New partnership puts focus on helping Australians stick to treatment
Specsavers and Macular Disease Foundation Australia have announced a strategic scoping partnership with a vision to increase and enhance support for patients diagnosed with neovascular age-related macular degeneration (nAMD).
The partnership represents an Australia-first move to overcome preventable vision loss from nAMD by improving appointment attendance and treatment adherence rates for patients. It is also an opportunity to gain a true understanding of incidence and prevalence rates of nAMD across Australia for the first time.
MDFA CEO Dee Hopkins says the project is at the heart of the organisation, which was established with a vision to provide a patient-centric, trusted service to those living with or at risk of macular disease.
“Our purpose is to reduce the incidence and impact of macular disease through leadership in prevention and early detection, disease management, advocacy, and research,” Ms Hopkins said.
“Every day we work collaboratively and in partnership with our community, health professionals, researchers, and government to minimise the impact of macular disease.
“For this project, we are thrilled to position ourselves alongside the nation’s largest optometry provider to determine how we can collaboratively improve the visual outcomes of our patients.
“Our shared vision is that the successful measures determined through the partnership will be shared with the entire industry to further impact the nation’s eye health.”
Specsavers Director of Optometry Dr Ben Ashby says the partnership is a natural progression for Specsavers, which has been delivering on a strategy in support of the National Eye Health Framework to reduce the incidence of preventable vision loss and blindness in the nation through improved prevention, early detection and co-management of eye diseases.
“Through the accessibility of our stores and the number of patients we see, we’re in a special position to positively impact the vision outcomes of our nation,” Dr Ashby said.
“We do this by utilising our anonymised patient data, by harnessing the latest in optometry technology in all of our clinics and through inter-disciplinary collaboration.
“For the past six years, we’ve implemented a strategy to detect every case of glaucoma within our patient base and believe we have reduced undiagnosed glaucoma in our patients by at least 60 per cent so far.
“We’ve also collaborated with Diabetes Australia, the Federal Government and wider industry to launch KeepSight, which is now seeing hundreds of thousands of patients at risk of vision loss to diabetic retinopathy receiving reminders for diabetes eye checks.
“While these strategies continue, we are now looking at how we disrupt the current prevalence statistics of unnecessary vision loss for patients with age-related macular degeneration.
“As a first step into this, we are proud to begin work on this nAMD project in partnership with MDFA.”
Neovascular age-related macular degeneration
Of the estimated 1.4 million1 Australians with evidence of age-related macular degeneration, it is estimated 156,0902 currently have neovascular age-related macular degeneration and require treatment.
Despite non-adherence to treatment leading to the development of severe vision loss or blindness,3 it is estimated 20-25 per cent4 of patients don’t receive the required intravitreal injection treatment.
Through their partnership, Specsavers and MDFA have targeted this group within the AMD patient contingent due to the potential to significantly reduce the incidence of preventable blindness by focussing on:
- Supporting the nAMD suspects to attend their first ophthalmology appointment
- Following this, supporting them to adhere to the treatment prescribed
Unlike early and intermediate cases of AMD, which may require ongoing monitoring before a referral is made, nAMD patients receive a prompt referral from optometry to ophthalmology for assessment and potential initiation of treatment.5
By targeting nAMD patients in this project, measurement of interventions from Specsavers and MDFA is straightforward, and it may be possible to see a shift from the current 22.2 per cent4 of patients who are lost to follow up and the mere 56,0006 who are estimated to receive treatment.
On top of this, research has found that after initiation of treatment, patients with nAMD may drop out of treatment due to a variety of non-clinical reasons including treatment burden (e.g. perceived excessive treatment visits, difficulty in attending, and pain/discomfort), lack of perceived benefit, cost burden and the existence of other medical conditions that are more severe.7
The partnership aims to overcome barriers to ensure every consenting patient is supported to adhere to prescribed treatment, including attending subsequent treatment appointments.
The project
The project has begun in pilot phase with 16 Specsavers practices from around the country currently involved.
Consenting patients with suspected nAMD who have had an eye test at these practices are being referred to MDFA via Oculo at the same time as their ophthalmologist referral.
MDFA then contacts the patient within three business days to check how they are feeling and to answer any questions that may have arisen from the referral. Here they encourage them to attend the appointment with the ophthalmologist and invite them to join the MDFA specialised treatment support program called ‘My Eyes.’8
Once the appointment has occurred, MDFA contact the patient again to find out the diagnosis and prescribed treatment as well as support them with answers to any questions or concerns they may have.
