ESA’s Drs Hussain Patel and Yi Wei Goh with guest speaker Dr James McKelvie

Eye Surgery Associates’ latest evening seminar at Auckland’s Tamaki Yacht Club drew a large group of optometrists who gathered together over dinner to hear guest speaker, entrepreneurial Waikato ophthalmologist Dr James McKelvie.

Dr McKelvie discussed equity and technology in eyecare and the challenges and possible solutions to meeting the rising demand for cataract surgeries nationally. “New Zealand’s increasing ageing population hints at an upcoming tidal wave of patients requiring cataract surgery and continuing clinic-based care for chronic ophthalmic conditions,” he said. To continue to deliver the life-changing outcomes cataract surgery brings, while sustaining a growing need, new tools are required, said Dr McKelvie. “We need to improve equity in access, create support for co-management, improve efficiency, add capacity and improve outcomes.”

Continuing this collaborative theme, ESA’s Dr Hussain Patel shared some insights from a joint glaucoma care programme initiated by the New Zealand National Eye Centre (NZNEC) and Auckland District Health Board (ADHB). The programme’s aim was to train optometrists to manage stable ADHB glaucoma patients independently, with glaucoma specialists overseeing treatment. So far, 16 optometrists have completed the programme, four of whom are running community-based glaucoma clinics at their practices, seeing 300-plus patients per year.

The programme is a successful model of collaborative care, said Dr Patel, with no significant adverse patient events. It has created a framework for ongoing patient care and referral back to ADHB; reduced waiting times for glaucoma follow-ups; and allowed the ADHB clinic to focus on more complex and surgical glaucoma, he said. “Our optometrists are safe and perform to a high-level with decision-making comparable to specialists’ for this group of patients. I would trust them to look after my family.”

ESA’s retina specialist Dr Monika Pradhan then discussed disease progression and management of advanced peripheral diabetic retinopathy (PDR). While surgical management of advanced PDR can save sight, the goal is to ensure PDR doesn’t progress to that state, she said, urging optometrists to refer diabetic patients to a GP for screening, offer health advice and educate them about the impact of disease progression. “Use the fundus and OCT images as a basis for discussion and show the patient what is happening at the back of the eye,” she said, adding “it may help to scare them a little.”

Stephanie Green, David Haydon and Dr Monika Pradhan

Finally, ESA’s Dr Yi Wei Goh shared insights into diagnosis and management of benign and malignant periocular tumours, using incredible photos to illustrate cases of naevus, epidermal inclusion cyst and keratoacanthoma, among others. While malignant melanoma only represents about 1% of all eyelid malignancies, it’s still responsible for two-thirds of eyelid malignant tumour-related deaths, she said. Risk factors include excessive sun exposure, genetics, light-skin pigmentation and changing skin naevi. Early signs to be watchful of include asymmetry, irregular borders, variegated colour, diameter ≥6mm, changing appearance and enlargement over time. Diagnosis, which may be suspected by clinical appearance, should be confirmed with incisional biopsy and histopathological analysis, she concluded.