Hundreds wait for eye appointments

Nelson and Marlborough’s district health board has acknowledged that some people are waiting ‘‘longer than ideal’’ for follow-up eye appointments in the top of the south.

Nelson Marlborough Health general manager clinical services Lexie O’Shea said demand for ophthalmology services in the region continued to grow rapidly as the population aged, new treatments became available, and the sector dealt with a workforce shortage.

As at February 12, there were 1011 overdue appointments across the region. Of those, there were 945 individuals waiting to be seen, with 66 people waiting for more than one type of appointment.

In the year ending June 2019, the ophthalmology service managed 12,717 appointments, an average of 256 a week.

O’Shea said most ophthalmology services were medical rather than surgical. It treated those with chronic diseases and provided surgery for conditions, including intravitreal injections for macular degeneration, cataract surgery, corneal transplants, eyelid surgery, squint surgery and glaucoma surgery.

She said most appointments were conducted within ‘‘appropriate clinical time frames’’. As at January 31, almost 70 per cent of patients were seen within the time they needed to be.

‘‘However, patients were still waiting longer than ideal to have their follow-up assessments, despite our use of locums who hold extra clinics.’’

O’Shea said those waiting for appointments were assessed, and those with the greatest need were seen first. Patients were told to see their optometrist or GP if their condition changed or they had concerns while waiting. Those needing surgery were prioritised, using a clinical assessment tool, by the urgency of their case.

There were three part-time and one full-time ophthalmologists working across Nelson and Wairau hospitals, she said, with a new ophthalmologist due to start in May. The position had been vacant for some time, with Nelson staff supporting the service at Wairau since May last year.

O’Shea said recruiting specialists in provincial areas was difficult, so the DHB had employed a range of healthcare professionals to support the specialists.

The service had been remodelled to better meet demand, with clinical nurse specialists, optometrists and technicians providing treatments alongside specialists such as ophthalmologists.

Nelson GP spokesman Dr Graham Loveridge said that while there was a waiting list for ophthalmology patients to be seen, if they qualified for publicly funded treatment, then the wait for treatment was not too long.

GPs were able to access hospital guidelines on who was eligible for publicly-funded treatment, and limited resources meant there was a higher threshold to qualify, he said. If it appeared that a patient was not eligible, private treatment was suggested.

The criteria for cataract surgery, for example, had increased, so a patient’s vision had to be below a certain point to get on a waiting list.

Loveridge said a major component of the waiting times was the relatively new treatment Avastin, which was injected into people’s eyes to stop the proliferation of new fragile blood vessels.

It was introduced as a treatment for those with diabetic eye disease and macular degeneration in late 2016. Many of those people needed ongoing injections every month or two.

‘‘It has been a very significant advance, because it is preserving people’s sight, but it has meant a huge increase in the workload,’’ Loveridge said.

The health board is on target to complete 525 cataract procedures this year, and has already administered 4500 intravitreal injections for macular degeneration.

Royal Australian and New Zealand College of Ophthalmologists (RANZCO) New Zealand branch chair Peter Hadden said overdue follow-up appointments in ophthalmology services had been slowly increasing in a number of DHBs.

‘‘We are concerned with unequal access to eye health care across New Zealand, and have been in contact with the minister and Ministry of Health about this issue.’’

Waiting times were dramatically reduced a number of years ago by temporary measures, he said, which included extended hours and outsourced clinics.

The demand for services kept increasing, however. Hadden said it was difficult to determine the exact reasons, as it seemed higher than expected based on population growth and ageing alone.

A Ministry of Health spokesman said that as at the end of January, the Nelson Marlborough DHB had reported that 176 patients were waiting more than 50 per cent longer than clinically appropriate. This was 5 per cent of the total people waiting to be seen. The board was ‘‘performing well’’ compared to the national picture, he said.

‘‘We are concerned with unequal access to eye health care across New Zealand.’’

Peter Hadden, Royal Australian and New Zealand College of Ophthalmologists