RACGP Conference GP15 22 September 2015 Melbourne Diabetic eye disease in Indigenous Australians: what GPs can do to help close the gap Kelly Jones, Mitchell Anjou, Peggy Chiang, Carol Wynne and Hugh Taylor The University of Melbourne

to Close the Gap for Vision for Indigenous Australians established in 2008 led by Professor Hugh Taylor total 12 staff funded by Harold Mitchell Foundation, Ian Potter Foundation, Greg Poche, other private donors and now Commonwealth Government our goal… to Close the Gap for Vision for Indigenous Australians www.iehu.unimelb.edu.au

National Indigenous Eye Health Survey 2008 Vision Loss in Children One fifth as common as in mainstream Vision Loss in Adults Blindness is 6 times more common Low Vision is nearly 3 times more common Causes of Blindness in Adults 32% Cataract 14% Refractive Error and Optic Atrophy 9% Trachoma and Diabetic Eye Disease Overall 94% of Vision Impairment is avoidable …and 35% have never had an eye exam

We know what we need to do… Implement the SAFE Strategy If VA is <6/12 or impaired function refer for assessment Ensure provision of surgery Retinal assessment for those with diabetes (every 12 months) Ensure provision of laser treatment Screening for VA (near and distance vision) Ensure provision of spectacles Trachoma Cataract Diabetes Refractive Error

42 Roadmap recommendations The Roadmap Launched 23 February 2012 42 Roadmap recommendations Cataract – 35/42 recommendations Refractive error – 34/42 Diabetic retinopathy – 35/42 Trachoma – 37/42

2025 34,000 2010 - No coherent plans - Incomplete programs - Status quo - Commitment and leadership - Roadmap fully implemented - Coherent, sustainable 2,000 15,000 Number of Blind and Visually Impaired Indigenous Australians ✗ ✔

The Importance of Diabetes in Eye Care

adults and older people MBS mandatory eye checks in Health Assessments for Aboriginal and Torres Strait Islander adults and older people   history to include ‘vision’ examination/assessment to include ‘eye examination’

What to check …Vision and eye examinations in MBS Aboriginal and Torres Strait Islander health assessments… Problem with vision or eyes? Visual acuity (near and distance) People with diabetes require annual retinal exam Trichiasis

Diabetes Retinal Examination At diagnosis of diabetes Every 12 months for people with diabetes Ophthalmoscopy (dilated fundoscopy, retinal photography) Refer to optometrist or ophthalmologist Not more than one year without examination

Essential elements in regional implementation Implementation resources Essential elements in regional implementation Establish regional stakeholder group Assess existing services (data sharing) and estimate gap Develop regional service directory Establish and confirm clinical pathways Identify coordination roles Stakeholders determine regional action plan and priorities Regular data collection and reporting

Draft Health Promotion Material https://www.youtube.com/watch?v=-OhHhpdQDMQ Grampians Need to promote annual eye exams for those with diabetes Community knowledge, clinic staff knowledge Need to build through community involvement and ownership Develop appropriate materials and strategies Consultations underway – Grampians, Kimberley, Western Sydney. National workshop in June 2015

…and so close the gap for vision We now have the evidence, strategy and capacity to eliminate unnecessary vision loss for Indigenous Australians… We are looking for the support of primary care to identify and manage eye health… We need concerted government commitment to implement the Roadmap across Australia… …and so close the gap for vision www.iehu.unimelb.edu.au