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Angelo L, Gokul A, Wadhwa H, McGhee CNJ, Ziaei M. Assessment of Health Disparities and Barriers to Accessing Keratoconus and Crosslinking at a Tertiary Referral Center. Cornea 2024; 43:277-284. [PMID: 37098115 DOI: 10.1097/ico.0000000000003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/10/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE The aim of this study was to determine the barriers to accessing the crosslinking service in Auckland, New Zealand. METHODS This was a prospective 1-year study of patients at Auckland District Health Board. Studied parameters included age, sex, body mass index, ethnicity, New Zealand Deprivation (NZDep; an area-based measure of socioeconomic status, 1 = low deprivation-10 = high deprivation) score of residence, disease severity (maximum keratometry and thinnest corneal thickness), attendance, distance travelled, car ownership, employment status, and visual outcomes. Statistical analysis was performed using independent t tests, Pearson correlation, independent samples ANOVA, MANCOVA, and binomial logistic regression. RESULTS Four hundred fifty-four patients with keratoconus were analyzed and had a mean age of 24.1 ± 0.8 years, mean body mass index of 33.0 ± 9.7 kg/m 2 , and 43% were female. Pacific Peoples consisted 40.2% of the population; Māori 27.2%; Europeans 21.2%; Asian 9.9%; and Middle Eastern, Latin American, and African (MELAA) 1.3%. The mean distance travelled was 12.5 ± 9.5 km, NZDep score was 6.8 ± 2.6, and attendance was 69.0 ± 42.5%. The lowest attendance was observed in Pacific Peoples (58.9%) and the highest was in Asians (90%) ( P = 0.019). The mean worst-eye visual acuity at attendance was 0.75 ± 0.47 logMAR (6/35). Unemployment was associated with worse best-eye visual acuity at FSA ( P = 0.01) and follow-up ( P < 0.05). Māori and Pacific Peoples had the highest NZDep ( P < 0.001), were younger at presentation ( P = 0.019), had higher disease severity ( P < 0.001), and worse visual acuity ( P < 0.001). CONCLUSIONS Poor attendance was seen in this cohort. Pacific Peoples and Māori presented younger with worse disease severity and visual acuity but also had the highest nonattendance. These results suggest that deprivation, factors associated with ethnicity, and unemployment are potential barriers to attendance.
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Affiliation(s)
- Lize Angelo
- University of Auckland, Auckland, New Zealand; and
- Greenlane Clinical Centre, Auckland, New Zealand
| | - Akilesh Gokul
- University of Auckland, Auckland, New Zealand; and
- Greenlane Clinical Centre, Auckland, New Zealand
| | - Himanshu Wadhwa
- University of Auckland, Auckland, New Zealand; and
- Greenlane Clinical Centre, Auckland, New Zealand
| | - Charles N J McGhee
- University of Auckland, Auckland, New Zealand; and
- Greenlane Clinical Centre, Auckland, New Zealand
| | - Mohammed Ziaei
- University of Auckland, Auckland, New Zealand; and
- Greenlane Clinical Centre, Auckland, New Zealand
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2
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Rapata M, Cunningham W, Harwood M, Niederer R. Te hauora karu o te iwi Māori: A comprehensive review of Māori eye health in Aotearoa/New Zealand. Clin Exp Ophthalmol 2023; 51:714-727. [PMID: 37560825 DOI: 10.1111/ceo.14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/11/2023] [Accepted: 06/23/2023] [Indexed: 08/11/2023]
Abstract
This article provides a summary of available data on Māori ocular health, highlighting significant disparities between Māori and non-Māori populations. Māori are more likely to develop diabetes, sight-threatening retinopathy and keratoconus, and present for cataract surgery earlier with more advanced disease. Limited data exists for macular degeneration and glaucoma, but there is some suggestion that Māori may have lower prevalence rates. The article emphasises the urgent need for robust national data on Māori ocular health to enable targeted interventions and funding allocation. Achieving equity for Māori in all aspects of health, including ocular health, requires concerted efforts from all stakeholders.
