Asked to identify the two most important barriers their patients faced in accessing IVI services, 73.3% of respondents selected hospital waitlists, ahead of geographical access at 41.9% and patient costs at 27.9%.
Given that geographical access was the second most frequently cited barrier, A/Prof Turnbull said adding optometrist injectors in rural areas would make the greatest difference outside the main centres, rather than simply adding capacity to existing metropolitan services. “This would be ideal and the MoH is keen on this to improve access to care. ODOB communications have stated this has support from Government.”
Pressure on IVI services to rise
The authors said pressure on IVI services is likely to increase as the population ages and treatment indications broaden. They noted New Zealand has close to 34 ophthalmologists per million people – below RANZCO’s target of 40 per million – while delays in ophthalmic care have already been associated with preventable vision loss.
The study also highlighted what the authors described as a disconnect in New Zealand’s current scope arrangements. Optometrists working within ophthalmology clinics can already assess patients, decide whether an IVI is required and prescribe anti-VEGF medicines, including bevacizumab and aflibercept, but cannot administer the injection themselves.
New Zealand already has experience with non-medical IVI delivery through nurse-led services, while optometrists and nurses have been administering injections in the UK for more than a decade, the authors said. A 2016 systematic review cited by the researchers concluded non-physician IVI delivery was feasible and safe.
With ophthalmic nurses already performing IVI in New Zealand hospitals, optometrist injectors might not make a big difference to capacity in hospital settings, other than freeing up ophthalmologists for other tasks, said A/Prof Turnbull. “But for other conditions, where there has been a move to optom-led FSA [first specialist assessment] clinics, this has helped clear backlogs. The biggest advantage is that optoms can also prescribe the medication, so it’s the complete package; whereas nurses would still need a prescriber or standing order.”
A/Prof Turnbull’s team proposed a pilot involving hospital-based optometrists to establish training and clinical audit requirements before wider community rollout. While acknowledging potential selection bias among university-affiliated respondents, the authors concluded that appropriately trained optometrists could help meet growing IVI demand and improve patient access and outcomes.