Among the wide-ranging health impacts of the pandemic, it’s important to focus on the implications for eye health, according to Lyn Brodie, CEO of Optometry Australia.
The introduction of Medicare rebates for tele-optometry is vital at a time when many people are missing out on necessary care, and tele-optometry will continue to be needed beyond the easing of pandemic restrictions, she says.
Lyn Brodie writes:
20/20 vision is the well-known term used to express normal vision, the clarity or sharpness of vision measured at a distance of 20 feet. The year 2020 was therefore, to be a very special gift to the eye health sector in providing an opportunity to raise community awareness around the subject of eye health.
Ophthalmologist Dr James Muecke was named Australian of the Year to really spearhead the conversation, and Optometry Australia seized the significant opportunity to unite the sector behind the theme ‘2020: The year of good vision for life’.
The Federal Government also saw the value, providing funding to support community awareness eye health initiatives.
Sadly, instead of this hoped-for focus, we are likely to see a decline in eye health improvements for Australians.
The impact of COVID-19 on the health and wellbeing of the population, beyond the direct effect on those who contracted the virus, will take time to really understand, although there are already environmental factors that we know will undoubtedly have already set Australians on the path to poorer eye health.
At the height of the COVID-19 pandemic in April, more than 90 percent of optometry practices closed or scaled back their hours of operation in response to the Australia-wide lockdown.
The data comes from an extensive survey conducted by Optometry Australia, the peak professional body representing almost 85 percent of all Australian-based optometrists.
In August, another poll of optometrists revealed an estimated 50 percent of optometrists were still working fewer hours than they were pre-COVID-19.
It will be critically important that optometrists return to optimal working capacity as quickly as possible to support community eye health needs. There are potentially many hurdles to be overcome before that is achieved.
Government support matters
In April 2020, 79 percent of employees were on Job Keeper and 11 percent of respondents were on Job Seeker, according to the major survey. These figures highlight the exceptionally high reliance on COVID-specific Government funding that continues to keep the profession afloat.
Recent indications are that practices are currently dealing with patient backlog so returning to more ‘normal’ turnover. Yet there is real concern that this level of activity will not be sustained as the economic reality of COVID is entrenched.
Although this speaks to the personal economic conditions of practitioners, it will compromise the professions’ capacity to provide eye health care to the community.
Stage 4 restrictions in Melbourne and Stage 3 restrictions in regional Victoria, along with mask requirements in Sydney, have once again meant that many patients will postpone eye health care.
There is real concern that care that could be postponed for a few months during the first wave should not be postponed any longer.
Optometrists are still able to provide essential care during Stage 4, but it is often the vulnerable patient groups who will be reluctant to venture out even knowing that care should not be delayed.
Exacerbating the situation and the sector’s ability to ensure quality eye care for the whole community is the Government’s reticence to provide rebates for any optometry consultations provided via telehealth, despite the fact that, in many cases, Medicare rebates can be claimed for equivalent face-to-face care.
Some optometry practices have, and continue to, provide telehealth to help ensure their patients can access the care they need. This carries a cost to the patient or the practitioner.
Optometry Australia strongly believes that Medicare rebates for tele-optometry would have enabled many more practices to support patients during the height of the pandemic and likewise, could encourage more people to access the eye health care they need now.
The situation in Victoria provides further argument that supporting telehealth is critical, to ensure chronic eye conditions and critical care is being managed while ensuring patient safety especially with vulnerable patient groups.
Ongoing care for established chronic conditions, such as diabetic retinopathy, glaucoma and macular degeneration, in many instances would be well supplemented by telehealth.
Patients with these conditions are often elderly with co-morbidities, and a particularly vulnerable group during this pandemic. Telehealth can also support diagnosis and management of a range of acute presentations, such as conjunctivitis, and some causes of red eye, without the need for the patient to leave home, and be employed to minimise physical interaction where replacement prescriptions for glasses are necessary.
Despite continual discussions with Government, no telehealth MBS items have yet been realised for optometry. The need potentially does not cease with easing of restrictions, as vulnerable patient groups are likely to be cautious for some time, and the threat of further waves is ever present.
Mental health concerns
The mental health of practitioners has been of paramount concern. The survey indicated that in April, 88 percent of optometrists were ‘travelling ok’.
Optometry Australia undertook to personally call every member to check on their health and well-being. More than 4,800 members were called, with 3,290 being reached. It was pleasing that such a large proportion were ‘traveling ok’; however, it is concerning that the remaining group were struggling.
There is no doubt that moving to Stage 3 and Stage 4 restrictions in Victoria has impacted on the mental health of the community, and therefore that of practitioners.
Ongoing discussion, support and tools are vital to ensure practitioners can stay safe and well themselves, in order to serve and support the community.
COVID-19 does present opportunities for the health sector, if we leverage the disruption to ensure positive systemic change to improve access for patients. The eye health sector has embraced this philosophy, driving collaborative and integrative care models at an accelerated pace within the public hospitals around the country.
These patient-centric models of care enhance the people’s daily living through the maintenance of quality vision, and will be at least a positive legacy in the year 2020.
Lyn Brodie is CEO of Optometry Australia.
Read Croakey’s coverage of telehealth and the pandemic.
Declaration from Croakey: Lyn Brodie is a director of the non-profit, public interest journalism organisation, Croakey Health Media