Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

The shortage of health professionals in almost every area is nothing new in Australia, but I believe it is especially important when it relates to children and infants. In Australia, 19.3 per cent of the population are aged below 15—that is 4,144,024 people, you will be interested to know. So, for four million people under the age of 15, there are currently only 20.3 full-time paediatric ophthalmologists in Australia. Many of these specialists are near retirement age, and both Tasmania and the ACT do not have a single paediatric ophthalmologist.

Paediatric ophthalmology is a subspecialty of ophthalmology which deals specifically with the medical eye care needs of children. It differs from adult ophthalmology because it involves eye diseases that are specific to children and deals with those diseases within the framework of a developing visual system and the developing child. Different techniques are often required in order to properly examine children's eyes, especially babies and infants. Therefore, the training of a paediatric ophthalmologist involves a longer than usual length of tertiary training; it is seldom less than 15 years from beginning university for a fully trained paediatric ophthalmologist.

The most common eye disorders in children are strabismus, which is misaligned eyes; amblyopia, which is poor vision due to abnormal visual experience in early life; and refractive errors caused in the focusing of the light by the eye and a frequent reason for reduced visual acuity. Strabismus and amblyopia affect about four to five per cent of the population, and they form the bulk of the workload for paediatric ophthalmology. Some of these children may actually have serious underlying medical conditions as a cause for their apparent eye disease—for example, eye or brain tumours.

Paediatric ophthalmologists also deal with a wide variety of disorders that potentially cause blindness, such as childhood cataracts, which affects one in 2½ thousand children; glaucoma, which now affects one in 8½ thousand children—a vast improvement over recent years; retinal disorders such as retinopathy of prematurity; and dealing with eye cancers in children, which occur in one in 18,000 children. Retinopathy of prematurity is a disease that primarily occurs in premature babies. It causes abnormal blood vessels to grow in the retina and this growth can cause the retina to detach from the back of the eye, leading to blindness. Some cases are mild and correct themselves, but others require surgery to prevent vision loss or blindness.

Paediatric ophthalmologists investigate children with visual failure and they also deal with children with genetic disorders that may affect their sight, and I certainly know that there are many children with Down syndrome who require the services of a paediatric ophthalmologist. Many of the children seen in a tertiary children's hospital ophthalmology clinic have complex medical problems, including cancer, neurological disorders and multisystem disease.

There is a rising number of premature infants who survive birth and then require screening in the nursery and, potentially, treatment for retinopathy of prematurity. Laser treatment for retinopathy of prematurity is one of the single most cost-effective interventions in all of medicine because it avoids a lifetime of blindness and dependency for most infants who are treated. In middle-income countries—that is, countries that are just beginning to afford care for premature infants, such as India, Vietnam and most of Latin America, retinopathy of prematurity is now the commonest cause of childhood blindness.

In Western countries, it is estimated that the whole-life cost to support a child who is blind from birth is about $2 million—per child, I should add. The commonest cause of blindness in Australia, which is 30 per cent of children, is brain damage in premature infants. The economic impact of vision impairment in children is considerable because they require increased support to achieve developmental milestones, in their education and in the transition to independent life. There is then the potential loss of earnings and the cost of extra care involved, plus in some cases limitations on career options. The presence of a visual impairment can have a severe impact on a child's emotional and psychological development as well, and it can be associated with a substantial reduction in quality of life. While the proportion of visually impaired children is lower than that of older adults, the impact of visual impairment during childhood lasts much longer and can be much greater.

There is a worldwide shortage of paediatric ophthalmologists and, as I mentioned earlier, there are only 20 paediatric ophthalmologists in Australia, many of whom are over 55 years of age. This is becoming a crisis for us. Paediatric ophthalmology is not a popular subspecialty for recently graduated ophthalmologists because of the inadequate time within the ophthalmology training programs in most states, a feeling that children are more difficult to examine and treat and, of course, that treating adults—for example, doing large numbers of cataract operations—is more financially rewarding.

Some steps were taken this year to reverse this trend, including an MBS item number specifically for the more complex examinations of young children and some federal funding put aside for a specialist training program to fund new paediatric ophthalmology training posts. But we need to do more to revitalise paediatric ophthalmology to take us forward. Those who practise in this area find it immensely interesting and personally fulfilling to treat a newborn baby's cataracts or to treat a premature infant with a potentially blinding eye disease to give that child a lifetime of sight. The Royal Australian and New Zealand College of Ophthalmologists believes that a multifaceted approach needs to be taken to rectify the shortage of paediatric ophthalmologists. They believe that we should have an increase in paediatric ophthalmology registrar training posts in major teaching hospitals through the Specialist Training Program. This will increase the exposure and skills of the entire ophthalmic profession to what is needed in paediatric ophthalmology. The college also believes that we need to increase grants to state governments to improve both salaries and equipment in children's hospital eye departments, thereby facilitating an increase in the number of appointed paediatric specialists to children's hospital eye departments. There needs to be some very serious planning here because, as I said, the average age of Australian paediatric ophthalmologists is currently over 55.

We also need to ensure that every major children's hospital in Australia has a full-time head at its eye department. Currently there is only one such appointee in Australia. I am pleased to say that it is at the Royal Children's Hospital in Brisbane. Dr Glen Gole, who occupies that position, is well known to many, many families who have been treated by him. But if we were to extend this to every hospital it would enable a career pathway to develop for full-time hospital based paediatric ophthalmologists. We also need to increase remuneration for consultations through Medicare rebates, such as item 109 I mentioned earlier, and specifically for the more complex examinations of young children. I think anyone who has a child would appreciate the difficulties of doing examinations on very young children, especially of their eyes. Australia needs to ensure it has the specialists to identify and treat eye related problems, most importantly to give children the best chance of developing intellectually, physically and emotionally, but also because it is cost effective for our community to assist its children to have a lifetime of sight.

Ursula Stephens (NSW, Australian Labor Party) Share this | Link to this | Hansard source

Thank you, Senator Boyce, for bringing the issue of paediatric ophthalmology to our attention.