Hessom Razavi

Problem: Despite its potential to improve service provision for country patients, teleophthalmology is currently underused in Australia. There is an associated lack of cost‐effectiveness data for teleophthamology.Design: Retrospective and prospective hospital‐based clinical audits of 5456 patients; descriptive survey of available telehealth equipment in 129 regional facilities; cost calculations for teleophthalmology, patient transfers and outreach services.Setting: Primary (optometry, general practice [GP], Aboriginal Medical Service [AMS]) and secondary (hospital) sites in regional Western Australia; a tertiary hospital in Perth.Key Measures for Improvement: Proportion of patients suitable for teleophthalmology; proportion of regional practices with telehealth technology; capital expenditure to equip regional practices for teleophthalmology; total savings from increased utilisation of teleophthalmology.Strategies for Change: Advocacy for funding, regulatory, training and infrastructure recommendations, in order to support efficient models of teleophthalmology.Effects of Change: A total of 15% and 24% of urgent patient transfers and outreach consultations, respectively, were found to be suitable for teleophthalmology, equating to a potential total cost saving of $1.1 million/year. Capital expenditure required for basic telehealth equipment was negligible for optometrists, compared to $20 500 per GP/AMS practice. Successful advocacy led to funding, training and policy changes to support optometry‐led teleophthalmology for country patients in Australia.Lessons Learnt: Public–private partnerships can result in significant cost‐savings for the Australian health system. Targeted, evidence‐based advocacy can inform government health reforms.

To estimate the prevalence and causes of severe visual impairment and blindness among children in Lorestan province of Iran, and to assess the feasibility of the Key Informant Method in this setting. Potential cases were identified using the Key Informant Method, in 3 counties of Lorestan province during June through August 2008, and referred for examination. Causes of severe visual impairment/blindness were determined and categorized using standard World Health Organization methods. Of 123 children referred for examination, 27 children were confirmed to have severe visual impairment/blindness or blindness. The median age was11 years (interquartile range 6-13), and 59% were girls. After adjusting for non-attenders, the estimated prevalence of severe visual impairment/blindness was 0.04% (0.03-0.05). The main site of abnormality was retina (44%), followed by disorders of the whole eye (33%). The majority of causes had a hereditary etiology (70%), which was associated with a family history of blindness (P = 0.002). Potentially avoidable causes of severe visual impairment/blindness were found in 14 children (52%). Almost all children with severe visual impairment/blindness had a history of parental consanguinity (93%). Our findings suggest a moderate prevalence of childhood blindness in the Lorestan province of Iran, a high proportion of which may be avoidable, given improved access to ophthalmic and genetic counselling services in rural areas. The Key Informant Method is feasible in Iran; future research is discussed.