At the professional level.
- Increase the clinical contact lens fitting expertise and
care of the keratoconic patient by supporting education seminars that
practitioners how to fit keratoconus properly. There is a contact
lens lab in every major city of Australia, each with their own design of
lens. They should be approached to conjointly support meetings where practitioners
can be exposed to the variety of lens designs available and how they are
- Approach the Contact Lens Society to actively support
the courses by having Fellows give the
lectures and workshops.
- Approach KA to have patients available for the workshops.
- Approach the Corneal Specialists in each city to lecture at the courses.
- Run local “information” evenings for keratoconus patients
in conjunction with KA.
- Encourage research into keratoconus at the university level. Even with
RGP lenses, the acuity and contrast sensitivity of keratoconus patients
is lower than normal. Surely all the research into higher order aberrations
can be put to a practical use and used to design contact lenses that improve
the VA of the keratoconus patient.
At the organization level.
The OAA and RANZCO have a distinct obligation to help KA end the discrimination
that its members suffer as a result of government policy and health fund
rules. There are two main areas that need attention.
As Matt points out, the refund for fitting a patient with keratoconus bears
no resemblance to reality, such that the cost of the lenses increases in
order to compensate for the time sent. A complex case can take up to 12 visits
and numerous lens changes to get to the stage where the fit is acceptable.
This is exacerbated by the fact that the advanced contact lens designs only
come with a maximum of 2 exchanges. In reality, a fee of $175.00 for fitting
and $500.00 for lenses can easily turn into a cost of $800.00 for the number
of exchanges required for the advanced cases.
Then there are the cases when a colleague has “had a go” at
it and failed. The following referral then drops the 10924 to a 10930.
Also, an interval
of 36 months between re-fits may be fine for the normal contact lens population,
but it does not take into account the rapid changes that occur in keratoconic
eyes. In these cases, the fee defaults to a 10930 again, but this is totally
inadequate when the re-fit, as usual, turns out to be difficult and time
consuming due to the nature of advancing keratoconus.
The KA approach of having a sliding scale depending on the
severity of the individual case has distinct merit.
A realistic fee for fitting keratoconus patients would lead to a drop in
the cost of the lenses, especially if the contact lens labs come to the party
and extend the warranties for the lenses. The OAA in conjunction with KA
is the body to try and implement these changes.
Health Fund rebates.
I find it amazing that, every Christmas, I see TV advertising
population to hurry on in and get their health fund rebates for spectacles
before the New Year, or “miss out”. So, spectacle wearers, who, let’s face
it, don’t need a new pair of glasses every year can and do get their money’s
worth out of their fund, even if it is a false saving. The funds encourage
this. But if you happen to have keratoconus and need new lenses, the refund
is a lousy $80.00 in most cases. Yet, the funds all advertise that they have
a maximum refund of $200.00. Just try to get it and see what happens.
The ideal situation for a patient with keratoconus is access
to the maximum rebate and the ability to accrue the rebate if lenses are
not required. Early
keratoconus is relatively stable, and if lenses are fitted correctly, have
an expected life of approximately three years. If the maximum refund were
allowed, and accruable, the patient would be entitled to a refund of $600.00
over the three-year period. This is especially important if gas permeable
scleral lenses are used. These lenses range in price from $2,000.00 to $3,000.00
a pair, and on average can last 6 to 7 years. The refund scheme outlined
above would therefore dramatically lessen the burden on those patients who
need scleral lenses.
At present, there is no item number for scleral lenses. This could be funded
by decreasing the refund on soft disposable lenses, or alternatively, decreasing
the yearly benefit of spectacles to a two year interval.
Negotiations with health funds are notoriously unproductive. However, as
stated above, there is strength in numbers. If we can increase the membership
of KA and then get behind them, things could really change for the better
for our keratoconus patients. It is our ethical and moral duty to help them.