seven Australians, 1.29 million,        range); and 513,000 were for children            by community optometry practices.
  over the age of 5012 and 1 in 10 New              aged 0-14 (representing 11.8% of the             However, it is estimated that 781,322
  Zealanders, 218,987, over the age of 4513         age range) suggesting that the majority          comprehensive eye examinations were
  are believed to have AMD. By 2020, the            of Australians are not having their eyes         performed by optometrists across
  projected number of people experiencing           tested as regularly as the industry              New Zealand in FY18, representing just
  vision loss or blindness from AMD is 91,300       recommends.                                      16.6% of the population. Based on a
  in Australia and 16,280 in New Zealand4,8.                                                         projected 6% annual growth rate in
                                                  • The volume of brief initial consultations        eye examinations, it is estimated that
• Diabetic Retinopathy: more than                   (10916) in Australia is in decline driven        optometric consultations will exceed
  300,000 Australians41 and between                 predominantly by people in the 45-64             917,000 by 2020 and 1.2 million by 2025.
  52,091 – 65,114 New Zealanders10 are              age range due to increased frequency

STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile
The Cost of Eye Health                               blindness is very limited with a significant
                                                         amount of confusion and uncertainty in
    The latest figures available on the cost of          relation to risk factors, symptoms and
    eye health in Australia and New Zealand              treatment.
    come from economic analysis completed in
    2009 and estimate the total financial cost         • The biggest barriers to people having their
    of vision loss to be $16.6 billion per annum in      eyes tested regularly tie back to a general
    Australia4 and $2.8 billion in New Zealand8.         lack of awareness and understanding of
    At the time optometric services accounted            eye health. Thinking nothing’s wrong, lack
    for 10% of health system expenditure                 of time and perceived cost were the main
    in Australia4 and 3.5% of health system              reasons that people don’t have their eyes
    expenditure in New Zealand8.                         tested. However, issues with everyday
                                                         activities such as reading, driving, or
    Health system expenditure was projected              looking at screens would trigger those that
    to rise 60% in Australia from $2.89 billion          haven’t had an eye test to do so most.
    in 2009 to $4.76 billion in 2020 and 164%
    in New Zealand from $198 million in 2009           • While most people have a basic
    to $522 million in 2020, while the cost              understanding of the role optometrists
    of optometric services was projected to              play in the delivery of primary health
    increase from $267 million to $467 million in        care, there is still a lack of awareness
    Australia and from $6.8 million to $18.1 million     that optometrists can detect major eye
    in New Zealand.                                      diseases.

                                                       • The majority of people expect their eye
    The Public View of                                   test to include everything needed to
    Eye Health                                           detect major causes of avoidable blindness
                                                         and most believe their care should be co-
    While it is clear that Australians and New           managed and their optometrist should use
    Zealanders value their eyesight, with 62%            a platform like Oculo to share their eye care
    and 67% respectively saying it was the               data with their ophthalmologist and GP.
    sense they would least like to lose and
    83% and 82% respectively believing their
    eyesight is priceless and wouldn’t be willing      The Delivery of
    to give it up for any amount of money,             Eye Health Care
    most people are not taking preventative
    measures to look after their eye health.           • The structure and delivery of eye health
                                                         services in Australia and New Zealand
    • More than half of Australians and New              are markedly different due to funding
      Zealanders over the age of 40 have                 arrangements and the general structure
      reported experiencing at least one                 of health care systems.
      eyesight issue that they haven’t seen
      an optometrist about, with the most              • In Australia, close working relationships
      common complaints relating to not being            and a more collaborative approach to
      able to see up close, or in the distance, as       patient care between ophthalmology
      well as they used to.                              and optometry is required to establish
                                                         more effective and efficient patient care
    • Between a third and a half of Australians          pathways and improve patient health
      and New Zealanders can’t recall having             outcomes.
      had an eye test in the past two years even
      though 85% think everyone should have            • In New Zealand, appropriate funding
      their eyes tested at least once every two          strategies are required for an eye health
      years; and less than a third of people have        model which includes services provided
      had a conversation about their family’s eye        in DHBs and the local community via an
      health history.                                    integrated and collaborative approach
                                                         to care, between ophthalmology
    • While myopia, hyperopia and cataract               and optometry, using an effective
      are the most recognised eye conditions,            communication platform and efficient
      the public’s understanding of the major            patient care pathways to improve patient
      eye diseases that cause vision loss and            health outcomes.

