Eye Health Progress Report

Key Action Area One: Reducing the Risk

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Objective: Eye disease and vision loss are prevented, where possible, through addressing known modifiable risk factors

Australian Government

National Eye Health Initiative (NEHI)

In response to the release of the Framework by Health Ministers, funding of $13.8 million over 4 years was allocated in the 2006 Federal Budget for a range of initiatives to promote eye health and strengthen eye health service delivery. These initiatives are included under the relevant key action areas below.

As stated in the Framework, raising general public awareness about eye health is the first line of defence in reducing the risk of avoidable blindness. A number of formative research projects have been undertaken to inform eye health promotion activities.

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Review of the evidence base for risk factors for eye disease and injury

The National Health and Medical Research Council (NHMRC) undertook a systematic review of the scientific literature to identify modifiable risk factors for eye disease and injury (2007-2008). It is expected that this will inform the development of communication activities aimed at promoting eye health and preventing avoidable blindness, within the NEHI.

Formative social marketing research

The Department undertook qualitative research in December 2006 and quantitative research in May 2007 to guide the development of eye health communication activities.

The research explored the perceptions, knowledge, opinions, attitudes and current practices regarding eye health with the primary target groups and the general public. It also investigated preferred communication channels, including preferred information formats with the target audience.

The research indicated that eye health is a latent issue among Australians and that there is a role for communications to raise awareness of, and educate people about, eye health. Options are being developed for the rollout of communication activities.

Eye Health Promotion Demonstration Project

Funding of $197,500 has been provided under the National Eye Health Demonstration Grants Program to the Association for the Blind of Western Australia for a demonstration project to develop and evaluate innovative ways to educate and inform the general public about the workings of the eye; the factors that lead to vision loss; and strategies to reduce the risk of eye disease and injury.

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Aboriginal and Torres Strait Islander eye health education

Funding of $150,000 has been provided under the National Eye Health Demonstration Grants Program to the International Centre for Eyecare Education to improve awareness and accessibility to quality eye health and vision care education resources for Indigenous communities in remote areas of Australia. The project will undertake a review of existing Aboriginal and Torres Strait Islander resources across the range of eye health and vision care issues, identify needs and gaps and develop new resources where required.

Raising public awareness of Macular Degeneration

Age-related macular degeneration is the leading cause of blindness in Australia, affecting over 600,000 Australians over the age of 55 years. In the May 2005 Federal Budget funding of $0.5 million over 4 years was allocated to the Macular Degeneration Foundation. This funding is a general contribution to the work of the Foundation in raising public awareness about macular degeneration and the steps people can take to prevent or slow down the progress of the disease.

During the first two years of the grant the funding was principally used to support an education officer to hold approximately 60 information sessions across Australia each year, targeted at the general population. In 2007-08 the reach of the education sessions was extended to several culturally and linguistically diverse groups.

Tobacco health warnings

Smoking is a confirmed risk factor for macular degeneration. A new graphic health warning ‘Smoking causes blindness’ was required to be printed on tobacco product packaging from 1 March 2007. As part of the second set of seven health warnings it will rotate annually with the first set. A targeted mail-out to eye health organisations and specialists was undertaken in mid 2007 advising of the new health warning, supporting fact sheet and poster.

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Trachoma initiatives

Trachoma remains an issue in some remote regions of Australia. In December 2005, the Office for Aboriginal and Torres Strait Islander Health (OATSIH) allocated $920,000 over three years for the implementation of a systematic approach to target, treat and control trachoma in Aboriginal and Torres Strait Islander communities.

These funds have been directed towards a number of initiatives to develop a sustained approach to trachoma control in Australia through:

• the production and distribution of the national Communicable Diseases Network Australia Guidelines for the Public Health Management of Trachoma in Australia to health professionals and key interest groups;


• the support of the relevant States (Western Australia and South Australia) and the Northern Territory to train health care workers in the use of the guidelines and the expansion of current trachoma control programs into areas where screening and treatment may not have previously occurred; and


• the establishment of a National Trachoma Surveillance and Reporting Unit (the Surveillance Unit) to improve the overall quality and consistency of data collection and reporting on trachoma in Australia.

Australian Capital Territory

In 2008 ACT Health has made a major commitment to greatly expanding public Ophthalmology for the 500,000 people of Canberra and surrounding South East NSW. In the first instance this expansion is focused on Hospital-based services at Canberra and Calvary Hospitals. Risk reduction strategies will be developed as resources become available, modelled on the Western Australian Eye Health Plan.