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Affiliation(s)
- Micah Rapata
- Te Whatu Ora Auckland/Health New Zealand Auckland, Auckland, New Zealand
| | - Will Cunningham
- Te Whatu Ora Auckland/Health New Zealand Auckland, Auckland, New Zealand
| | - Matire Harwood
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Rachael Niederer
- Te Whatu Ora Auckland/Health New Zealand Auckland, Auckland, New Zealand
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Ramke J, Zhao J, Wilson O, Lee A, Dakin S, Watene R, Cunningham W, Harwood M, Black J. Geographic access to eye health services in Aotearoa New Zealand: which communities are being left behind? Clin Exp Optom 2023; 106:158-164. [PMID: 35917587 DOI: 10.1080/08164622.2022.2102410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
CLINICAL RELEVANCE Efforts to provide accessible eye care must consider the extent to which travel-distance may be a barrier for some communities. BACKGROUND This study aimed to determine the distribution of - and geographic access to - eye health services in Aotearoa New Zealand. We further sought to identify communities who might benefit from provision of eye health services that were more geographically accessible. METHODS We obtained addresses of optometry and ophthalmology clinics from regulatory bodies and augmented this with online searches. Address locators were created using a Land Information dataset and geocoded using ArcGIS 10.6. A national population was derived using Statistics New Zealand's Integrated Data Infrastructure. We generated population-weighted centroids of each of New Zealand's 50,938 meshblocks and calculated the travel distance along the road network between each clinic and population (meshblock centroid). The proportion of the population living >50 km from each clinic type was calculated; as was the median, inter-quartile range and maximum distance across area-level deprivation quintiles in each district. RESULTS A national population of 4.88 million was identified, as were addresses for 344 optometry, 46 public ophthalmology and 90 private ophthalmology clinics. Nationally and within each district, travel distance to optometry was shorter than to either type of ophthalmology clinic. The region of Northland - with a high proportion of the population Māori and in the highest quintile of area-level deprivation - had the furthest average distance to travel to optometry and public ophthalmology, while the West Coast region on the South Island had the farthest to travel to private ophthalmology. Several communities were identified where longer distances intersected with higher area-level deprivation. CONCLUSION Most New Zealanders live within 10 km of eye health services. However, to achieve equitable eye health, strategies are required that make affordable eye health services accessible to communities for whom large travel distances intersect with high deprivation.
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Affiliation(s)
- Jacqueline Ramke
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jinfeng Zhao
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Oliver Wilson
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Arier Lee
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Steven Dakin
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Renata Watene
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - William Cunningham
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Matire Harwood
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna Black
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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Anstice NS, Alam K, Armitage JA, Biles B, Black JM, Boon MY, Carlson T, Chinnery HR, Collins AV, Cochrane A, Duthie D, Hopkins S, Fitzpatrick G, Keay L, Watene R, Yashadhana A, Bentley SA. Developing culturally safe education practices in optometry schools across Australia and Aotearoa New Zealand. Clin Exp Optom 2023; 106:110-118. [PMID: 36336833 DOI: 10.1080/08164622.2022.2136514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Access to culturally safe health services is a basic human right, however through the lasting effects of colonisation, oppression, and systemic racism, the individual and community health of Indigenous peoples in Australia and Aotearoa New Zealand have been severely impacted. The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy of the Australian Health Practitioners Regulation Agency, and the Standards of Cultural Competence and Cultural Safety of the Optometrists and Dispensing Opticians Board of New Zealand, recognise the importance of access to safe health care for Aboriginal, Torres Strait Islander and Māori patients, which encompasses both clinical competency and cultural safety. Universities have an ongoing responsibility to ensure their learning and teaching activities result in graduates being able to provide culturally safe practice. This article highlights the emergence of culturally safe practices in the Australian and Aotearoa New Zealand optometry curricula over the last five years incorporating Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities. Whilst there is still much work to do to achieve the goal of graduating culturally safe optometrists, this paper focuses on features that enable or impede progress in the development of culturally safe practices within the optometry programmes to improve eye health equity for Indigenous recognise the diversity of Indigenous cultures across Australia and NZ.