    Australia                                              New Zealand
    $16.6 billion                                          $2.8 billion
STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile
STATE OF THE NATION Australia & New Zealand Eye Health Report 2018 - Specsavers ProFile
In May 2003, in recognition of the 45 million people in the
world that are blind and the further 135 million people that
are visually impaired, the 56th World Health Assembly passed
resolution WHA56.26 on the elimination of avoidable blindness.
In response to the resolution, the        Specsavers entered the
Australian Government Department          Australian and New Zealand
of Health and Ageing developed a          markets in 2008 with a goal to
strategic National Framework for          change the face of optometry               Early findings on the
Action to Promote Eye Health and          and improve the eye health of           impact of certain clinical
Prevent Avoidable Blindness and           Australians and New Zealanders
Vision Loss in 2005.                      by providing accessible and
                                                                                   interventions on patient
                                          affordable eye care to everyone.        outcomes have important
The Framework outlined five key           Specsavers has worked                    implications for the eye
action areas that have the potential      resolutely towards this goal over
to lead to the prevention of avoidable    the past 10 years and recently
                                                                                        health industry
blindness and low vision which were:      consolidated its various eye care
1) reducing the risk of eye disease and   strategies into a single-minded
injury; 2) increasing early detection;    mission: to transform eye health
3) improving access to eye health care    in Australia and New Zealand, a
services; 4) improving the systems        mission that supports the National     This report includes some of our
and quality of care; and 5) improving     Eye Health Framework.                  early findings, which have important
the underlying evidence base1.                                                   implications for the eye health
                                          We have already taken                  industry. In particular, the value of a
It has been 13 years since the            significant steps                      systematic approach to optometry
Framework was developed and while         toward addressing key                  and disease detection for improving
a considerable amount of work has         challenges and are in the              early detection and intervention
been undertaken by government,                                                   to reduce the amount of avoidable
                                          process of implementing
non-government and the private                                                   blindness resulting from glaucoma,
sector, the goal to eliminate avoidable   new projects while                     age-related macular degeneration
blindness by 2020 will not be             continuing to build on the             and diabetic retinopathy.
achieved. While important progress        foundations of previously
has been made, there is still a long      established initiatives,               Over the coming years, it is vital that
way to go to achieve that goal and        working collaboratively                we continue to work collaboratively
significant challenges to overcome.       with government, non-                  towards our goal with renewed
                                          government and the                     passion and determination. We
In the 2014-15 National Health                                                   must do more to put eye health
                                          industry in an effort to
Survey, 12 million Australians (55%                                              on the agenda and not only raise
of the population) reported having at     transform eye health                   public awareness of eye health
least one long-term vision disorder,      and improve health                     but also drive behavioural change;
up from 9.7 million (51%) in 2001.        outcomes for patients.                 we must continue to improve our
Furthermore, it is estimated that as                                             evidence base and then respond
many as 822,000 people in Australia       This inaugural ‘State of the Nation:   to what the data is telling us; we
and 175,000 people in New Zealand         Eye Health Report 2018’ contains       must be systematic in the way
are currently experiencing vision         the latest research and evidence on    we test patients for eye diseases,
loss or blindness, yet 90% of vision      the state of eye health in Australia   ensure our optometry workforce
loss and blindness is preventable or      and New Zealand. Through the           can service the demand and are
treatable through the management of       combination of Specsavers’ eye         skilled in eye disease detection;
known risk factors and/or treatment.      care initiatives, we now have access   ensure we have appropriate
                                          to an unprecedented volume of          referral pathways; and importantly
With an ageing population, the            new data and information on levels     we need to continue improving
Australian Government estimates           of eye care in Australia and New       communication and collaboration
vision impairment will, over the          Zealand and the impact that certain    between professions to satisfy
coming years, emerge as the most          strategies and interventions can       patient demand and effectively
prevalent health condition among          have on patient outcomes in relation   manage patient outcomes.
older people.                             to the major eye diseases.

                                                                                                                       Optometrists are primary health care
                                                                                                                       providers and the first line of defence
                                                                                                                       in preventing avoidable vision loss and
                                                                                                                       blindness through the early detection,
                                                                                                                       treatment and management of eye
                                                                                                                       conditions and diseases.

                                                                                                                       By performing eye examinations,
                                                                                                                       optometrists assess the eye and visual
                                                                                                                       system, sensory and ocular motor
                                                                                                                       disorders and dysfunctions of the eye
                                                                                                                       and the visual system; detect signs of
                                                                                                                       eye diseases and diagnose refractive
                                                                                                                       disorders. They are also responsible
                                                                                                                       for appropriately managing health
                                                                                                                       disorders involving the eyes using a
                                                                                                                       multi-disciplinary approach, engaging in
                                                                                                                       therapeutic management of certain eye
                                                                                                                       conditions and diseases, and prescribing
                                                                                                                       glasses and contact lenses.

