Vision Impact Fund

Supporting impactful projects that align with our priority areas.

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About the Vision Impact Fund (VIF)

Advancing Eye Health in Western Australia

The Vision Impact Fund (VIF), an initiative by the Perth Eye Foundation, seeks to address the salient challenges in Western Australia's eye health sector. Our goal is to provide substantial support to organisations and individuals dedicated to improving eye health outcomes throughout the region.

Prioritising Real Needs

Our commitment to Western Australia's eye health is rooted in the insights from our WA Vision Health Report. This research provides a comprehensive overview of the WA vision health sector, examining demographic trends, prevalent eye conditions, and the current state of research and funding mechanisms. Through this analysis, we've identified a series of key priority areas that we believe need our collective attention. The Vision Impact Fund is our direct response to these findings, ensuring our funding is directed to the genuine needs of the sector.

Our Priority Areas

The prevalence of eye conditions increases with age. Nintey-three (93) % of people >65 years are affected by an eye condition in comparison to 12% of children aged 0-14 years (NHS).
The Australian population is ageing due to low fertility and increasing life expectancy. The median age of the Australian population has increased from 35 to 38 years between 2000 and 2020. The median age of the WA population increased from 34.6 to 37.5 years in this period.
Given Australia’s aging population, the burden of eye disease is likely to increase in the future.
The prevalence of cataract increases with age. An Ontario, Canada study with a similar aging population to Australia projected the number of cataract operations to increase by 128% between 2007 to 2036 with the proportion provided to patients aged over 85 tripling.

The prevalence of eye conditions increases with age. Nintey-three (93) % of people >65 years are affected by an eye condition in comparison to 12% of children aged 0-14 years (NHS).
The Australian population is ageing due to low fertility and increasing life expectancy. The median age of the Australian population has increased from 35 to 38 years between 2000 and 2020. The median age of the WA population increased from 34.6 to 37.5 years in this period.
Given Australia’s aging population, the burden of eye disease is likely to increase in the future.
The prevalence of cataract increases with age. An Ontario, Canada study with a similar aging population to Australia projected the number of cataract operations to increase by 128% between 2007 to 2036 with the proportion provided to patients aged over 85 tripling.

Over 50% of all eye conditions diagnosed in the NEHS were new diagnoses suggesting a significant burden of undiagnosed eye conditions in the community.
The rate of undiagnosed eye conditions in the NEHS was 5.58% of all Indigenous participants and 3.03% of all non-Indigenous participants. In addition, three of the top 4 causes of blindness, AMD (54.6%), glaucoma (8.1%) and DR (5.4%) in WA, have better outcomes for patients when identified early.
This suggests the need for increased regular eye examinations.

As primary care physicians, GPs are often the first point of contact with the health system for a patient with an eye disorder.
1.9% of GP consultations in Australia are related to an eye disorder equating to approximately 315,239 services in WA in 2020.
Ophthalmic anti-infectives are amongst the most common medications prescribed, accounting for 0.8% of all prescriptions.
The epidemiology of eye diseases and standard of care is unknown for this patient cohort.
It is important that GPs are resourced appropriately, clinically supported, and have adequate training to ensure patient safety and high standards of care for this large patient volume.

GP’s are an integral component of the eye health care workforce and commonly refer to ophthalmologists.
Referrals account for 6.5% of all specialist referrals, which is disproportionately higher than the proportion of the specialist workforce (1%) represented by ophthalmology. There were an estimated 99,549 referrals to ophthalmology from GPs in 2020.
GPs are not often recognised as part of the eye health care workforce as is evident by their absence in key government and non-government reports.

Emergency departments are overwhelmed.
In Australia, 65.5% of eye presentations were classified as semi-urgent or and non-urgent urgent and 92% of eye conditions were not admitted in 2019.
In 2019, 65% of eye presentations to a WA emergency department were classified as semi-urgent or non-urgent. This may represent cases, which could be redistributed to other primary health care avenues and reduce this burden.
The relatively modest size of this issue should be recognised; in 2019, 65.5% of low acuity eye presentations representing approximately 7166 cases or 0.8% of the 929,507 total presentations to the WA emergency departments.

