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OCT Special Report

Wednesday, December 14, 2016

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Macular foundation calls for Rebate on ongoing OCT scans

Wednesday, December 14, 2016

The Macular Disease Foundation Australia (MDFA) has called on Medicare to extend its rebate on optical coherence tomography (OCT) scans. 

On 1 November, an OCT item was added to the Medicare Benefits Schedule (MBS). The MDFA welcomed the news that a rebate would be provided for an ophthalmologist-performed OCT scan in the initial diagnosis of wet age-related macular degeneration, diabetic macular oedema and other similar conditions.

However, the organisation also expressed concern that only one OCT scan would be reimbursed per year, meaning the rebate would not cover ongoing OCT scans used to monitor the outcome of ongoing eye injection treatments.

According to the MDFA, without OCT scans to determine the response to treatment, patients would require monthly eye injections. 

MDFA CEO Ms Julie Heraghty said, “The addition of [a] new MBS rebate for an initial OCT to facilitate approval of Pharmaceutical Benefits Scheme treatment is a good start, but it does not reflect the fact that regular OCT scans are globally accepted as standard of care to guide ongoing intravitreal treatment.”

In a statement, the MDFA recommended that up to six OCT scans per year should be funded for the purpose of monitoring response to eye injections, and indicated that it would continue to make representations to Medicare and policy-makers for “a more appropriate” rebate. 
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New partnership boosts indigenous eye health resources

Wednesday, December 14, 2016

Edith Cowan University’s Australian Indigenous HealthInfoNet has partnered with The Fred Hollows Foundation to further develop eye health information on HealthInfoNet web resources. ...read more

Age-related cataracts linked to depression

Wednesday, December 14, 2016

Older adults with cataracts are more likely to have depressive symptoms, according to the results of a study published in the December issue of Optometry and Vision Science. 

Mr Haifang Wang of Soochow University, Suzhou, China, and colleagues studied more than 4,600 Chinese adults aged 60 years or older. Our study sheds further light on the complex relationship between aging, vision loss, cataract, and depression and suggests that there may be a role for cataract surgery in improving mental health in the elderly,” Mr Wang wrote.

The study found that symptoms of depression were 33% more likely when cataracts were present.
For adults with cataracts who had received no formal education, a 50% increase was found.

“These results suggest that optometrists and vision care professionals should think beyond the direct effects of cataracts on visual impairment,” Mr Michael Twa, editor-in-chief of Optometry and Vision Science, said in a release. “We should also consider the broader impact that vision loss may have on mental health and well-being.” 

The researchers noted that the study does not indicate whether vision loss may cause older adults to become isolated and withdrawn, or whether depression might make them less likely to seek treatment for cataracts.

As previously reported by Insight an Australian study by The George Institute for Global Health found patients waiting for their first eye cataract surgery showed signs of depression.  The Australian researchers found depressive symptoms in 28.6% of patients – three times higher than would normally be expected – with older adults having high rates of these symptoms.

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Study assesses diabetic eye disease care pathways

Wednesday, December 14, 2016

A recent report on diabetic retinopathy highlights the need for clear patient care pathways and robust health systems to prevent unnecessary vision loss associated with diabetes.

The Diabetic Retinopathy Barometer Report: Global Findings, produced by the International Federation on Ageing, International Diabetes Federation and International Agency for the Prevention of Blindness, surveyed nearly 7,000 adults with diabetes and heath care professionals in 41 countries. 

The study was produced with support from Bayer Pharma and sought to assess awareness of diabetic eye disease (DED) and barriers to diabetes management. 

Findings included:
- 27% of patients either never discussed eye complications with their doctor or did so only after the onset of symptoms. 
- 38% of patients said long waits for an appointment time were a barrier to eye exams. 
- 59% of health care providers either did not have any information on diabetes and potential eye complications, or had information which was insufficient or not included.
- 21% of ophthalmologists had not received specific training in the treatment and diagnosis of diabetic retinopathy (DR) and diabetic macular edema (DME).

“Ophthalmologists acknowledged the complex, and sometimes inadequate, patient referral pathways, a lack of integrated care, and ineffective screening services as serious systemic challenges that contribute to poor overall outcomes in diabetic eye health,” the report said.

Addressing barriers to eye screening – which include the high cost of exams, fear of treatment results and long wait times - was identified as a critical policy issue. 

“A lack of understanding about the importance and urgency of timely screening and treatment could in part explain the finding from health professionals that patients present when vision loss had already occurred and sometimes too late for treatment,” the report noted.

Of the adults with diabetes surveyed, 27% had a diabetic eye disease; 7.6% had DME.

The health care providers surveyed included ophthalmologists (37%), diabetes specialists (17%) and primary care providers (16%).  Other respondents were optometrists, nurses and health educators. 

“Initiatives to address the gaps in the care pathway are essential to preventing unnecessary blindness and visual impairment”, the report said. 

The number of people with diabetes nearly quadrupled since 1980 to 415 million adults today. It is set to rise to 642 million by 2040, and make up about 10% of the global adult population aged between 20 and 79 years, according to the report. 
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Art and longevity for the new Coco Song collection

Wednesday, December 14, 2016


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New College of Optical Dispensing launched

Wednesday, December 07, 2016


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Cataract patients experience depression and falls

Wednesday, December 07, 2016

New research shows that one in three patients waiting for their first eye cataract surgery suffer from falls, while about 30% show signs of depression.