                                                                                                                       When an optometrist identifies
                                                                                                                       signs of an issue within the eye
                                                                                                                       that requires medical or surgical
                                                                                                                       treatment, or detects an eye
                                                                                                                       disease that requires further
                                                                                                                       assessment and management
                                                                                                                       by a tertiary specialist, the
                                                                                                                       patient is referred to an

                                                                                                                       When an optometrist treats a patient
                                                                                                                       with ocular manifestations of a systemic
                                                                                                                       health condition, they will engage in

                                                                                                                       appropriate co-management of the
                                                                                                                       patient and provide reports to relevant
                                                                                                                       health practitioners involved in the

                                                                                                                       patient’s care.

                                                                                                                       As part of a holistic approach to patient
                                                                                                                       care, optometrists will refer patients to
                                                                                                                       the appropriate patient advocacy group
                                                                                                                       for non-clinical support (for example
     The structure and delivery of eye health services in                                                              Glaucoma Australia or Macular Disease
                                                                                                                       Foundation of Australia).
     Australia and New Zealand are markedly different, due
     primarily to funding arrangements and differences in the                                                          In both Australia and New Zealand,
     general structure of the health care systems.                                                                     optometrists undergo a minimum of 5
                                                                                                                       years of university education and are
                                                                                                                       authorised to prescribe medicines for the
     The professions that are engaged in the               include general practitioners, nurses,                      treatment of eye conditions within their
     delivery of eye care, however, are similar            pharmacists and allied health workers. The                  scope of practice and training.
     and can be broken into two key groups – eye           services delivered by the eye health care
     health care professionals and generalist              workforce include prevention, diagnosis,                    To practice in Australia, optometrists
     health care professionals.                            management, treatment and rehabilitation.                   are regulated and registered by
                                                                                                                       the Optometry Board of Australia,
     Eye health care professionals include                 Optometrists and optical dispensers make up                 while in New Zealand, optometrists
     optometrists, ophthalmologists, orthoptists,          the majority of the eye health care workforce               are regulated and registered with
     ophthalmic nurses and optical dispensers*             in Australia, with optometrists providing over              the Optometrists and Dispensing
     while generalist health care professionals            75% of primary eye care.                                    Opticians Board of New Zealand.

12                     *known as dispensing opticians in New Zealand, but for the sake of ease, herewith collectively referred to as optical dispensers.
OPHTHALMOLOGISTS                                  ORTHOPTISTS                                       OPHTHALMIC NURSES
Ophthalmologists are medical                      Orthoptists are allied eye health care            Ophthalmic nurses are nursing professionals
practitioners who have undertaken                 professionals who are trained to                  that work in hospitals alongside
additional specialist training in the             diagnose and manage disorders of                  ophthalmologists and care for patients
diagnosis and management of disorders             eye movements and associated vision               with eye disorders and diseases.
of the eye and visual system.                     problems and sensory deficiencies. In
                                                  Australia, they are also trained to perform       Ophthalmic nurses complete general nursing
Ophthalmologists are tertiary                     investigative testing and procedures              training then additional training to specialise in
practitioners who provide the                     under direction of an ophthalmologist             the nursing care of patients with eye problems,
full spectrum of eye care, from                   or optometrist and engage in the                  whether in hospital, clinic or private practice
performing comprehensive eye                      rehabilitation of patients with vision loss.      under the direction of an ophthalmologist.
examinations to diagnosing
                                                  To be an orthoptist in Australia requires
diseases and disorders of the                     a degree in orthoptics. In New Zealand,           OPTICAL DISPENSERS
eye, and carrying out medical                     there is currently no training for
treatment and complex surgery.                    orthoptists, they are generally recruited         Optical dispensers interpret optical
                                                  from the UK.                                      prescriptions provided to a patient by an
Many ophthalmologists are also involved                                                             optometrist or ophthalmologist, and fit
in scientific research into causes and cures      Orthoptists in Australia work in                  and service optical appliances such as
for eye diseases and vision problems.             many areas including neonatal care,               spectacle frames and lenses. While they
                                                  paediatrics, rehabilitation, geriatrics,          are not permitted to examine eyes, or
An ophthalmologist in Australia or New            neurological impairment, community                write prescriptions, optical dispensers
Zealand is required to have undertaken            services and ophthalmic technology.               play an integral role in the eye health team
a minimum of 12 years of training,                They are mainly employed by                       as they are responsible for accurately
comprising of six to seven years at a             ophthalmologists, low vision clinics or           assessing the individual needs of the
medical school, graduating with a degree in       public health services such as hospitals.         patient to ensure they receive a suitable
medicine; two years (minimum) as a newly                                                            eye wear product and solution.
qualified doctor undertaking basic medical        Orthoptists in New Zealand are employed in
training; and five years of ophthalmic            public hospitals and have a particular focus      In Australia, optical dispensing is deregulated
specialist training and successful                on children with eye health problems.             (except NSW) and optical dispensers are
completion of examinations set by The                                                               required to undertake a Certificate IV in Optical
Royal Australian and New Zealand College                                                            Dispensing. In New Zealand, dispensing
of Ophthalmologists (RANZCO).                                                                       remains a regulated profession and to practice
                                                                                                    as an optical dispenser, you must be registered
                                                                                                    with the Optometrists and Dispensing
                                                                                                    Opticians Board of New Zealand and hold a
                                                                                                    current practising certificate.

