19 May 2017

Eye-care report author: 'People were waiting huge amounts of time'

8:35 am on 19 May 2017

It is surprising more patients did not lose their sight over major delays to follow-up care in Otago and Southland, an eye specialist says.

An opthalmologist examines a young girl (file photo)

Fourteen patients suffered major or moderate loss of vision, and another two had their lives put at risk, the report found (file photo). Photo: 123RF

An external review report commissioned by the Southern District Health Board and released on Wednesday found 14 patients suffered major or moderate loss of vision because of delayed follow-up appointments over 15 months until October last year.

James Stewart

James Stewart Photo: Supplied

Two more patients with cancer who experienced significant delays also had their lives put at risk.

Asked if he was surprised at the number who suffered harm, the lead author of the review, James Stewart, said what surprised him was that there weren't more. "People were waiting huge amounts of time and I'm not surprised at all. This is why we see people in a timely way when they've got glaucoma or macular degeneration or whatever."

The report says under-resourcing meant eye departments in Dunedin and Invercargill lacked capacity to manage high demand from a growing and ageing population, and the relatively new ability to give Avastin eye injections to maintain good vision in those with macular degeneration.

Dr Stewart said when he went to Dunedin to review services he expected it to be about macular degeneration and delivery of Avastin injections.

"But the striking thing really was the wide range of the different eye conditions, plus the two patients with cancer... What happens is that, when you're struggling, people do realise that the Avastin patients really do need to be seen soon, but then the other patients that don't need to be seen quite so soon get squeezed out."

He said clinicians at the DHB had done all they could over years to alert management. "They had a day trying to look at ways of coping with the increasing workload, they flagged this as being clinical risk. And the trouble is that nothing happened until there were these serious adverse events and media coverage of them."

All DHBs were under huge financial constraints, he added.

"Doctors are forever wanting more money, new instruments, more staff, and somehow they've got to be able to pick out when there is a real issue from perhaps a lower priority issue."

Dr Stewart said the DHB should increase capacity in its eye departments. "They need to be better organised. There've been big issues about cases being lost to follow-up, referrals being lost. I think they've actually made quite a lot of progress in tidying that up. They have been working very hard at addressing these problems over the last couple of years but there is still a way to go."

More also needed to be done nationwide, and he believed action was needed when demand began outstripping supply. "The health system needed to sort of make a radical adjustment rather than a little bit more funding here, a little bit more funding there, because we used to cope with our workload, whereas now up and down the country, we're not [coping]."

Other measures that could help included wider use of optometrists working alongside ophthalmologists in clinics and elsewhere, as well as nurses and other staff.

Dr Stewart said consideration could also be given to funding regular eye check-ups for those over 45 by optometrists. "The main thing they come up with though is glaucoma, and glaucoma is a leading cause of blindness even though we can treat it. And the big problem is people don't realise they've got it so it's picked up by having a regular eye examination, and that's how we find glaucoma in most cases."

Ministry of Health confident of improvements

The Ministry of Health said it was confident DHBs would get on top of delays in some areas for follow-up eye appointments.

Acting chief medical officer Andrew Simpson said about half of the 20 DHBs reported delays late last year.

However, he said they had begun making changes, including using more locum ophthalmologists, and he was confident they would deal with it well.

"They reviewed the cases that they have on their follow-up lists to see which ones need to be prioritised to be seen first.

"I'm aware that all the DHBs and all the clinicians are advocating that if any patients on follow-up feel there is concern and they need to be seen more urgently, the first thing they should be doing is contacting their DHB or their doctor."