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Affiliation(s)
- Nicola S Anstice
- Optometry and Vision Science, Flinders University, Adelaide, Australia
| | - Khyber Alam
- Division of Optometry, University of Western Australia, Perth, Australia
| | - James A Armitage
- School of Medicine (Optometry), Deakin University, Geelong, Australia
| | - Brett Biles
- Office of Medical Education, University of New South Wales, Sydney, Australia
| | - Joanna M Black
- School of Optometry and Vision Science, The University of Auckland, Aotearoa New Zealand
| | - Mei Ying Boon
- Optometry and Vision Science, University of Canberra, Bruce, Australia
| | - Teah Carlson
- College of Health, Massey University, Aotearoa, New Zealand
| | - Holly R Chinnery
- Department of Optometry and Vision Science, The University of Melbourne, Melbourne, Australia
| | - Andrew V Collins
- School of Optometry and Vision Science, The University of Auckland, Aotearoa New Zealand
| | - Anthea Cochrane
- Department of Optometry and Vision Science, The University of Melbourne, Melbourne, Australia
| | - Debbie Duthie
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Shelley Hopkins
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Australia
| | - Gary Fitzpatrick
- Division of Optometry, University of Western Australia, Perth, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Renata Watene
- School of Optometry and Vision Science, The University of Auckland, Aotearoa New Zealand
| | - Aryati Yashadhana
- Office of Medical Education, University of New South Wales, Sydney, Australia
| | - Sharon A Bentley
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Australia
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Silwal PR, Lee AC, Squirrell D, Zhao J, Harwood M, Vincent AL, Murphy R, Ameratunga S, Ramke J. Use of public sector diabetes eye services in New Zealand 2006-2019: Analysis of national routinely collected datasets. PLoS One 2023; 18:e0285904. [PMID: 37200245 DOI: 10.1371/journal.pone.0285904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/03/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE To assess diabetes eye service use in New Zealand among people aged ≥15 years by estimating service attendance, biennial screening rate, and disparities in the use of screening and treatment services. METHODS We obtained Ministry of Health data from the National Non-Admitted Patient Collection on diabetes eye service events between 1 July 2006 and 31 December 2019 and sociodemographic and mortality data from the Virtual Diabetes Register and linked these using a unique patient identifier (encrypted National Health Index). We 1) summarized attendance at retinal screening and ophthalmology services, 2) calculated biennial and triennial screening rate, 3) summarized treatment with laser and anti-VEGF and used log-binomial regression to examine associations of all of these with age group, ethnicity, and area-level deprivation. RESULTS In total, 245,844 people aged ≥15 years had at least one diabetes eye service appointment attended or scheduled; half of these (n = 125,821, 51.2%) attended only retinal screening, one-sixth attended only ophthalmology (n = 35,883, 14.6%) and one-third attended both (n = 78,300, 31.8%). The biennial retinal screening rate was 62.1%, with large regional variation (73.9% in Southern District to 29.2% in West Coast). Compared with NZ Europeans, Māori were approximately twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, 9% relatively less likely to receive biennial screening and received the fewest anti-VEGF injections when treatment was commenced. Disparities in service access were also present for Pacific Peoples compared to NZ Europeans, younger and older age groups compared to those aged 50-59 years and those living in areas with higher deprivation. CONCLUSIONS Access to diabetes eye care is suboptimal, with substantial disparity between age groups, ethnicity groups, area level deprivation quintile and across districts. Efforts to improve access to and quality of diabetes eye care services must include strengthening data collection and monitoring.