  AUSTRALIA                                       both Australia and New Zealand. In recent         struggles to give all New Zealanders
                                                  years, however, Specsavers has led a move         equitable access to eye health services.
  In Australia, responsibility for the delivery   in Australia for a closer working relationship
  of eye health care services is spread across    and collaborative approach to care between        District Health Boards (DHBs) are
  both the public and private health care         ophthalmologists and optometrists with a          under immense pressure and are
  system as well as both primary and tertiary     view to establish more effective and efficient    struggling with demand. Innovative
  care. In addition to government funding,        patient care pathways and improve eye             interventions introduced by individual
  private health insurance is an important        health outcomes.                                  eye departments within DHBs, aimed
  component in the funding of eye health                                                            at reducing waiting times and achieving
  care in Australia. While the Medicare           Collaboration and patient co-management           performance targets, are not currently
  Benefits Schedule (MBS) covers in full,         between optometrists and GPs and other            proving to be sustainable or scalable.
  or in part, a wide range of consultations,      generalist health care professionals is at this
  procedures and tests, out of pocket costs       point limited, inconsistent and ill-defined.      Appropriate funding strategies are
  incurred by patients utilising private sector                                                     required for an eye health model which
  services are often covered by private                                                             includes services provided in DHBs and
  health insurance.                               NEW ZEALAND                                       the local community via an integrated and
                                                                                                    collaborative approach to care, between
  Traditionally primary and tertiary specialist   In New Zealand, eye health services are           ophthalmologists and optometrists, using
  eye health care professionals have operated     mainly hospital based and patients often          an effective communication platform
  independently as silos and co-operation,        have to wait long periods for hospital            and efficient patient care pathways
  collaboration and co-ordination have been       appointments, and in outpatient clinics,          to improve eye health outcomes.
  key issues for the eye health system in         waiting to be seen. The current system

     THE NUMBERS                                                                                                 Long-term
                                                                                                               vision disorders
                                                                                                             increase with age:
                                                                                                            10 (0–14)
     PREVALENCE RATES                                                                                        93% (55+)
     Some people are born with                      Approximately 90% of vision
     eye conditions while some                      loss and blindness in Australia
     develop problems as a child.                   and New Zealand is caused by one
     More commonly, however, eye                    of the five major eye conditions:
                                                                                                  the prevalence of vision loss and blindness
     conditions develop during                      uncorrected or under-corrected
                                                                                                  in Australia, and have remained widely
                                                    refractive error, glaucoma, age-              used and cited in both Australia and New
     adulthood and become more
                                                    related macular degeneration,                 Zealand. In 2016 the National Eye Health
     prevalent with age.                            diabetic retinopathy and cataract4.           Survey (NEHS) was conducted in Australia
                                                    Furthermore, 90% of vision loss is            and was the first nationwide population-
     Myopia and hyperopia are the most              preventable or treatable5 either              based survey to determine the prevalence
     commonly reported eye conditions in            through the management of                     and major causes of vision loss and
     Australia and New Zealand, however like        known risk factors or through                 blindness in Australia. Such a survey has
     most developed countries, the main causes                                                    not yet been undertaken in New Zealand.
                                                    effective surgical or non-surgical
     of vision loss and blindness are age-related
     degenerative eye diseases. After the age       treatment to either restore sight             Based on self-reported data from the
     of 40, vision loss and blindness increases     or prevent further vision loss.               Australian Bureau of Statistics (ABS)
     three-fold with each decade of age1.                                                         2014–15 National Health Survey, over 12
                                                    Australia has some of the best eye health     million Australians (55%) reported having
     The population in both Australia and New       research and data sources in the world,       at least one long-term vision disorder7, with
     Zealand is ageing, both in terms of the        however, it is far from exhaustive and is     long-sightedness and short-sightedness
     number of older people in the population       becoming outdated, while New Zealand          being the most commonly reported. The
     and as a percentage of the population.         eye research to date remains limited. There   proportion of people with long-term vision
     The proportion of the Australian population    is no systematic means of capturing and       disorders increased with age, from 10% of
     aged 55 years and over is projected to         monitoring eye conditions and diseases in a   children aged 0–14, to 93% of people aged
     increase to one in three by 20322, while the   national register in either country.          55 and over7.
     proportion of the New Zealand population
     aged 45 and over is projected to be as high    The main data sources available for           Based on a number of reports including
     as one in two by 20683.                        monitoring the prevalence of major eye        the 2010 Centre for Eye Research Australia
                                                    conditions are studies that include an        and Access Economics report, “Clear Focus:
     With an ageing population,                     eye examination, sample surveys that          The Economic Impact of Vision Loss in
     the number of older people                     collect self-reported information and data    Australia in 2009” and the 2016 “National
     experiencing vision problems                   collected for administrative purposes6.       Eye Health Survey”, the current prevalence
     due to eye conditions and                      These data sources predominantly              of vision loss and blindness in Australia
                                                    focus on measuring prevalence of              is estimated at between 453,000 and
     diseases is expected to increase
                                                    vision loss and blindness, meaning that       822,000. In New Zealand, the current
     exponentially over future                      little research or data exists into the       prevalence of vision loss and blindness
     decades increasing the demand                  general prevalence of eye conditions          is estimated to be around 175,0008.
     for, and the costs of, eye health              and diseases among the population.
     and vision care services.                                                                    Given the variations in reported data for
                                                    The Melbourne Visual Impairment Project       vision loss and blindness and the limited
     The Australian Government estimates that,      (MVIP) and the Blue Mountains Eye Study       data available on general prevalence of
     as the population ages, visual impairment      (BMES), both conducted in Australia in the    eye conditions and diseases, this report
     will emerge as the most prevalent              1990s, were the first two comprehensive       has used a combination of data sources to
     health condition among older people2.          and internationally-renowned studies of       report on eye disease prevalence rates.

