Shelley Walters Verity Moynihan All photos are displayed with the permission of the participants.

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1 Shelley Walters Verity Moynihan 2015 All photos are displayed with the permission of the participants.

2 Has been operating for over 20 yrs Covers a large land mass many communities remote Moving population Limited visits for Ophthalmologists and Optometrists Large distances to travel for routine Eye Care Walters, S., Mak, D., Barry,C., McAllister, A. (2003)

3 12 sites with cameras Operators qualifications Reception, Bus Driver, Nurse, AHW Coordinator assists with support, advice, screening has a small travelling camera.

4 Operator perform VA, takes photo, collects Ophthalmology history sends to LEI. Ophthalmologist reads photos, recommends action. Operator acts on recommendations. Continuity of care for the client

Ophthalmology Review Referred By: Dr Diabetic Retinopathy: Yes Non Proliferative Retinopathy (NPDR) (Mild): No Non Proliferative Retinopathy (NPDR) (Moderate): Yes Non Proliferative Retinopathy

5 Ophthalmology Review Referred By: Dr Diabetic Retinopathy: Yes Non Proliferative Retinopathy (NPDR) (Mild): No Non Proliferative Retinopathy (NPDR) (Moderate): Yes Non Proliferative Retinopathy (NPDR) (Severe): No Proliferative retinopathy (PDR): No Maculopathy: Yes Photo Quality: Adequate Specialist Notes: Moderate NPDR and maculopathy. Please book for ophthalmology review in Broome in May. Thanks Verity

7 Stats identify sites requiring assistance Identify when cultural/social events have taken place Identify s age and gender of screening Outcomes of Screening eg. Diabetic Retinopathy Azzopardi, P., Brown, A., Etal (2012)

9 Figure N: Age and Gender Distribution for Patients in the Retinal Screening Program, Female Male

10 Provided to the operator on a face to face basis. Provided to the client at clinic setting by the operator. Annual Eye Health Conference for Eye team in Broome. Net working with Ophthalmologist over the phone or during Ophthalmology clinics.

12 Sustainability needs: Eye Health Coordinator Ownership of program by operator/clinic/community Rapport Building with community members Communication between stakeholders

13 Movement of population Movement of Health staff Lack of AHW/Nurses Remoteness of communities Cultural requirements

14 Lack of awareness of adolescent diabetes and the impact of Gestational diabetes, low birth weight and growth faltering infants into the next generation. Lack of Adolescent education. Lack of communication between stake holders Lack of accurate data The effect of over servicing on the client and clinic by regional health staff. Azzopardl, P., Brown, A. Et al (2012)

15 Lack of awareness lack of screening Perception of shame The need to be accepted by peers Silent symptoms perceived state of health Lack of support for peer acceptable counselling. Lack of accurate data unknown numbers O Dea, K., Rowley, G., Brown, A. (2007)

Increased awareness of the effects of diabetic eye disease by community and clinic Increased number of cameras and operators Improved access into remote

17 Increased awareness of the effects of diabetic eye disease by community and clinic Increased number of cameras and operators Improved access into remote areas Increased involvement by clinic staff Increased awareness of the role of the AHW Increased awareness that anyone can use the camera working as a team.

18 Strong focus on the yr old screening for diabetes Increased encouragement and training of AHW Increased communication with all stake holders Baker IDI Heart & Diabetes Institute, Diabetes Australia. (2014) IDF/ISPAD. (2012)

The Diabetic Retinal Screening program is providing a routine eye health check to isolated people to aid in the early detection of Diabetic Retinopathy that would otherwise not be accessible.

19 The Diabetic Retinal Screening program is providing a routine eye health check to isolated people to aid in the early detection of Diabetic Retinopathy that would otherwise not be accessible. Improved outcomes due to early detection and decreased invasive procedures with poorer outcomes Increased opportunities for Diabetic Education and in particular Diabetic Eye Health with in the community.

Walters, S., Mak, D., Barry, C., McAllister, I. (2003). Screening for Diabetic Retinopathy in the Kimberley Region of Western Australia. Journal of Ophthalmic Photography. 25(1). O Dea, K., Rowley, K.

21 Walters, S., Mak, D., Barry, C., McAllister, I. (2003). Screening for Diabetic Retinopathy in the Kimberley Region of Western Australia. Journal of Ophthalmic Photography. 25(1). O Dea, K., Rowley, K., Brown, A.(2007). Diabetes in Indigenous Australians: possible ways forward. Medical Journal Australia, 86(10). indigenous Assopardl, P., Brown, A., Zimmet, P. Et al (2012). Type 2 Diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening, management and prevention. Medical Journal Australia. 197(1). 2 diabetes young. Baker IDI Heart & Diabetes Institute, Diabetes Australia. (2014). Diabetes: the silent pandemic and its impact on Australia. snew/ IDF, ISPAD. (2012) Global IDF/ISPAD Guidelines for Diabetes in Childhood and Adolescence. maternal and child health.

Diabetic retinopathy (DR)

Diabetic retinopathy (DR) Diabetic retinopathy screening in remote communities A futuristic outreach model Nicola Glasson Dr Lisa Crossland PhD, MPH&TM, BA (Hons) Professor Sarah Larkins MBBS, BMedSci, MPH&TM, FRACGP, FARGP, GradDip