Dec 2016

Waiting times: a national problem
BY JAI BREITNAUER
Senior ophthalmologists are welcoming the
national publicity achieved by the story that
some South Island patients are going blind as
a result of waiting times for follow-up care.
“We had discussed this situation with the minister
of health in March 2015 and no action has occurred
from government,” says Royal Australian and New
Zealand College of Ophthalmologists (RANZCO) NZ
President Dr Stephen Ng. “For us, it’s a chance to
highlight it’s a national problem. All DHBs are under
the same pressure. All DHBs have large numbers
of follow-up appointments that are delayed to the
point where it is becoming a huge clinical risk. The
people on the waiting list who are reported to have
gone blind in Invercargill, well we all know of cases
where this has happened in other DHBs.”
Dr Ng says the issue finally came to light after two
ophthalmologists, one from Nelson Marlborough
DHB and one from Southland, placed patients on
the local risk register. Usually, these occurrences
are reported to a local manager in the DHB, but
by placing them on the register they were picked
up by the Health, Quality and Safety Commission
and included in the commission’s Learning from
adverse events report. The report, published on
10 November, highlighted the rise in reported
ophthalmology-related events to 44 this year,
and the resultant risk of vision loss from too long
waiting times. The national media coverage resulted
from a RANZCO press release issued just prior
to the report, which renewed calls for an urgent
government review of waiting time targets. It
highlighted the case of “KB” – a 23-year-old who
was diagnosed with glaucoma and, due to the lack
of timely follow-up, was left blind in one eye and
needing urgent surgery to save the other eye.
“This year, Southern and Nelson Marlborough
DHBs both reported a number of individual
ophthalmology events, including a delay in followup
appointments. The Commission commends
these DHBs for showing leadership in this reporting.
These DHBs are currently reviewing these events
and will make improvements based on the
findings,” said commission chairman Professor Alan
Merry.
“This is a prompt for other DHBs to look closely
at their ophthalmology services to ensure people
are being seen in a timely manner, with high-risk
patients prioritised.”
Targets putting pressure on services
Dr Ng believes the solution to this problem is
greater than can be handled at a local level.
“The health targets for seeing new patients need
adjustment [which needs to be done at government
level]. At present every DHB is required to have
patients that are referred for specialist appointments
to be seen within four months. That means those
people get in the door, but those who have already
been seen and need follow-up care get less priority.
They end up in this delayed follow-ups cohort that is
building up and building up because of the pressure
to get [new patients] in the front door – it means the
follow-ups are just being shut out.”
The aging population, increased diabetes and
the success of treatments for other eye conditions
have resulted in a larger number of people needing
ongoing ophthalmology care, explains Dr Ng.
“This is an expected part of the baby boomer
generation that everyone has been talking about
for years – it’s here and now. It’s exacerbated by the
fact the government has targets for new patients
and surgery that don’t take into account the huge
number of people requiring chronic care for the rest
of their lives.”
Dr Graham Reeves, a consultant ophthalmologist
with Counties Manukau and new Eye Institute
doctor (see story p16), agrees. “This is not
necessarily an isolated problem. New Zealand has
an ageing population with chronic eye disease [and]
once diagnosed, you need to care for those patients
for the rest of their lives.”
Dr Reeves notes this task in itself is difficult under
current conditions, but the Ministry of Health has
120-day maximum wait time guidelines for surgery
which (as well as the guidelines for new referrals) is
shifting the focus away from the patients who need
care the most, he says.
“We have to focus on new surgical patients,
mostly cataracts, to avoid being penalised. Other
patients suffer the consequences because we can’t
keep up. We don’t have enough doctors or physically
enough space.
“There’s no easy answer, but it’s difficult when
priority is being placed on patients who may not
be going blind. Having cataracts is traumatic, but
completely reversible, while delays in the treatment
of those with other conditions can result in
permanent blindness.”
A question of community care
Both Dr Reeves and Dr Ng want more focus to be
placed on increasing resources around patients with
conditions like glaucoma and AMD.
“We need more ophthalmologists and we
need more investment in training for nurses and
optometrists to work alongside us in teams to deal
with the huge numbers we’re seeing in every DHB,”
says Dr Ng, adding he favours some form of allied
community care. Dr Reeves says many of the clinics
he works in are already running joint initiatives with
nurses and community optometrists.
In a world where ophthalmologists are
collaborating more with optometrists and the
scope of prescribing rights within the optometry
industry have been extended, it seems logical to
support the opportunity to offer additional training
to optometrists to take on this increased role of
community-based patient care. However, one
source who did not wish to be named, says that
in the past shared-care programmes have fallen
over due to one important sticking point – money.
The public system can’t support the current rate
of pay of the average optometrist working at their
current speed. It’s not financially sustainable in a
sector that many feel is underfunded and stretched
already, the source says. “Simply put, it’s cheaper to
keep this level of eye-care in a public hospital.”
Another issue is risk and who is responsible for
it. An issue highlighted earlier this year when a UK
optometrist was taken to court and found guilty
after failing to spot a serious medical condition in a
young patient, resulting in the patient’s death.
“Many optometrists would still prefer the
ophthalmologist to have responsibility as the main
care giver,” the source says, highlighting training
differences. “Many lay-people see an optometrist
and an ophthalmologist as the same thing, but we
do two very different jobs.”