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New South Wales

Vision and Falls in the Elderly:

The Statewide Ophthalmology Service Working Groups meet as required and the Cataract and Falls project funding proposal is being developed to replace the ‘Cataract Surgery Outcomes”.

Area Health Services’ Initiatives

Additional activities and initiatives carried out throughout NSW by Area Health Services also aim to reduce the risk of eye disease and injury in the community. This includes undertaking a range of activities to reduce the risk of eye disease and injury, such as communication initiatives promoting eye health in relation to sun protection and eye safety through health development programs across all settings and age groups risk factors. Also operating is a rigorous immunisation program for childbearing women and offers a referral/appointment fast track service with local ophthalmologists for Aboriginal clients using diabetes clinics.

Eye awareness outreach programs are run in local communities and in rural communities, in particular targeting the Greater Western Area Health Service. Regular community education sessions also promote eye health and safety. Ophthalmology short courses are available to healthcare workers and education and discharge information on eye conditions is widely distributed and available in various languages.

The Sydney Eye Hospital collaborates with the Greater Metropolitan Clinical Taskforce Ophthalmology Service in the initiation of eye workshops for Emergency Clinicians and development of the Eye Emergency Manual. All general Emergency Departments in all Area Health Services refer to the Eye Emergency Manual.

The Eye Clinic at the Children’s Hospital, Westmead is conducting a comprehensive retrospective study to review the prevalence and cause of eye injury in children. This will be used to advise the Department of Health and Department of Education and Training as to the development and implementation of prevention programs.
Additionally, an educational program, “NORMALEYES”, has been piloted. This program targets primary school aged children, to educate them as regards maintaining healthy eyes and vision through lifestyle and risk minimization behaviours. It is anticipated that this program will be made available to school and groups such as Life Education and Kidsafe.

The Broken Hill Health Service provides two clinic days per week staffed by an Ophthalmologist and Ophthalmic Registrar carrying out screening and treatment of eye disease and/or injury; nurses assist by performing preliminary tasks such as Dilatation, Field Testing and Acuity Testing. One half day per week is provided by the Ophthalmic Registrar and an assisting nurse for pre-operative assessment of patients and for procedures. An Orthoptist visits regularly, assisting the medical staff with procedures and attending to children with eye problems. A registrar is permanently located in Broken Hill on 3-month rotations from the Prince of Wales Hospital Sydney also providing an outreach service to Menindee, Wilcannia and Maari Ma.

Retinal photography is conducted by Diabetes Educators for diabetic clients during complication screenings of clients in the Dareton Primary Health Care Service and is also provided as part of the Chronic Disease program in the Ivanhoe, Menindee and Tibooburra Health Services where Ophthalmological and Optometric clinics were conducted in December 2007. In the Wentworth Health Service, accident and emergency and transfer facilities are provided at Wentworth District Hospital pursuant to the NSW Health” Eye Emergency Manual” developed by the Statewide Ophthalmology Service.

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Chronic Disease Prevention

The Framework outlines the links between lifestyle risk factors, chronic disease and eye health. The strategic priorities for Chronic Disease Prevention in NSW are defined in the NSW State Plan and NSW State Health Plan, with key activities focussing on tobacco control and prevention of overweight and obesity.

NSW Health's specific strategies in regard to tobacco control include:

• implementation of the Public Health Act 1991 and the Public Health (Tobacco) Regulation 1999 to prohibit sales of tobacco and non-tobacco products to minors and limit the display of tobacco products at point of sale;
• implementation of the Smoke-free Environment Act 2000 and Smoke-free Environment Regulation 2007 which ban smoking in all enclosed public places, including licensed venues;
• investing in mass media campaigns that raise community awareness of the health risks of smoking;
• continued funding for the NSW Quitline to support those in the community seeking assistance to quit smoking; and
• smoking cessation interventions including providing training for health professionals to provide evidence based cessation advice.

In regards to overweight and obesity prevention, NSW Health has numerous programs in schools, such as Fresh Tastes @ School (healthy canteens), and Live Life Well @ School. A recent program introduced in preschools is Munch & Move, which focuses on upskilling pre school teachers on nutrition and physical activity. NSW Health is also supporting the national social marketing campaign which will target adults in relation to nutrition, physical activity and healthy weight, and is currently planning the establishment of a telephone based coaching service for adults around these risk factors.

In addition, NSW Health is funding a large diabetes prevention trial in Sydney South West Area Health Service. The purpose of this program is to develop, implement and evaluate community based intensive lifestyle interventions (in relation to diet and exercise) for those at high risk.