In 2016, MBS item numbers 12325 and 12326 were introduced to support diabetic retinopathy retinal fundus photography screening in primary care.
Between the financial years 2016 ─ 2021, the cumulative use of item numbers 12325 and 12326 nationally was 10,598. WA had the third highest total utilization and second highest per capita utilization.
The cumulative 10,598 screening episodes over 5 years fell significantly short of the projected 400,000.
A number of studies have assessed potential factors, which may have contributed to this significant underutilisation. These include costs of retinal cameras, time constraints, the need for dedicated staff to take the responsibility for DR screening, lack of skills to make a DR diagnosis, lack of awareness of Medicare incentives for non-mydriatic retinal photography, optometrists being perceived as ideal for DR screening, and limited referral pathways.

The National Health Workforce Dataset is created through a survey, which is completed by AHPRA-accredited health practitioners during annual registration.
The survey contains questions, which assess the characteristics of the workforce and aim to predict trends such as vocation, retirement, and geographical location of work intentions.
These data inform a number of key reports such as the Eye Health Workforce In Australia report that informs the government and peak-body policy decisions around training and workforce distribution strategy.
Data is self-reported and missing some granularity in the geographical distribution of the workforce. For example data is postcode-based and does not capture the often multiple places of work for one clinician.
Greater detail may lead to better policy making.

In 2018-19, age-standardised rates of cataract surgeries for Indigenous Australians (8,519 per 1,000,000) remained lower than those of non-Indigenous Australians (9,102 per 1,000,000).
Cataract surgery coverage rates across Australia are significantly lower in Indigenous (61.47%) Australians compared to non-Indigenous (87.63%) Australians (p<0.001).¹²
This suggests an ongoing gap in access to eye health care

Results from the AIHW data indicated that across Australia, around 6,100 Indigenous Australians (around 3,655 per 1,000,000) had cataract surgery between 2017 and 2019 with the rate being highest in remote and very remote areas and lowest in major cities.
In WA, between 2017 and 2019 the met need for cataract surgery was estimated to be 76% in NG Lands, 57% in the Wheatbelt, 53% in the Kimberley region, 49% in the Goldfields, 44% in the Great Sothern region and the Pilbara, 35% in the Mid-West, 29% in Perth, and 25% in the South-West.
Indigenous Australians are more reliant on public hospitals for cataract surgery with approximately 80% of cataract surgeries for Aboriginal and Torres Strait Islander people and 29% for non-Indigenous people are performed in public hospitals.
A recent report prepared for Vision2020 concluded that as Indigenous Australians have higher rates of cataracts and predominantly have surgery in public hospitals, they are disproportionately affected by the long wait times, which may be a contributing factor to lower surgery rates and coverage.
The RANZCO InReach Ophthalmology network offers a pathway for Aboriginal and Torres Strait Islander patients to be wait listed for procedures directly on the public hospital wait list from private practices.

Analysis of the AIHW elective surgery activity data suggests that the median wait times for cataract surgery are increasing in Western Australia (Figure 14).
In 2011, the mean median wait time was 80 days, compared to 123 days in 2019.
The large increase in average wait times between 2017 and 2019 appears to be driven by the increase in WA Country Health Service (Figure 15).
The longest metropolitan wait time was Joondalup Health Campus, 146 days.
Volume-weighted wait time was slightly higher in regional sites compared to metropolitan sites for cataract procedures (153.3 vs 64.2 days, P < 0.001).