     Glaucoma is a group of eye
     diseases that can cause damage
     to the optic nerve often resulting in
     the gradual loss of peripheral vision.

     While glaucoma is often associated with
     increased intraocular pressure (IOP) resulting
     from either malfunction or malformation of the
     eye’s drainage system, it can also occur with
     normal or even below normal eye pressure.
     People with early stage glaucoma experience
     no symptoms, but without timely detection
     and treatment irreversible damage to the eye
     may occur causing blurred or misty vision.
     This may eventually lead to irreversible vision
     loss and even blindness.
                                                          Prevalence of Glaucoma
     There are different types of glaucoma, however,
     Primary Open-Angle Glaucoma (POAG) is                Glaucoma Australia estimates that          Australia from glaucoma is 41,900,
     the most common and accounts for 90% of              as many as 300,000 Australians are         of whom 18,000 will be blind4.
     glaucoma cases in Australia and New Zealand9.        currently living with glaucoma although
     POAG occurs when, for unknown reasons,               as many as 50% are unaware they have       Glaucoma New Zealand estimates
     the fluid that flows in and out of the anterior      the disease9.                              prevalence of the disease in New Zealand
     chamber in the front of the eye passes too                                                      to sit at 115,000 people, again with 50%
     slowly through the meshwork drain. As a result,      Two in 100 Australians are expected        of these being undiagnosed10. By 2020
     eye pressure builds and starts to damage the         to develop glaucoma in their               the projected number of people with
     optic nerve. This type of glaucoma is painless       lifetime9. By 2020 the projected           vision loss in New Zealand from glaucoma
     and causes no vision changes at first.               number of people with vision loss in       is 7,287, of whom 3,147 will be blind8.


     At 62 years of age, Simon is an active person.    epiretinal membrane formation with some
     He enjoys the outdoors, boat rides and            associated macular oedema.
     scenic walks with his wife. Until his most
     recent eye test, his eye health was not on his     “I was told that there were
     radar. After losing his glasses, it took him a    symptoms in my peripheral
     year to visit his local optometrist to get new    vision but it wasn’t until I
     ones, and while there it was suggested that       was going through one of the
     he see an optometrist given it had been over
                                                       tests that I realised that I had
     10 years since his last eye test.
                                                       issues. It just wasn’t obvious
     Simon’s eye examination took an                   in my day-to-day life.”                      But what I’ve learnt is that it’s so
     unexpected turn when his OCT, tonometry                                                        important to leave it up to the
     and visual field tests all showed strong          The ophthalmologist confirmed that Simon     professionals to decide that. This
     signs of glaucoma so he was referred to an        had the chronic simple glaucoma and was      has snuck up on me and I didn’t
     ophthalmologist for further testing.              prescribed Xalatan, one drop in each eye
                                                                                                    see it coming. I don’t like thinking
                                                       daily to stop the condition worsening.
     Simon’s uncorrected vision was 6/12 in                                                         about how different my life could
     the right eye and 6/9 in the left. IOP was        “Losing my eyesight is the                   have been if I hadn’t walked into
     28mmHg in the right eye and 24mmHg                only incentive I need to use                 the optometrist on that day. I
     in the left. Corneal pachymetry readings          my eye drops every day. It was               couldn’t be more thankful that my
     were 490 microns in the right eye and             a shock to learn that my eye                 early stage glaucoma was picked
     503 microns in the left. Zeiss fields were                                                     up because I could not imagine a
                                                       sight was deteriorating, a real
     performed and results showed both eyes                                                         life without sightseeing with my
     were outside normal limits. OCT results           wake up call. I was raised the
                                                       Aussie way – I’ll be right.                  wife and sharing Sunday drives in
     showed retinal nerve fibre loss was outside
     normal limits bilaterally. There was bilateral                                                 our MX5.”