Representatives of RANZCO met with the chief
medical officer on 15 November, together with
representatives from nursing and optometry, to try
to get to grips with the problem.
“Allowing chronic eye conditions to advance
unchecked, places a significant burden on the
health service with more complex, time-consuming
and expensive treatments required,” explains
RANZCO president Dr Brad Horsburgh. “Studies
show that, while the cost of treating chronic
eye conditions and having regular check-ups to
maintain eye health is minimal, the economic
impact of treating and supporting a person who
has lost their vision is substantial. The government
could make cost savings in the long run by
preventing blindness now.”
A report, Social and economic cost of macular
degeneration in New Zealand, launched at the time
of going to press by Macular Degeneration New
Zealand shows the cost of blindness due to macular
degeneration is around $216.6 million a year, which
vastly outweighs the cost of treatment to prevent
people going blind in the first place, continued
RANZCO.
“RANZCO is really trying to concentrate on the
needs of our patients, they’re the ones suffering
under the system,” says Dr Ng. “We want to be at
the forefront of trying to define solutions.”
For more, see our new column “Eye on optics by
Happy holidays!
EDITORIAL
Welcome to the last issue of the year and
two exciting new columns.
Eye on Optics by Chalkeyes pays tribute
to that rascally business columnist Chalkie, who
used to frequent the back page of infamous Kiwibattler,
the Independent Business Weekly. Like
Chalkie, the column is anonymous to allow the
small group of regular, authoritative writers to
share their well-considered views without fear of
losing their jobs.
Macular milestones, meanwhile, has been
put together with MDNZ and trustee Dr David
Worsley to highlight interesting macular
research. This new, quarterly column augments
the work of our wonderful monthly research
columns Eye on Opthalmology and Focus on
Research (thanks Hutokshi, Charles and Hussain,
we really couldn’t do it without you!)
What a year! Each month we find ourselves
struggling to include all the happenings in
our exciting industry and this month was no
exception. Silmo, Visionz, ADONZ and the Eye
Institute conferences have all vyed for space
between a wealth of news and views. We hope
you enjoy reading it all as much as we enjoy
covering it for you!
Have a fabulous holiday. We’ll be back with
even more in our February issue.
Cheers and a very Merry Christmas,
Chalkeyes” on p27. ▀
Join us for a fantastic
day at the track
On Saturday 18th February 2017
at Auckland Racing Club, Ellerslie
Lesley Springall, publisher, NZ Optics
Essilor launches Digitime
Essilor has launched Varilux Digitime, a new
range of occupational lenses for modern
presbyopes, taking into account patients’
daily digital needs.
The new addition to the Varilux range of
progressive lenses (worn by more than 400 million
people worldwide) will add a point of difference
to your practice, explained Tim Thurn, Essilor’s
director of professional services, speaking at Essilor’s
Platinum Partner’s regional conference in Auckland
last month. They are also far easier and simpler to
understand and prescribe, compared with Essilor
and Nikon’s older occupational lens offerings,
Interview and Weblens, designed in 1998 and 2000
respectively, well before smartphones, he said.
Today’s digital devices have changed presbyopes’
visual and postural behaviour, with 70% of 45 to 65
year olds saying they suffer from tired eyes and neck
and shoulder pain - a common ailment as people
stick their necks out and lean forward to read their
screens more easily.
It all comes down to how far away your screen is,
said Thurn, with research by Essilor showing that
people have very variable distances of preferred
screen usage. A person’s average eye distance to
their desk computer is 63 cm, but the range varies
from between 38cm and 88cm, a whopping 50cm
variation between users.
The distance between eyes and device should be measured
Thus in addition to normal progressive
measurements, to maximise the effect of Digitime,
Essilor requires the patient’s preferred eye distance
from their desktop computer to be measured.
Without this, the lens manufacturing process will
default to the 63 cm average, which works, but not
as well as when the actual device distance is known,
stressed Thurn.
Varilux Digitime comes in Near, Mid or Room
variations, with the first focusing on near vision
CONTINUED ON P4
Join us for a fantastic
day at the track
On Saturday 18th February 2017 at Auckland Racing Club, Ellerslie
Join us from 12 noon in the Guineas Room, where you will be treated to drinks on arrival and a
delicious buffet lunch, plus much more. Witness the extravaganza of horse racing including the
prestigious Avondale Cup and Avondale Guineas races. Enjoy a great day, while fundraising for
Macular Degeneration New Zealand and their work in the Macular Degeneration community.
A table of 10 package is $1,250
(incl. GST) and includes:
• Table in the Guineas Room for 10 guests, including
drinks on arrival, buffet lunch, afternoon tea and
cash bar
• Entertainment throughout the day including
tipsters, jockeys, celebrities and unique
experiences
• Opportunity to display product and branded
pull-up banners in the Guineas Room for the day
• Free carparking
A Unique Experience is $100 (incl. GST)
for 4 people for either option:
1. Experience the Commentary Box
2. Experience the Race Start
Book now to be on the inside!
Individual tickets $140 (incl. GST).
Earlybird tickets $125 (incl. GST)
(before 31 December).
Visit www.mdnz.org.nz to secure your tickets online.
1 in 7 people over 50 will get Macular Degeneration.
All funds raised on the day will gratefully go to support the Macular Degeneration community.
To take up this opportunity, please contact Alice McKinley at 027 634 0495 or events@mdnz.org.nz
December 2016
NEW ZEALAND OPTICS
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