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Affiliation(s)
- Pushkar Raj Silwal
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Arier C Lee
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Squirrell
- Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Jinfeng Zhao
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrea L Vincent
- Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
- Whitiora Diabetes Service, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Population Health Directorate, Counties Manukau Health, Auckland, New Zealand
| | - Jacqueline Ramke
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Harbers A, Davidson S, Eggleton K. Understanding barriers to diabetes eye screening in a large rural general practice: an audit of patients not reached by screening services. J Prim Health Care 2022; 14:273-279. [PMID: 36178842 DOI: 10.1071/hc22062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Diabetes is a leading cause of blindness in New Zealanders, yet a significant proportion of patients with diabetes are not reached by diabetes eye screening. Aim Our study audited patients with diabetes in a large New Zealand rural general practice, to identify addressable barriers preventing patients from attending diabetes eye screening. Methods All patients who had missed a diabetes eye screening appointment at the Dargaville Hospital Eye Screening Clinic between 2018 and 2021 were identified. Demographic information, laboratory and disease status data were recorded and analysed. Semi-structured telephone interviews were undertaken with 66 patients exploring barriers to diabetes eye screening. Descriptive statistical analysis was performed on quantitative data and a thematic analysis on qualitative results. Results One-hundred and fifty-four (27%) of 571 patients invited to screening missed at least one appointment; of these, 66 (43%) were interviewed. Quantitative analysis suggested Māori patients were less likely to be reached, with a 20% higher number of missed appointments than European patients and a higher glycated haemoglobin (HbA1c). Māori patients reported greater barriers to attending eye screening. Common barriers identified by participants were transport, work and family commitments, financial, health and lack of appointment reminders. Discussion Increased barriers for Māori patients could explain the reduced ability of the screening service to reach Māori patients. In order to address inequity and increase overall screening rates, diabetes eye screening and primary care services need to improve the booking system, facilitate transport to screening, engage patients and their whānau and build trust.
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Affiliation(s)
- Angel Harbers
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Scott Davidson
- Department General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; and Dargaville Medical Centre, Dargaville, Northland, New Zealand
| | - Kyle Eggleton
- Department General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Dawson S, Banister K, Biggs K, Cotton S, Devane D, Gardner H, Gillies K, Gopalakrishnan G, Isaacs T, Khunti K, Nichol A, Parker A, Russell AM, Shepherd V, Shiely F, Shorter G, Starling B, Williams H, Willis A, Witham MD, Treweek S. Trial Forge Guidance 3: randomised trials and how to recruit and retain individuals from ethnic minority groups-practical guidance to support better practice. Trials 2022; 23:672. [PMID: 35978338 PMCID: PMC9383663 DOI: 10.1186/s13063-022-06553-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/16/2022] [Indexed: 11/23/2022] Open
Abstract
Randomised trials, especially those intended to directly inform clinical practice and policy, should be designed to reflect all those who could benefit from the intervention under test should it prove effective. This does not always happen. The UK National Institute for Health and Care Research (NIHR) INCLUDE project identified many groups in the UK that are under-served by trials, including ethnic minorities.This guidance document presents four key recommendations for designing and running trials that include the ethnic groups needed by the trial. These are (1) ensure eligibility criteria and recruitment pathway do not limit participation in ways you do not intend, (2) ensure your trial materials are developed with inclusion in mind, (3) ensure staff are culturally competent and (4) build trusting partnerships with community organisations that work with ethnic minority groups. Each recommendation comes with best practice advice, public contributor testimonials, examples of the inclusion problem tackled by the recommendation, or strategies to mitigate the problem, as well as a collection of resources to support implementation of the recommendations.We encourage trial teams to follow the recommendations and, where possible, evaluate the strategies they use to implement them. Finally, while our primary audience is those designing, running and reporting trials, we hope funders, grant reviewers and approvals agencies may also find our guidance useful.