Age-related macular                                In the early stages of the disease, Bruch’s        The Macular Disease Foundation of
degeneration (AMD) is a                            membrane thickens and small yellow                 Australia estimates that as many as
                                                   spots called drusen start to accumulate            one in seven Australians, or 1.29 million
degenerative eye disease that
                                                   beneath the RPE. These initial signs of            people, over the age of 50 have some
damages the macula, the central                    AMD can have no visible symptoms at all.           evidence of the disease and approximately
part of the retina, causing                        Not everyone that presents with drusen             17% of these people, around 200,000,
progressive loss of central vision.                will necessarily lose their vision, however        will experience vision loss12. By 2020,
                                                   the existence of drusen does increase the          the projected number of people with
It is usually related to ageing and                chances of developing late-stage AMD.              vision loss in Australia from AMD is
predominately develops after the age of 50,        The progression of early-stage AMD to              91,300 of whom 53,000 will be blind4.
although certain forms of the disease can          late-stage AMD is generally associated with
also affect younger people.                        an irreversible decrease in visual acuity          The prevalence of AMD was estimated at
                                                   and occurs because the RPE cells die or            218,987 people in New Zealand in 2016
There are two types of AMD – dry AMD               they fail to keep blood vessels from the           and approximately 7.6% of these people,
(geographic atrophy) and wet AMD (exudative        choroid from growing under the retina.             around 19,825, have vision loss from it13.
or neovascular AMD). Dry AMD accounts                                                                 Approximately 10% of people aged 45 to
for approximately 33% of all cases of late         Vision becomes increasingly blurred or             85 experience some form of the disease
stage AMD and is a slow form of the disease        distorted, reading becomes difficult,              and it is estimated that 199,140 have
causing a gradual loss of vision. Wet AMD          colours become less vibrant and people’s           early stage AMD while 19,847 have late
occurs when the retinal pigment epithelium         faces become more difficult to recognise.          stage AMD13. Worsley and Worsley, 2015,
(RPE) cells fail to stop choroidal blood vessels                                                      also predicted a 12.9% increase in the
from reproducing under the retina. The                                                                prevalence of AMD in New Zealand from
new rapidly growing choroidal vessels are          Prevalence of AMD                                  2014 through to 202614. By 2020, the
fragile and can leak or bleed under the retina                                                        projected number of people with vision
causing scarring to occur, leading to loss of      AMD is the leading cause of blindness in           loss in New Zealand from AMD is 16,280
vision. In these cases, vision changes are         Australia and New Zealand, responsible for         of whom around 9,100 would be blind8.
often sudden and severe.                           almost 50% of all cases of blindness11.

