To cope with the growing treatment crisis, the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) has backed the right for ophthalmologists to train hospital-based optometrists to give intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.
The introduction of anti-VEGF injections has revolutionised the treatment of patients with neovascular age-related macular degeneration (AMD), diabetic macular oedema and retinal vein occlusions. But with an increasingly elderly population, demand is outstripping the health service’s ability to provide timely treatments, leading to some patients going blind unnecessarily.
In some New Zealand District Health Boards (DHBs), special nurse practitioners have been trained to give injections, but this has not been anywhere near enough to cope with demand, especially in poorer regions such as Gisborne, said Gisborne-based ophthalmologist and Otago University clinical senior lecturer Dr Graham Wilson. “The big issue here is that we have one eye doctor for 50,000 people, whereas the New Zealand average is one for 33,000. Also, we have poorer socioeconomic stats, and 47% of the DHB is Māori who we know are more likely to get diabetes and retinopathy.”
Revealing RANZCO’s support at an optometrists’ dinner in Auckland, Dr Wilson said blindness is down 50% because of anti-VEGF injections, but the increased treatment burden is putting a massive strain on overworked hospital staff and health budgets.
To cope with demand, at the request of his DHB, Dr Wilson employed four optometrists, two for glaucoma, one for paediatrics and one for AMD and diabetes, whom he began to train to inject. However, this led to some criticism relating to optometrists’ lack of training with needles and sterile techniques. A bit of toing and froing resulted, with Dr Wilson pointing out there was a significant patient population in Gisborne at risk of going blind because of a lack of funds and people to treat them.
