Evaluation of Eye Care Models and Assessment of Novel Clinical Uses of Ocular Imaging to Improve Care of Individuals with Diabetes

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Embargoed until 2024-11-15
Copyright: Khou, Vincent
Diabetes is a condition affecting 7.4% of Australians. Individuals with diabetes often develop complications, which include retinopathy, neuropathy, and kidney disease. Consequently, these individuals require multidisciplinary care. The provision of accessible and timely care is critical, especially with retinopathy, where eye examinations are required to prevent and delay visual impairment. Thus, the objective of the thesis was to assess the current standard of eye care and investigate new ways to enhance eye care for individuals with diabetes. This was explored over two sections. The first section comprised of three studies to explore current models and examine the efficacy of new models. The first study investigated wait lists at a public hospital ophthalmology clinic through a review of referrals. This study established that wait lists were encumbered by poorly targeted referrals for chronic ocular conditions, which could potentially delay access to eye care for individuals with diabetes. Subsequently, two studies were conducted to assess changes in access from two recently implemented models. The second study comprised of a randomised clinical trial that evaluated a metropolitan public hospital collaborative optometry-ophthalmology clinic. Low‑risk participants with diabetes examined by an optometrist experienced quicker wait times without affecting diagnostic accuracy. The third study evaluated a nationwide diabetic retinopathy screening programme operated at primary health care facilities. A survey of health care practitioners, and audit of photos graded by an optometry-led service revealed an increase in access to retinopathy screening. Evaluation of these models revealed that optometrists play a vital role in providing alternative pathways, and that the models improve access in both urban and non‑urban regions. The second section of the thesis comprised of two experimental studies investigating new uses of corneal confocal microscopy and optical coherence tomography which visualise the corneal nerves and retinal layers, respectively. Two cross-sectional studies were conducted to examine corneal and retinal changes in individuals with diabetes. These studies indicated reductions in corneal nerve morphology and retinal layer thicknesses. Since optometrists are familiar with these devices, there is potential to enhance eye examinations in the future by utilising these ocular imaging instruments to detect other diabetic complications.
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PhD Doctorate
UNSW Faculty