DIABETIC RETINOPATHY                               retinopathy or macular oedema. Proliferative       getting regular eye tests16. More than
                                                   retinopathy occurs when many of the blood          300,000 Australians with diabetes mellitus
                                                   vessels in the retina are blocked depriving        are presently living with some degree
Diabetic retinopathy is one of                     several areas of blood supply. When this           of diabetic retinopathy. By 2020, the
the most common complications                      happens, the brain sends signals to grow           projected number of people with vision loss
                                                   new blood vessels, which may be abnormal           in Australia from diabetic retinopathy is
associated with diabetes
                                                   and fragile and grow on the surface of the         13,4404.
mellitus and while everyone with                   retina and along the surface of the clear,
diabetes is at risk of developing                  vitreous gel that fills the inside of the eye.     In New Zealand, the prevalence of diabetes
diabetic retinopathy, it affects                   These blood vessels have thin, fragile walls       mellitus by district health board (DHB) area
                                                   that can leak blood into the centre of the eye     is estimated to range from 4.17% to 8.35%.
around one in three people
                                                   causing blurred vision and blindness. Macular      The Ministry of Health estimated 260,458
living with diabetes15.                            oedema occurs when fluid leaks into, and           New Zealanders were diagnosed with
                                                   accumulates in, the macula causing swelling        diabetes mellitus as at December 2015 and
Diabetic retinopathy can be easily managed         and blurred vision. This is more likely to occur   projects an average annual growth rate of
if detected and treated early and almost all       as the disease develops. Around 50% of             new diagnoses of 5%17. New Zealand’s Māori
cases (98%) of sight-threatening diabetic          people with proliferative retinopathy also         and Pacific Island populations are particularly
retinopathy are preventable4. Diabetic             have macular oedema4.                              at risk, with 8% of Māori and 10.1% of Pacific
retinopathy occurs when diabetes mellitus                                                             Islanders having diabetes, compared to 2.9%
damages the tiny blood vessels inside the                                                             of New Zealanders with European descent18.
retina. In the early stages of the disease, the    Prevalence of
blood vessels of the retina can develop small      Diabetic Retinopathy                               Approximately 20% to 25% of New
swellings in the walls (micro aneurysms)                                                              Zealanders with diabetes mellitus have
but as the disease progresses, some of the         Diabetes Australia estimates that 1.7 million      some form of diabetic retinopathy, equating
blood vessels that nourish the retina can          people in Australia are living with diabetes       to between 52,091 and 65,114 people19.
become blocked. Diabetic retinopathy often         mellitus although around 30% of these              Māori and Pacific Islanders are more likely
has no visible symptoms and can progress to        are undiagnosed, and more than 100,000             than New Zealanders with European
advance stages without the patient realising       people are newly diagnosed each year15.            descent to develop sight-threatening
they have an issue with their eyes.                                                                   diabetic retinopathy. By 2020, the projected
                                                   Around 1.2 million Australians are registered      number of people with vision loss in New
Vision loss as a result of diabetic retinopathy    with the National Diabetes Services Scheme         Zealand from diabetic retinopathy is 2,682,
can occur in one of two ways – proliferative       and of these, around 630,000 are not               including 353 Māori8.

A cataract is a clouding of the eye’s
naturally clear lens. The lens is made
predominantly of water and protein, with
the protein arranged to let light pass
through and focus on the retina. Some of
the protein may clump together and cloud a
small area of the lens. When this happens,
the lens becomes opaque and the amount
of light that passes through it is reduced
and scattered, and the image cannot be
correctly focused on the retina. Over time
                                                                                                        of Australians
the cataract may grow larger and cloud
more of the lens resulting in poor vision.                                                           aged 55 are affected
Cataracts can develop over many years                                                                   by untreated
and have no visible symptoms early on.
There are four main types of cataract –         Prevalence of Cataract
age-related cataract; congenital cataract;
secondary cataract (where the cataract is       In Australia, it is estimated that untreated
linked to certain other health issues such as   cataract affects almost 1.5 million people
diabetes mellitus); and traumatic cataract,     over the age of 556, which represents 31%        according to the Ministry of Health, 16,420
(where cataracts develop as the result of an    of that age group.                               publicly-funded cataract operations were
eye injury either soon after or years later).                                                    performed nationally in 201621. The total
                                                By 2020, the projected number of people          number of cataract operations is likely to be
There are also three main forms of cataract     with vision loss in Australia from cataract is   double that when private surgeries, which
– nuclear cataract, which occurs in the         126,400, of which 11,350 will have cataract-     are not publicly reported, are included21. By
centre of the lens; cortical cataract, which    related blindness4.                              2020, nearly 22,800 New Zealanders are
radiates from the outside of the lens to the                                                     projected to have cataract-related vision
centre; and subcapsular, which starts from      In New Zealand, there are no reported            loss and around 2,000 are projected to have
the back of the lens20.                         figures for untreated cataract but               cataract-related blindness8.