‘My Eyes’ then commences. The program involves periodic check-ins with the patient, aligned with their treatment intervals to support them through their treatment.
All ‘My Eyes’ patients also receive specifically tailored information and resources about nAMD every two months, are connected to other services such as peer support groups and the free National Helpline run by MDFA (1800 111 709).
Through this methodology, MDFA is able to report on patient consent/participation rates, anonymised patient diagnoses, false positive ophthalmology referral rates and patient sentiment.
This is shared with participating Specsavers optometrists who can also feedback on the process in monthly project meetings. Any patient trends or opportunities for development are identified and the project can morph to ensure the most effective visual outcomes for patients.
Early findings
While the project is still in infancy early trends are encouraging, with 75 per cent of participating patients joining ‘My Eyes’ and early figures showing the first patients adhering to treatment.
A better picture of the state of nAMD in Australia is also beginning to emerge as data from the project is captured.
Optometrist Yavani Mudaly co-owns two participating Specsavers practices in New South Wales and says that while the project has had a slower start due to COVID interruptions and lockdowns, her team of optometrists are looking forward to being at the forefront of this opportunity to make a positive difference for patients with AMD.
“So far patients have been very willing and even grateful for the opportunity to participate and be better informed about their disease. If this project means that even one of my patients attends their ophthalmology appointment or adheres to treatment when they otherwise wouldn’t, it is worth it for me. It’s exciting to be on a journey that will incrementally change the visual outcomes for Australians with AMD,” she says.
Patient, Irene says that being involved in the project, especially the peer support group inclusion, has made her feel less alone and more supported to take her nAMD diagnosis seriously.
“I am just so grateful to my optometrist for getting me involved in this, as I don’t know anyone with nAMD and now I have the opportunity to interact with people who deal with the same problems as I have. I am full of hope, as I know this will improve my mental state and give me information, which would be most welcome,” she says.
Next steps
Dr Ashby says that the project may take several years to test and slowly grow as key trends and data emerges from the pilot phase and the impact of the coordinated collaboration starts to develop.
“Eliminating loss to follow-up and increasing treatment adherence rates within our patient base would significantly reduce the unfortunately high amount of Australians who lose vision to nAMD every year,” Dr Ashby says.
“As always, we’re committed to sharing the blueprints to any success in patient health outcomes as we work closely with MDFA to formulate a strategy that could eventually impact all Specsavers patients with AMD nationwide. As we receive key learnings and data, we’ll be sharing it on our industry data website HealthHub (www.healthhub-anz.com), which interested parties can subscribe to.”
Note: this article first appeared in mivision.
References
1 Deloitte Access Economics and Macular Degeneration Foundation (2011). Eyes on the future – A clear outlook on age-related macular degeneration. Accessed at https://mdfa-s3fs-prod.s3-ap-southeast-2.amazonaws.com/s3fs-public/Deloitte_Eyes_on_the_Future_Report_web.pdf
2 Deloitte Access Economics and Macular Degeneration Foundation (2011). Eyes on the future – A clear outlook on age-related macular degeneration. Accessed at https://mdfa-s3fs-prod.s3-ap-southeast-2.amazonaws.com/s3fs-public/Deloitte_Eyes_on_the_Future_Report_web.pdf. (2022 prevalence estimates are derived from a straight-line extrapolation between 2020 and 2025 estimates in this report.)
3 Wong T et al. (2007). The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology. 2008 Jan;115(1):116-26. doi: 10.1016/j.ophtha.2007.03.008. Accessed at https://pubmed.ncbi.nlm.nih.gov/17675159/.
4 Obeid A et al. (2018). Loss to follow-up among patients with neovascular age-related macular degeneration who received intravitreal anti-vascular endothelial growth factor injections. JAMA Ophthalmol. 2018;136(11):1251-1259.
5 RANZCO Referral Pathway for AMD Management. Accessed at https://ranzco.edu/home/health-professionals/referral-pathway-for-amd-management/.
6 Extrapolated to 2022 from: Ranibizumab and aflibercept: analysis of use for AMD, DMO, BRVO and CRVO. (2018) Accessed at https://www.pbs.gov.au/pbs/industry/listing/participants/public-release-docs/2018-05/ranibizumab_and_aflibercept__analysis_of_use_for_amd%2C_dmo%2C_b
7 Vaze et al. (2014). Reasons for discontinuation of intravitreal vascular endothelial growth factor inhibitors in neovascular age-related macular degeneration.
8 MDFA’s My Eyes and other treatment adherence strategies are also supported by Roche, Apellis and Novartis.
Posted: 29 April 2022
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