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Affiliation(s)
- Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, BS8 2PS UK
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | - Katie Biggs
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA UK
| | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | - Declane Devane
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | | | - Talia Isaacs
- UCL Centre for Applied Linguistics, IOE, UCL’s Faculty of Education and Society, University College London, London, WC1H 0AL UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW UK
- National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) East Midlands, University of Leicester, Leicester, UK
| | - Alistair Nichol
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Adwoa Parker
- York Clinical Trials Unit, University of York, York, UK
| | - Amy M. Russell
- WHO Disability Team, Geneva/ Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Victoria Shepherd
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Frances Shiely
- Health Research Board Clinical Research Facility and School of Public Health, University College Cork, Cork, Ireland
| | - Gillian Shorter
- Drug and Alcohol Research Network, Queen’s University Belfast, Belfast, UK
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Bella Starling
- Public Programmes Team (now Vocal), Manchester University NHS Foundation Trust, Research & Innovation Division, The Nowgen Centre, 29 Grafton Street, Manchester, M13 9WU UK
- NIHR Manchester Biomedical Research Centre, NIHR Manchester Clinical Research Facility, Manchester, UK
| | - Hywel Williams
- Centre of Evidence-Based Dermatology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH UK
| | - Andrew Willis
- NIHR ARC East Midlands, University of Leicester, Leicester, UK
| | - Miles D. Witham
- NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle University and Newcastle upon Tyne NHS Trust, Newcastle, NE4 5PL UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
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Yap A, Wang N, Squirrell D. Ethnic differences on long term outcomes of polypoidal choroidal vasculopathy after predominantly bevacizumab monotherapy. BMC Ophthalmol 2022; 22:325. [PMID: 35902835 PMCID: PMC9330682 DOI: 10.1186/s12886-022-02551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background A 3-year single-centre, retrospective, comparative, non-randomized cohort study to describe the long-term outcomes of treatment-naïve, Caucasian and non-Caucasian eyes with polypoidal choroidal vasculopathy (PCV) after treatment with predominantly Bevacizumab monotherapy or in combination with rescue photodynamic therapy (PDT). Methods Demographics, visual outcomes, optical coherence tomography (OCT) and treatment data were collected up to 3 years after the first visit. Stratified analysis according to ethnicity and baseline vision was performed to identify factors predictive of long-term visual improvement and maintenance. Results A total of 89 eyes with PCV were identified, of which 14 received rescue verteporfin PDT. There was an equal distribution between Caucasian and non-Caucasian individuals. Non-Caucasians present at a younger age (67.3 vs. 76.0 years, p = 0.002), have a higher proportion of foveal involvement (80.9%, vs.54.2% p = 0.007), choroidal hyperpermeability (50% vs 25.8%, p = 0.013) and lower baseline visual acuity (53.1 vs. 63.3 letters, p = 0.008). Mean visual acuity (VA) gain was + 8.9 letters and + 5.0 letters at 1 and 3 years of follow-up, respectively. Non-Caucasian individuals had a lower mean final visual acuity (VA) (54.7 vs. 70.5, respectively; P < 0.001) and net gain in VA (+ 2.0 vs. + 7.6 letters, p = 0.581) compared to Caucasian individuals. The mean total number of injections given over 3 years was 14. Conclusions Most patients treated with predominantly Bevacizumab anti-vascular endothelial growth factor (VEGF) monotherapy achieved sustained visual acuity gains out to 3 years. Due to ethnic-specific differences in presenting PCV phenotypes, non-Caucasians presented with lower baseline VA and had poorer long-term visual outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02551-3.