Northern Territory

With the assistance of Commonwealth funding for the ‘Trachoma Training and Implementation Program’ over 06/07 and 07/08, the NT has employed a Trachoma Program Coordinator for the NT.

The Safety & Injury Prevention Coordinator with the NT Department of Health and Families coordinated the promotion of messages around eye safety around Territory Day (when fireworks can be legally purchased and discharged in the NT). Eye injuries arising from fireworks were markedly reduced from previous years.

Prevention through improved management of diabetes:

• The NT’s Preventable Chronic Disease Strategy guides activity in this area. The strategy has recently been evaluated and undergoing refreshing.

• Northern Territory practitioners in health services with a predominantly Indigenous clientele provide protocol-driven care. Eye health checks and follow-up are built into the locally developed, regularly evaluated and updated guidelines (Central Austral Rural Practitioners Association or CARPA Guidelines), which are supported financially and with significant Department of Health and Families’ clinician leadership and input.

• The Department of Health and Families partners the Menzies School of Health Research in the health service based quality improvement program ABCD which has facilitated significant gains in diabetes management, including eye health checks.

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Queensland

Lions Eye Health Program

The Lions Eye Health Program has commenced in Queensland, with Lions Clubs becoming involved in education of their communities about the need for eye health checks. There is an emphasis on screening for diabetic retinopathy and glaucoma. Lions clubs and its members assist their communities by screening programs in conjunction with their local eye care professionals. The emphasis is on the need for an eye health check every 5 years and more frequently in those in the high-risk groups for diabetic retinopathy and glaucoma.

Chronic Disease Prevention and Management

To address the morbidity associated with chronic disease and the growing demand for health services, the Queensland Government, through the Smart State: Health 2020 Directions Statement, has identified the prevention and management of chronic diseases as one of its major strategic priorities. The subsequent Queensland Strategy for Chronic Disease 2005-2015 identifies the need for:

• improved primary prevention of risk factors;
• better integrated early detection and management of risk factors and disease markers; and
• effective management of existing disease and prevention of complications.

Some examples of this in relation to eye health include:

• The Queensland Health/Mater Children’s Transition Project disseminates guidelines for health professionals and General Practitioners caring for children and adolescents with diabetes types 1 and 2 to screen and monitor for complications and associated medical conditions including eye complications.

• The Inala Chronic Disease Management Project’s goal is to improve the quality of life for people with Type II diabetes, living in the Inala catchment area, by building the capacity of the primary care sector and providing accessible, evidence-based care in the community through multidisciplinary integration across the primary, secondary & tertiary interface. Part of this project includes a comprehensive training and education program provided to Clinical Fellows (advanced trained GPs), GPs and other Health Professionals in relation to retinal disease.

• The Royal Children’s Hospital in collaboration with the University of Queensland provides a paediatric retinal screening program for children and adolescents with diabetes throughout Queensland through the Centre for On-Line Health.

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South Australia

Cosmetic contact lenses

Cosmetic (or plano) contact lenses have proven to present the same eye health risks as prescription contact lenses. Until recently, their sale was unregulated, with teenagers buying them from market stalls and fashion outlets. Surveys indicated that they were sharing them like clothes and jewellery, resulting in serious eye infections and potential blindness.
In October 2007 the sale of cosmetic contact lenses was regulated in SA. They can now only be purchased on the production of a valid prescription from an optometrists or medical practitioner.
In October to December 2007, a successful PR and education campaign was implemented in SA with a target group of 12 – 25 year olds to warn about the health risks associated with unsupervised use of cosmetic contact lenses. A web site was established, funded by Department of Health, OAA (SA) and Contact Lens Manufacturers Association.

Falls Prevention

Poor vision is proven to be a major contributor to the incidence of falls in older Australians.
In 2005 / 06 a falls prevention program was piloted in the western suburbs. It encompassed a training program for carers in aged care facilities in addition to the production and distribution of awareness posters in a variety of languages in community centres, libraries, medical centres and optometrists in the area. Subsequently falls prevention resources continue to promote the importance of ensuring good vision to prevent falls.
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South Australian Spectacle Scheme

South Australian Spectacle Scheme (SASS) is an initiative that provides subsidised spectacles for concession card holders in SA. It is funded jointly by the SA government and participating optometrists. After approximately 20 years, the program has been reviewed and an improved model that brings it up-to-date with contemporary eye care practices has been proposed to government. The new model will allow SASS participants to access a wider range of spectacle frames, lens coatings and tints in addition to contact lenses.

