Diabetic screening in Western Australia: A photographer’s perspective

Abstract

Western Australia has a large landmass and low population density. Dating back to the 1970s and even today, specialist medical services are often lacking or non-existent outside of Perth, the capital city. Diabetes has always been a major health problem, particularly in the Australian Aboriginal community. In conjunction with the Lions Save Sight Foundation and Diabetes Foundation of Western Australia a diabetic screening programme was initiated in 1978 for rural and remote diabetics. The programme aimed to screen for diabetic retinopathy, educate diabetics, medical and paramedical personnel and to arrange treatment for sight threatening eye disease. Eye screening continues to date although the role of the Lions Eye Institute has changed from programme initiator to reading centre and teaching unit, and continues to evolve with changing technologies.

Retinal Photography Screening Programs to Prevent Vision Loss from Diabetic Retinopathy in Rural and Urban Australia: A Review

“…From the earliest studies undertaken in the mid-1990s until the most recent study published in 2013, a consistent finding has been the identification of patients who had not undergone an eye examination in the recommended time frame to be screened for DR, demonstrating the effectiveness of retinal photography-based DR screening programs to augment current eye care services. This finding was observed in studies undertaken in urban populations, [6][7][8][9][10][11] rural and remote communities, 3,7,8,[12][13][14] and regional areas 6,8,15 in Australia. This finding is not surprising and supports the literature internationally that has shown the effectiveness of DR screening programs.…”

“…The projects were undertaken in a range of setting including urban populations, 6-11 rural and remote communities 3,7,8,12-14 and regional areas. 6,8,15 Locations included a pathology collection center, 10 Indigenous primary health care, 9 general practice, 8,11 prison, 12 mobile unit set up in the community, 3,6,7,12,14,16 Aboriginal community controlled organizations 12,13 and telemedicine. 15 Each study used retinal photography.…”

Outcomes of using telehealth for the provision of healthcare to Aboriginal and Torres Strait Islander people: a systematic review

“…22,23,26,31,32,35 The cost of providing services by telehealth was reported to be less than providing similar face-to-face services. 27,29,37 Process improvements such as decreased failed to attend rates and improved screening rates were also reported. 10,22,23,28 Two studies explored the Indigenous patient's perspective on the use of telehealth.…”

“…Store-and-forward services were used in screening programs for ear health, [22][23][24]28 and diabetic eye disease. 29,30 Video conferencing was used to: provide medical consultations, 25,26,[31][32][33][34][35] for the supervision of chemotherapy administration, 25,26,35 and for the delivery of speech rehabilitation therapy. 36 Remote telehealth monitoring was used for in-home/ in-hub monitoring of chronic diseases in the Staying Strong pilot project.…”

An Innovative Australian Outreach Model of Diabetic Retinopathy Screening in Remote Communities

“…Since the introduction of the program, screening of the eligible diabetic population living in remote communities has become more comprehensive, increasing from 33.7% to 47.9% across its three years of operation. International rural and remote DR screening programs reported population coverage ranging from 39% to 85% [ 23 – 31 ]. Indeed, achieving high rates of screening is particularly challenging in these study communities given the transient and highly mobile nature of the population, the fact that patients are often employed away from townships, the delivery of screening only once annually, and the lack of a fully coordinated approach to screening with visiting optometry and ophthalmology services.…”