Eye health care – who are you going to call?

13 September 2019

Kindly provided the New Zealand Association of Optometrists 

If you have a patient in need of comprehensive eye health care – who are they going to call?

This may not be an issue causing great debate within the GP community but it does merit some consideration when we consider the facts.

Visual impairment is a national and global health concern that has a negative impact on physical and mental health. Visually impaired individuals are at particularly high risk for chronic health conditions, accidents, social withdrawal, depression, and mortality. The number of people with visual impairment and blindness is increasing due to an overall aging population. (American Academy of Ophthalmology https://www.aao.org/eye-disease-statistics)

While people can live an active life well into their 'golden years' without ever experiencing severe vision loss, as one ages there is higher risk of developing age-related eye diseases and conditions. These include: age-related macular degeneration, cataract, diabetic eye disease, glaucoma, low vision and dry eye. For this reason the US National Institutes of Health, Eye Institute recommends that everyone age 50 or older should visit an eye care professional for a comprehensive dilated eye exam.

Many eye diseases have no early warning signs or symptoms, but a dilated exam can detect eye diseases in their early stages before vision loss occurs. Early detection and treatment can help save sight, even if a person is not experiencing any vision problems. An eye care professional (ophthalmologist or optometrist) can advise on how often you need to have further eye exams depending on each person's specific risk factors. (NIH, National Eye Institute https://nei.nih.gov/healthyeyes/aging_eye)

The WHO defines comprehensive eye care as the provision of a continuum of health promotion, prevention, treatment and rehabilitation services that address the full spectrum of eye conditions to meet the patient’s needs throughout their life course, while ensuring an integrated service delivery approach within and beyond the health sector. The comprehensive eye care team, comprised of ophthalmologists, optometrists and allied ophthalmic personnel, is essential to delivering comprehensive eye care. (Resnikoff S, et al. Br J Ophthalmol 2019; 0:1–5. doi:10.1136/bjophthalmol-2019-314336)

Recently, the New Zealand Ministry of Health workforce and service demand modelling showed New Zealand’s need for health services is projected to increase at a higher rate than the projected growth of the specialist workforce during the next 10 years. The modelling is conservative as it does not take into account current unmet health need.   This means the current estimated workforce shortage of approximately 1000 specialists is projected to continue and indications are that for most specialties the gap between the specialist workforce capacity and health service need will widen by 2028. This ‘service gap’ may include longer waiting times for specialist assessments, longer waits for treatment, and higher thresholds for accessing services.

Some specialties will be affected more than others. In two case studies using data on workforce and service use data produced by the Ministry of Health, the workload per orthopaedic surgeon will need to increase by 6% by 2028 to match current service levels. This does not take account of the already significant unmet need today. Workloads per ophthalmologist will need to increase by 20%, which again is likely to see a worsening of current levels of unmet need. (Forecasting New Zealand’s future medical specialist workforce needs, ASMS research update, Issue 15| 2019, ISSN 2624-0335 )

Members of the New Zealand Association of Optometrists (NZAO) are committed to supporting GPs by providing comprehensive eye health services to local communities throughout New Zealand.  As authorised prescribers optometrists are able to diagnose and treat eye-disease.  You can find an optometrist near you by using the search function on the NZAO website: www.nzao.co.nz 'find and optometrist'.  Making contact and finding an optometrist that you feel comfortable in working with could be a good investment of time. 

It is more than just glasses.  An optometrist assessment can provide all the parameters of eye health that will enable your patient to receive an appropriate level of prioritisation should they require a referral to a DHB eye department for publicly funded services. For some people you may feel the cost of an eye examination could be a barrier and in this situation it is useful to consider the options offered by Enable for children and MSD for beneficiaries.

NZAO produces the Primary Eyecare quarterly newsletter which are sent direct to GPS – recent topics included: the association between obstructive sleep apnoea and optic neuropathy; mortality after a CVA in age related macular degeneration patients treated with Bevacizumab (Avastin) ocular injections; orbital fractures in children; customised spectacles using 3-D printing technology; and a systematic review, meta-analysis and modelling of the prevalence of presbyopia and vision impairment.

Send NZAO your contact details and we will add you to our mailing list: info@nzao.co.nz