It was an ophthalmologist in Wuhan who called the first alert about a new, lethal outbreak. Dr Li Wenliang warned of a new SARS-like virus, which we are now referring to as COVID-19.
Dr Li initially was disciplined by Communist party officials. This is much more in line with the early response of the Chinese Government to SARS in November 2002- July 2003, when delays in public health reporting of cases translated to weeks and months of unchecked transmission(1).
This time around, China has - in the main - been praised for the transparency of its communications. This will be a key factor for a successful response.
Reflecting on this, I was struck how much better healthcare professionals could be at sharing failures and challenges, especially when they represent risks for patients. This is not just ophthalmologists unmasking public health emergencies, but equally eye care professionals looking at the quality of care we provide.
In January as the WHO declared a public health emergency of international concern, the UK’s health system watchdog, the Healthcare Safety Investigation Branch (HSIB) released a report reviewing glaucoma care in Britain. I really applaud the UK for having an HSIB in the first place and even more so for making its reports public.
The report entitled Lack Of Timely Monitoring Of Patients With Glaucoma(2) looks at in detail at the case of a 34 year old mother of 3 who became severely visually impaired due to delays in her care and from the individual reviews the eye care system for glaucoma care.
There were some really salient findings and recommendations that equally apply to eye care in Australia, the US and elsewhere around the world.
Optometry plays a critical first line in disease detection. Better clinical decision support technologies will contribute to fewer referrals of normal patients (false positives) and fewer patients with disease being missed (false negatives). The greater the accuracy in referrals and triage, the more efficiently scarce resources can be applied.
The report also calls out the need for better standardisation of practice for ophthalmologists who are not glaucoma specialists - specifically noting that the patient described had seen 7 ophthalmologists in 11 months as she was losing sight, but that the locum, trainee and non-specialist ophthalmologists she saw had inadequately managed her care.
The system is already struggling, with more than 20 people a month in the UK irreversibly losing sight because of inadequate glaucoma management. In light of the growing burden of disease - in the UK’s case a 44% increase in the next 15 years - the report calls for new approaches for management including teleophthalmology or virtual clinics for remote monitoring and better collaboration across optometry, ophthalmology and other care providers. Professionals should work to the top of their scope.
Like in Australia and the US, this will require infrastructural changes - particularly around how and for what providers are paid and what technology supports them.
Worldwide, 78 million people have glaucoma, but about half of those living in the developed world don’t know it - and that number is estimated at 90% in poorer countries. The theme for this year’s World Glaucoma Week is to raise the awareness of people over the age of 40 and particularly those who have relatives with glaucoma to get tested.
We really hope it’s a successful campaign - and as such increases the pressure on eye care systems to adapt. We need to transparently talk about what’s working AND what isn’t, so we can work smarter, and not just harder.
With all the demands on the health system, the need to innovate only grows.
Spread the word this World Glaucoma Week! #glaucomaweek
1. Qiu W, Chu C, Mao A, Wu J. Studying Communication Problems for Emergency Management of SARS and H7N9 in China [published correction appears in J Glob Infect Dis. 2019 Jan-Mar;11(1):52]. J Glob Infect Dis. 2018;10(4):177–181.
2. Healthcare Safety Investigation Branch. Lack Of Timely Monitoring Of Patients With Glaucoma: Healthcare Safety Investigation I2019/001. Available at https://www.hsib.org.uk/documents/199/hsib_report_lack_timely_monitoring_patients_glaucoma.pdf Accessed 24/2/2020.
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