Improving eye care for remote Top End Indigenous communities

When intravitreal anti-VEGF therapy for diabetic macular oedema (DME) became available in 2014, there was a rapid increase in the need for indigenous patients with DME to access OCT scans and anti-VEGF therapy. At this time there was only one OCT scanner in the Top End located in the eye clinic at Royal Darwin Hospital (RDH).

Ten to twenty patients per week, and their carers, were flown to Darwin from communities such as Gove and Katherine for an OCT scan to determine whether they would benefit from anti-VEGF therapy and to monitor its outcomes. The transport and accommodation costs were enormous and large numbers of patients either did not attend or discontinued their treatment.

Ophthalmologists Dr Tharmalingam Mahendrarajah and Dr Nishantha Wijesinghe realised that by funding OCT machines in remote communities they could radically improve this situation and save the health system significant expenditure. With the support of Professor McCluskey and other visiting consultants from the Save Sight Institute, careful negotiation and lobbying with RDH and NT Health resulted in the purchase of an OCT scanner for Katherine.

An audit performed by Professor McCluskey and his Fellow 12 months after purchase, showed that within 6 months the OCT scanner had paid for itself from savings in patient travel. The audit also showed that patient attendance and treatment outcomes had improved significantly. A second OCT was subsequently purchased for the Gove community. OCTs for other remote communities are being considered.

Subsequently, monthly medical retina and injection clinics with a consultant and registrar from RDH have been running successfully in Gove and Katherine with very few patients needing to travel to RDH and vastly improved patient compliance and treatment outcomes.

In 2020, the COVID-19 pandemic has highlighted how successful this community based model of care has been, as regular visiting registrar clinics have been able to continue in both Gove and Katherine, with back-up telehealth consultant support from Darwin. There has been minimal disruption to intravitreal therapy for patients in these communities.