Wait times captured through the AIHW data do not capture the time from initial diagnosis by a general practitioner or optometrist and referral to an ophthalmologist. This waiting time from initial referral to a public hospital until first visit is referred to as the ‘hidden waiting list’ or the ‘wait for the wait’.
There are no data available for the ‘hidden waiting list’ in WA.
There is some reporting of this figure nationally; however, it is inconsistent and ranges from a median wait time of 3 months in Victoria to 10-20 months in the 90th percentile in Queensland.
Wait times for cataract surgery have negative health consequences and increased health care costs.
This is an issue from a patient outcome, health, economic, and transparency perspective.

An online search did not reveal any eye health care services specific for people with CALD backgrounds in Western Australia.
This may represent a gap, given there are services established for other areas, including cancer screening, chronic disease prevention, dental health, immunisation programs, mental health, newborn screening, sexual health, and women’s health on the WA Health Multicultural Health Services Directory.
The Victorian Eye Health promotion website Vision Initiative provides translated eye health resources in 10 languages other than English.

The AIHW provides an excellent breakdown of health care expenditure in Australia through the Australian National Health Account, which was produced by compiling data from over 50 sources.
Figure 4 in the report provides a visual overview of the flow of funds through the healthcare system from source to area of expenditure; however, it was not possible to filter this database by disease sector.
Therefore, achieving a granular analysis of the eye health sector of the Australian health care system was not possible within the constraints of the publicly available data.

There is no local formal training available for orthoptists, ophthalmic nurses, ophthalmic theatre nurses, and ophthalmic nurse practitioners.
There is no local training for diabetic educators in ophthalmology.
The emergency physician curriculum standards contain ophthalmic outcomes; however, there is no ophthalmic CPD offered through the Australian Collage of Emergency Medicine (ACEM) e-learning platform.
The Australian Collage of Rural and Remote Medicine (ACRRM) have ophthalmic outcomes in their curriculum standards; however, there is no additional CPD offered.
There is a paucity of tailored education available for ophthalmic nurses in Western Australia.

The burden for all vision disorders increased slightly between 2003 and 2018. AMD increased by 2%, cataract and lens disorders increased by 2.5%, glaucoma increased by 0.4%, other vision disorders increased by 0.2% and refractive errors increased by 0.7%.
This is despite a significant reduction in the national fatal burden during the same time period.
This suggests that the overall health of Australians is improving; however, the eye health of Australians remains unchanged or slightly worse during this period.
Despite this, WA had a DALY rate of 3.2 for hearing/vision, which was the lowest in the country.

90% of vision impairment and blindness among both Indigenous and non-Indigenous Australians is preventable or treatable and approximately 50% of the causes of vision impairment are undiagnosed.
In the NEHS 30% of non-Indigenous, and 50% of Indigenous Australians with intermediate AMD had not accessed optometry or ophthalmology services within the past 12 months. Early diagnosis is important, as presenting VA is a strong predictor of the outcome for anti-VEGF treatment in neovascular AMD.
The NEHS reports that 52.87% of diabetic (self-reported) Indigenous participants adhered to the NHMRC diabetic eye examination guidelines (within the past 12 months) and 77.7% of non-Indigenous participants adhered to the screening guideline (within the past 2 years).
Results from the National Eye Health Survey found that 46.6% of the non-Indigenous population and 72.5% of the Indigenous population who had probable or definite glaucoma did not have a known history of the diagnosis.
In the NEHS, 50% of non-Indigenous and 56% of Indigenous participants with undiagnosed glaucoma had accessed optometry or ophthalmology services within the past 12 months.
This suggests that preventative eye health could reduce the burden of eye disease significantly and there is a large burden of silent, undiagnosed eye disease in the community.

The majority of research output in Western Australia is generated by the top institutions and researchers.
Sixty-seven (67) % of publications were authored by the top 5 researchers (0.076% of researchers).
Sixty -six (66) % of publications were affiliated with the top institution (The Lions Eye Institute).
There is a long tail of 220 Western Australian research institutions which were affiliated with the research.
This suggests that there are many researchers and institutions producing once off or small volumes of work.