The Observatory

The First OCT Item Number in Australia

The National Eye Health Survey told us that more than 453,000 Australians are blind or vision impaired and a significant portion of these people suffer from diabetes-related eye diseases. We also know that generally, eye health outcomes are poor for those living in rural and remote locations where there is a lack of easily available and coordinated access to specialist services, such as those provided by ophthalmologists.
In response to concerns regarding barriers for Aboriginal and Torres Strait Islander people and non-Indigenous Australians living rurally and remotely accessing ophthalmology services , Vision 2020 Australia developed a formal position statement  in October 2016, outlining key recommendations to eliminate these barriers and improve access to these sight-saving therapies. 
In October 2016, the Royal Australian and New Zealand College of Ophthalmology (RANZCO) received correspondence from the Commonwealth Department of Health, advising that a Medical Benefits Schedule (MBS) item for Optical coherence tomography (OCT) was to be listed from 1 November 2016, fulfilling one of the recommendations put forward. 
Item descriptor to commence from 1 November 2016- Category 2- Diagnostic Procedures and Investigations. Group D1- Miscellaneous Diagnostic Procedures and Investigations. Subgroup 2- Opthalmology.
Item 11219 will reimburse the use of OCT as an alternative diagnostic procedure to FA to determine patient eligibility requirements for initial treatment with anti-VEGF therapies, including ranibizumab and aflibercept, in age-related macular degeneration, DMO and central or branch retinal vein occlusion. 
This is great news for patients. OCT is noninvasive and reproducible, requiring neither dye injection nor the bright lights used for fluorescein angiography, so it’s both easier for ophthalmologists to interpret; and advantageous for patients. OCT is also very good at measuring thickness of the retina, so it’s helpful in manageing treatment for diseases that cause fluid to build-up, which occurs in all the retinal conditions listed in the item number.
The eye health and vision care sector has made great advances through the National Eye Health Survey, listing of a diabetic photo-screening MBS item number and supporting the roll out of five million dollars worth of screening cameras to Indigenous health centres across Australia.
However, as Professor Fred Hollows and Professor Archie Cochrane said “There should never be survey without service”, and this new item number adds momentum to a complementary campaign to improve services to all Australians. 

Looking forward

While this is great news for patients who require treatment for diabetes related eye disease, the sector’s work is not complete. To quote Professor Jay S. Duker, Tufts Medical Center, Boston, USA, “In 2016, you can’t manage diabetic macular edema, wet age-related macular degeneration (AMD) or retinal vein occlusions without an OCT. It’s standard of care for treatment of those diseases.”
The eye health and vision care sector is keen to explore ways to fund the placement of additional OCT machines, which have proven to be robust in pilot mobile treatment facilities in Queensland and Western Australia. 
Vision 2020 Australia and members are also advocating for the item descriptor to be expanded to allow payment of rebates for additional OCT scans used to monitor the outcome of ongoing treatment. This measure would support patients by potentially reducing the need for monthly eye injections; but also will ensure the service is sustainable, encouraging health services to invest in the OCT equipment. 
Further, Vision 2020 Australia is lobbying the Pharmaceutical Benefits Advisory Committee to support implementation of a recommendation which would allow non-ophthalmologist doctors such as registrars to phone the Pharmaceutical Benefits Service to gain authority for restricted drugs under the instruction of an ophthalmologist, once again improving access to these restricted drugs.
Every advance in retinal imaging has been accompanied by a greater understanding of disease, leading to better therapy for patients. All Australians rightly expect to have access to great medical advances and Vision 2020 Australia and its member organisations are facilitating this through targeted and expertise-driven advocacy with all levels of government.
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About the Author

Dr Rowan Porter

Dr Rowan Porter, MBBS, FRANZCO is a RANZCO council member and representative to the Vision 2020 Australia Aboriginal and Torres Strait Islander Committee. Dr Porter is a medical retina specialist with a special interest in Indigenous eye health working in both urban and remote centres delivering standard of care services through a range initiatives. These include the Inala Centre of Excellence in Indigenous Health and the IDEAS (Indigenous Diabetes Eyes and Screening) Van. He also works in advocacy at a federal level through the Vision 2020 Australia Aboriginal and Torres Strait Islander Committee.View author's posts
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