Central Northern Adelaide Health Service

Central Northern Adelaide Health Service includes basic information about eye care and eye health in all health promotion activities. Eye health is part of the Aboriginal adult health check, all screenings, diabetes education sessions and as part of the referral pathways. In addition, all prisoners receive eye testing whilst incarcerated if required.

Children Youth and Women’s Health Service

Parent information as anticipatory guidance is provided to parents of all those new births registered by Children, Youth and Women’s Health Service in the form of a free production called the “Welcome to Your Baby” magazine and the website www.cyh.com

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Eye Safety in Small Business Project

Southern Adelaide Health Service conducts the Eye Safety in Small Business Project which was funded through SafeWork SA using funds designated for projects aimed at improving health and safety in South Australian workplaces.

The aim of the Eye Safety in Small Business Project was for Southern Primary Health - Noarlunga (SPH-N) and the Lonsdale and Hackham Small Business Associations to work collaboratively in reducing the incidence and severity of eye injuries in industrial workplaces in the Southern area.

The objectives of the project were to:

• improve eye safety awareness among employers and employees in the Southern area;
• ensure that improvements to workplace eye safety extend to those sections of high risk industries; and
• work towards reducing presentation rates for eye injury at Noarlunga Community Hospital`s Emergency Department.

The implementation of the Eye Safety in Small Business Project resulted in the development of an Eye Safety Training Kit, piloted within the metal industry in the Southern Industrial area and available to SPH-N, SafeWork SA and all Industry groups for adaptation.

The project also led to the development of Eye Safety Information Guides for employers and employees. These have been distributed to 326 targeted local small businesses.

In addition to continuing with the strategies implemented during the project, such as offering on-site Eye Safety training workshops and distributing the Employer and Employee Eye Safety Information Guides, other initiatives were also implemented. These were namely the Emergency Department Approach to Eye Injuries in Small Business and Eye Safety training programs for Year 11 and 12 students undertaking metalwork studies.

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Tasmania

Tasmania has undertaken and has continued a number of programs either aimed specifically at reducing the risk of eye disease and injury, or these factors are part of a larger program, such as chronic disease management.

Visual Impairment Prevention Program

The health service relationship between General Practitioners, Optometrists and Ophthalmologists, fostered by the Tasmanian section of the Visual Impairment Prevention Program, is continuing.

The Visual Impairment Prevention Program increased the awareness of Low Vision Clinics (LVC) of which there are four in Tasmania – three are under the auspices of the Guide Dog Association of Tasmania in Hobart, Launceston and Ulverstone and the fourth LVC is conducted by Optometrists at the Royal Hobart Hospital.

Type 2 Diabetes Referral Guide and Personal Diabetes Record

These services were introduced prior to the reporting period, but have continued during the reporting period.

The Referral Pathways Guide is currently being reviewed by the Tasmanian Divisions of General Practice network in consultation with the Tasmanian Department of Health and Human Services (DHHS). The Guide has facilitated improvement in appropriate utilisation and coordination of services across the multidisciplinary health team for people with Type 2 diabetes and includes recommendations on timely referral to eye health practitioners for the prevention and management of eye diseases associated with diabetes.

The Patient Diabetes Record is used by General Practitioners and Diabetes Educators in general practices and Diabetes Educators in DHHS. This record assists patients in communicating with the professionals involved in their care and is also used as a reminder for regular and screening appointments in addition to providing information. The Record facilitates collaborative and effective diabetes self management, including that for eye health care.

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Chronic Disease Management

In Tasmania, prevention activities have been geared towards chronic diseases prevention using the SNAPPs framework (Smoking, Nutrition, Alcohol, Physical Activity, Psychosocial conditions), as follows:

• implementation of the Tasmanian Tobacco Action Plan;
• implementation of a broad range of strategies under the Tasmanian Food and Nutrition Policy;
• development of a population-level/primary prevention action plan to reduce harm from alcohol; and
• development and implementation of a range of initiatives under the Tasmanian Physical Activity Plan, auspiced by the Premier’s Physical Activity Council.

In addition, under the Australian Better Health Initiative, Tasmania is:

• establishing a framework and regional structure to support chronic disease self-management; and
• providing new resources to Diabetes Tasmania to work with persons identified as being at risk of diabetes.

Cosmetic Contact Lens

The DHHS has, in cooperation with the Optometrists Association Australia, undertaken two media “events” to highlight the risks of inappropriate use of cosmetic contact lenses.