The George Institute for Global Health conducted a study of 329 patients at eight public hospitals in Sydney, Melbourne and Perth, funded by the National Health and Medical Research Council (NHMRC).

One third of the patients were found to have experienced a fall during their wait for their surgery, with almost half of those falls being serious – including 15 head injuries.

“Cataract surgery is highly successful and can transform lives. It is therefore key that a patient has prompt access to surgery to avoid serious injuries and significant psychological distress,” Associate Professor Lisa Keay of The George Institute said.

Researchers also found depressive symptoms in 28.6% of patients – three times higher than would normally be expected – with older adults having high rates of these symptoms.

Ms Anna Palagyi, a research fellow at The George Institute explained that depression and falls are not only a burden to the individual, they can also be costly to the health system.

“Many people choose to go private to have cataract surgery, but others rely on public hospital services,” Ms Palagyi said. “We need to ensure we provide timely and high quality surgery in our public hospitals.”

Ms Palagyi and Ms Keay are co-authors of “While We Waited: Incidence and Predictors of Falls in Older Adults With Cataract,” published in IOVS in November.

The NSW Agency for Clinical Innovation (ACI) is currently supporting parallel work looking at outcomes of cataract surgery. Acting chief executive Professor Donald MacLellan said ACI is continually looking at new ways to improve the care of ophthalmology patients. 
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CERA celebrates anniversary, secures new grants

Wednesday, December 07, 2016

The Centre for Eye Research Australia (CERA) recently celebrated its 20th anniversary and announced it has secured several major grants. 

Closely affiliated with the University of Melbourne Department of Ophthalmology and located at the Royal Victorian Eye and Ear Hospital, CERA has more than 155 researchers, staff and postgraduate students. 

Researchers, staff and supporters attended a celebration held in Melbourne on November 17. Describing CERA’s beginnings in the 1990s, Professor Hugh Taylor, its inaugural managing director, said, “There was huge potential, so I thought let’s pull together the hospital, the profession, the college and the associations advocating for the blind with the University and call it the Centre for Eye Research.”

CERA published 192 research papers, conducted 19 clinical trials and won 34 competitive grants totalling over $4.8 million in 2015.

In late November, CERA announced Associate Professor Lyndell Lim, who leads CERA’s Clinical Trials Research Centre, is one of five recipients of the 2016 Ramaciotti Health Investment Grants. 

The grants, worth up to $150,000, are awarded to early career scientists to support translational health or medical research with a path to clinical application within five years. Assoc Prof Lim’s grant supports her research that will improve cataract surgery outcomes in patients with diabetic macular oedema.

In December, CERA announced more than $1.4 million in two project grants has been awarded to CERA Deputy Director, Professor Robyn Guymer, and Associate Professor Alex Hewitt. The grants were part of the National Health and Medical Research Council (NHMRC) 2016 funding announcements.

Prof Guymer’s grant supports her research into the underlying mechanisms by which debris accumulates in the retina in age-related macular degeneration (AMD).

“Finding out more about this process is critical for understanding disease pathways and ultimately developing novel treatments targets for early AMD,” said Prof Guymer.

Assoc Prof Hewitt’s grant assists his work on a new generation of gene therapy. “The goal is to build towards therapies that will enable direct gene-editing in the eye,” he said. 
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Google AI detects diabetic retinopathy

Wednesday, December 07, 2016

Google researchers have created a deep learning algorithm that can diagnose diabetic retinopathy, according to a paper published in November in the Journal of the American Medical Association (JAMA). 

Machine learning, a type of artificial intelligence (AI), is a discipline within computer science that teaches machines to detect patterns in data. Deep learning involves training an algorithm, or “neural network”, to perform a specific task by learning from a large set of examples, removing the need to explicitly specify rules.

Google ‘trained’ the algorithm by using 128,175 images (the “development set”) obtained from EyePACS in the United States and three eye hospitals in India. 

The performance of the algorithm was assessed by applying it to two data sets (“the validation sets”), consisting of 9,963 images taken at EyePACS screening sites and 1,748 images that have been publically available.

All of the images in the development and clinical validation sets were graded for the presence of diabetic retinopathy, diabetic macular edema and image quality by ophthalmologists.
 
Comparisons of the grades given by the algorithm with those given by the ophthalmologists showed that the performance of the algorithm was “on par” with that of the ophthalmologists.

In a Google Research blog post published on the same day as the JAMA article, Ms Lily Peng Google product manager, and Mr Varun Gulshan Google research engineer, and co-authors of the paper, explained that diabetic retinopathy is the fastest growing cause of blindness and that, if caught early, is treatable. 

“Unfortunately, medical specialists capable of detecting the disease are not available in many parts of the world where diabetes is prevalent. We believe that Machine Learning can help doctors identify patients in need, particularly among underserved populations,” Ms Peng said.

Mr Gulshan and Ms Peng noted “there is still a lot of work to do”, adding that they are working with retinal specialists to define even more robust reference standards that can be used to quantify performance. 

Furthermore, they said that their colleagues at DeepMind Health, which uses AI to bring benefits to medical research, are working on applying machine learning to 3D imaging technology.

The research paper for this project is available to view on the Journal of the American Medical Association website.
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