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Conference paper at eResearch Australasia Conference at Goldcoast Qld November 2010 presented by Des and Simon.

eOptometry, a new paradigm in rural and remote vision care
Desmond J. Maddalena1, Simon Grbevski2


1Aivision Pty Ltd, Sydney, Australia, des@aivision.com.au
2 Aivision Pty Ltd, Sydney, Australia, simon@aivision.com.au

Vision testing has largely remained in fixed locations such as optometry clinics in urban and rural centres owing to a number of factors chiefly the need for expensive lens based testing equipment and limited numbers of highly skilled professional vision experts. Recent studies [1-3] have identified a significant disparity between the availablity of vision care services between urban, rural and remote areas. Rural and remote communities have an older population base [1,2] and been shown to suffer from greater prevalence of eye problems than their urban conterparts [1,2] but have poorer services.

A study by Access Economics [3] modeling the supply and demand for optometry services in Australia from 2005 to 2020 found that vision care professionals preferred to live in or near urban centres rather than in rural and remote areas. There were more males in the rural and remote workforce than females but these were in older age brackets suggesting they would be retiring in the near future increasing the severity of the shortage of services. The study found that there was a feminisation of the optometry workforce with larger proportions of females graduating than males. The proportion of females in the workforce has risen from about 13% to over 40% between 1977 and 2005. Unfortunately the females were more mobile, leaving the workforce to have children then preferring part-time rather than full time work thereafter.

Surveys [3] suggested that selected younger professionals might be induced to travel and work in rural and remote areas if their salaries were significantly increased by 15-20% in those areas even though rural optometrists were already receiving higher average salaries than their urban counterparts. The model examined the affects of a real income increase of 30% as an inducement but found that even at these levels there was likely to be an under supply in regional and rural areas well into the future unless the supply of graduates was increased substantially. Various measures were proposed to allieviate the problem but all of these rely on changes in governmental policy and increased expenditure by the government at a time when funds are scarce. What is needed of course is some new technology that will allow a new approach to the problem.
 
In Australia in 2005-6 [3], the largest proportion of optometry tests 51.9% of 5.3 million services as recorded by Medicare is for Item 10900 (Comprehensive initial consultation) and a further quarter (25.3%) were for Item 10918 (Subsequent consultation). These are what might be considered standard eye tests involving a visual refraction. Since vision testing is largely based upon the visual discrimination of images of fixed size at known distances it has been possible to carry out limited qualitative vision testing on computer monitor screens for some time. However, until now variations of the classic letter type Snellin eye test charts adapted for use on computer screens have largely been used as screening devices to give an indication whether an individual should go for an eye test at a clinic.

A new generation of lensless vision tests called Optiscribe designed specifically to be carried out remotely over the Internet on a personal computer in the home gives promise of a revolution in vision testing in rural communities. Less travelling to an urban or rural centre, no more waiting and the possibility of shopping around for a good price on spectacle frames and lenses over the Internet. These new vision tests offer the promise of  supplying vision care to those that might otherwise wait or not seek help until their vision problems are more serious. It will also substantially reduce the routine vision testing load on the rural optometrist allowing them to concentrate more fully on delivering a higher quality vision care to those with more serious vision problems.

The challenges of delivering an accurate vision test that can lead to the prescription of corrective lenses over the Internet will be discussed together with a demonstration of the new Australian owned and developed Optiscribe vision testing system. The Optiscribe eyetest is only available at http://www.eyetestclinic.com/
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References

Like to know more .... contact author.

 

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