Tasmanian Eye Health and Care Initiative

In March 2007, the Royal Guide Dogs of Tasmania successfully sought funding from the Eye Health Demonstration Grants Program to pilot a collaborative eye health and vision care program across Tasmania focussing on a coordinated systems approach to implementing the key areas for actions as identified in the National Framework.

The objectives include to:

• improve the quality and safety of eye health care by educating professionals in health and related sectors to promote best practice;
• ensure efficient and effective coordination of services and appropriate referral protocols between eye health and vision care service providers and other service providers;
• reduce the risk factor for eye disease and vision loss and increase early detection by raising awareness among the Tasmania general public; and
• support the National Eye Health Initiative by demonstrating the program’s impact through research, monitoring and evaluation.

The pilot is implemented by a project officer and a steering committee of which DHHS is a member. DHHS will have a significant role in the raising awareness program, to be based on the successful Vision 2020 program in Victoria. The project commenced in October 2007.

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Victoria

In April 2008, the Department of Human Services (the Department) contributed to national policy by providing comments out-of- session, prior to the meeting of the AHMRC, on the draft of the revised The Diabetes Type 2 Guidelines on Diabetic Retinopathy.

Life! - Taking Action on Diabetes Program

The Victorian government has funded Diabetes Australia - Victoria to implement the Life! - Taking Action on Diabetes program. Life! has two goals:

• To arrest the growth in type 2 diabetes; and
• To contribute to the earlier diagnosis of type 2 diabetes in those who have undiagnosed type 2 diabetes.

Through systematic risk assessment, Victorians at high risk of developing type 2 diabetes will be identified and community-based lifestyle behaviour change programs will be provided for 25,000 eligible people. The six-session lifestyle behaviour change program is delivered by accredited facilitators and supports participants to develop healthy eating behaviours and increase rates of physical activity. Participants are supported to work towards a weight loss of at least 5% of their body weight and 30 minutes of moderate physical activity per day.

Life! focuses on Victorians aged over 50 years and Aboriginal and Torres Strait Islander people of all ages. The implementation of this program is phased, targeting areas of high need as a priority, with state wide coverage by 2011.

The Vision Initiative (TVI)

The TVI is the Victorian Public Health response to the National Framework. The aim of the TVI is to raise awareness of the importance of eye health among the general public and the health and related sectors. In 2005-06, the Department provided $600,000 to further develop and implement the TVI conducted as a pilot from 2003. From 2006-2010, $618,000 has been allocated for TVI activities. The program includes both primary prevention activities (Public Health) and disease management activities (Primary Health).

The key objectives include to:

• increase the awareness and knowledge of the priority population groups about the importance of prevention activity and regular eye examinations;
• improve the understanding and awareness of health and community professionals of eye health and vision issues and referral pathways; and
• ensure a platform for collaboration and sustainable partnerships between Victorian eye health and vision care providers, government and other organisations.

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Western Australia

Development of WA State Eye Health Plan

In 2006 under the leadership of Professor Ian Constable a Draft WA State Eye Health Plan was reviewed by a meeting of stakeholders providing eye health services in Western Australia. The draft plan underwent a preliminary review and was subsequently adopted by the Neurosciences and the Senses Health Network as its key policy platform on eye health. This paper has become a key resource for all aspects of WA Health planning for ophthalmology services. It provides key recommendations in relation to preventable eye disease and has been used in developing Area Health Service clinical service plans.

In the first instance, under the guidance of the Clinical Lead of the Neuroscience and the Senses Health Network three initial priorities were identified - one of these was to ensure that eye health formed part of the new health promotion planning for WA. The Neurosciences and the Senses Health Network is now seeking to develop key models of care to underpin a more extensive implementation of the recommendations from the Draft Plan.

Western Australian Health Promotion Strategic Framework

In keeping with the emphasis of the Draft WA Eye Health Plan a focus on eye disease was included as a priority area in the development of the WA Health Promotion Strategic Plan. This plan was developed as a framework for procurement of Health Promotion programs from the NGO sector in Western Australia.

Recognition that the risk behaviours relating to high burden of disease conditions including diabetes, heart disease and cardiovascular disease are the same as the key modifiable risk factors for eye disease underpinned the inclusion of eye health as an element of the program. Lessons from the Vision 2020 program in Victoria were noted and this information considered in developing the Strategic Framework in WA.

Future health promotion programs will continue to include eye health as an element of the program especially as it has become evident that focussing on preventable blindness seems to be an effective message in influencing lifetime risk behaviour in younger people.
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