REFRACTIVE ERROR                                                                                 Prevalence of Refractive Error
More than half of all vision loss in            There are four main types of refractive          More than half of all vision loss
Australia and New Zealand is caused             error – myopia (short-sightedness where          in Australia and New Zealand is
by refractive error5, whereby the shape         light focuses in the front of the retina         caused by uncorrected or under-
of the eye prevents light from focusing         so distant images are blurred caused by          corrected refractive error5.
precisely on the retina resulting in a          excessively steep curvature of the cornea
blurred image.                                  or excessive axial length of the eye or          Approximately 2.4 million Australians and
                                                both); hyperopia (long-sightedness               480,000 New Zealanders over the age of 40
The length of the eyeball, changes in           where the light focuses behind the retina        have some form of refractive error22, which
the shape of the cornea, or ageing of           so close images are blurred caused by the        represents 22% of that age group and based
the lens can all cause refractive errors.       curvature of the cornea being flat or the        on self-reported data, presbyopia affects the
Symptoms include blurred vision, eye            axial length of the eyeball being short);        sight of 1.3 million Australians over the age of
strain, tiredness, reduced concentration        astigmatism (a focusing error that causes        556. By 2050, it is predicted that there will be
and headaches. Uncorrected refractive           asymmetric blur at all distances mostly          22 million Australians and New Zealanders
error occurs when a person’s vision             caused by the shape of the cornea or by          with myopia, up from 4 million in 200023.
is reduced because they either need             slight tinting of the lens); and presbyopia
glasses and don’t have them, or the             (an age-related vision difficulty at normal      By 2020, the projected number of people
prescription in their current glasses is        reading distance caused by the loss of           with vision loss from refractive error,
not correct. Refractive error can affect        flexibility in the muscle in the eye that        excluding presbyopia, is 423,793 in
people at any age.                              changes the shape of the lens).                  Australia4 and 92,936 in New Zealand8.

OPTOMETRIC SERVICES                                                                                  Private health insurance has limited uptake
                                                                                                     in New Zealand compared to Australia and
                                                                                                     the government only has a few limited
Access to, and utilisation of, eye health         participating optometrists under the Medicare      programs in place that provide financial
services are imperative if we are to              Benefits Schedule (MBS), essentially making        support to eligible people. These include
successfully eliminate avoidable vision loss      standard comprehensive eye examinations            the ‘Children’s Spectacle Subsidy’ from the
and blindness in Australia and New Zealand.       available to residents at no charge24.             Ministry of Health for eligible children 15
Regular eye examinations are required for                                                            years of age or younger; the urgent and
people of all ages, genders and ethnicities for   In New Zealand, however, the government            essential need funding for adults suffering
the prevention, early detection and treatment     does not provide funding for universal             hardship from the Ministry of Social
of eye diseases and conditions.                   access to eyecare outside of the District          Development via hardship grants that
                                                  Health Boards (DHBs). Almost all residents of      must be repaid to the crown; and the ‘Get
In Australia, residents with a valid Medicare     New Zealand are required to pay for all costs      Checked’ program for people with diabetes.
card without optometry restrictions, as well      associated with services provided by an            Additionally, the Accident Compensation
as certain categories of visitors to Australia,   optometrist, which is a disincentive to access     Commission will provide eye examinations
can claim benefits for services provided by       care in the community.                             for treatment of injury due to an accident.

To gain a better understanding of the               (Items 10912, 10913 and 10914)                   It should be noted that on 1 January
demand for specific optometric services           • Other Comprehensive Consultations –              2015, the Australian Government
in Australia, a 10-year analysis of the             Diabetes Mellitus (Item 10915)                   introduced a 5% reduction in optometry
following Medicare item numbers has been          • Subsequent Consultation (Item 10918)             MBS fees, an indexation freeze to July
undertaken:                                                                                          2018 and a change in frequency of
                                                  Visual Fields, categorised under the MBS           comprehensive eye examinations which
• Comprehensive Initial Consultations             as Computerised Perimetry Services,                had a moderate but direct impact on the
  (Items 10900, 10910, 10911, 10905 and           (Items 10940 and 10941) have also                  way optometrists claimed optometric
  10907)                                          been analysed due to their importance              services during FY15 and FY16, but did
• Brief Initial Consultation (10916)              in the detection of glaucoma.                      not affect the overall trend of optometric
• Other Comprehensive Consultations                                                                  services delivered in Australia.

From July 2008 to June 2018, Medicare             item numbers, has increased by 51% over            the past 10 years is presented in Table
benefits have been processed for 71.7             the past 10 years with an average increase         1.1 and Chart 1.1. The share of optometric
million optometric consultations. The total       in services of 4.7% per year. The number           consultations by age range in FY18 is
number of consultations, across all MBS           of optometric consultations by year over           presented in Chart 1.2.

Table 1.1
Total Optometric
consultations by year
Source: Australian
Government, Department
of Human Services -
Medicare Items Reports

           Chart 1.1 Total Optometric consultations by year                      Chart 1.2 Total optometric consultations by age range, FY18

                                                                                                    8. 5-3
 7000000                                                                                              68 4
                                                                                                         %                65 6%
6000000                                                                                                                     .6
 5000000                                                                                       9.62%
 3000000                                                                                                4
                                                                                                    0-1 %
 2000000                                                                                               29
                                                                                                                      55 .61%

                                                                                                             15.7 4



             FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

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