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Affiliation(s)
- Aaron Yap
- Department of Ophthalmology, The University of Auckland, 85 Park Road, Grafton, Auckland, 1051, New Zealand.
| | - Nancy Wang
- Department of Ophthalmology, The University of Auckland, 85 Park Road, Grafton, Auckland, 1051, New Zealand
| | - David Squirrell
- Department of Ophthalmology, The University of Auckland, 85 Park Road, Grafton, Auckland, 1051, New Zealand.,Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
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9
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Hill S, Mullins P, Murphy R, Schmiedel O, Vaghefi E, Ramke J, Squirrell D. Risk Factors for Progression to Referable Diabetic Eye Disease in People With Diabetes Mellitus in Auckland, New Zealand: A 12-Year Retrospective Cohort Analysis. Asia Pac J Ophthalmol (Phila) 2021; 10:579-589. [PMID: 34905518 DOI: 10.1097/apo.0000000000000464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To evaluate the prevalence and risk factors for the development of any and referable diabetic eye disease in a multi-ethnic New Zealand population with diabetes mellitus attending a regional retinal screening service. METHODS Retrospective observational cohort study of people living with diabetes who attended the Auckland Regional Diabetic Retinal Screening Programme 2006-2018 inclusive (n = 41,786). RESULTS Any retinopathy/maculopathy was present at first screening for 48.2% [95% confidence interval (CI): 45.8%-50.6%] / 37.8% (95% CI: 35.5%- 40.1%) of people with Type 1 and 25% (95% CI: 24.6%-25.4%) / 21.9% (95% CI: 21.5%-22.3%) with Type 2 diabetes. Referable retinopathy at baseline screening was 4.4% (95% CI: 3.6%-5.3%) and 1.6% (95% CI: 1.5%-1.7%) among people with Type 1 and Type 2 diabetes mellitus, respectively. After 4 years, cumulative incidence for referable retinopathy /referable maculopathy was 12/36 per 1000 people with Type 1 and 2.4/16 per 1000 people with Type 2 diabetes. Independent hazards for disease progression varied for the diabetes cohort types but baseline grade, duration of diabetes, and HbA1c were common to all. CONCLUSIONS Referable diabetic eye disease at the first screening and after 4 years of follow-up is uncommon. Lengthening of the screening intervals for people with no or mild diabetic eye disease at first screening assessment could be considered.
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Affiliation(s)
- Sophie Hill
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
- Ophthalmology Department, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Peter Mullins
- Department of Statistics, University of Auckland, Faculty of Science, Science Centre 3030, Auckland 1010, New Zealand
| | - Rinki Murphy
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
- Department of Medicine, University of Auckland, Building 507, Grafton, Auckland 1023, New Zealand
| | - Ole Schmiedel
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
| | - Ehsan Vaghefi
- School of Optometry and Vision Science, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Jacqueline Ramke
- School of Optometry and Vision Science, University of Auckland, Grafton, Auckland 1023, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - David Squirrell
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
- Ophthalmology Department, University of Auckland, Grafton, Auckland 1023, New Zealand
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10
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Smith JR. Reviewing the reviews. Clin Exp Ophthalmol 2021; 49:995-996. [PMID: 34599538 DOI: 10.1111/ceo.14003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Justine R Smith
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
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Rogers JT, Black J, Harwood M, Wilkinson B, Gordon I, Ramke J. Vision impairment and differential access to eye health services in Aotearoa New Zealand: protocol for a scoping review. BMJ Open 2021; 11:e048215. [PMID: 34518256 PMCID: PMC8442104 DOI: 10.1136/bmjopen-2020-048215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/04/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION In Aotearoa New Zealand, Māori and Pacific people experience worse health outcomes compared with other New Zealanders. No population-based eye health survey has been conducted, and eye health services do not generate routine monitoring reports, so the extent of eye health inequality is unknown. This information is required to plan equitable eye health services. Here we outline the protocol for a scoping review to report the nature and extent of the evidence reporting vision impairment, and the use of eye health services by ethnicity in New Zealand. METHODS AND ANALYSIS An information specialist will conduct searches on MEDLINE and Embase, with no limit on publication dates or language. We will search the grey literature via websites of relevant government and service provider agencies. Reference lists of included articles will be screened. Observational studies will be included if they report the prevalence of vision impairment, or any of the main causes (cataract, uncorrected refractive error, macular degeneration, glaucoma or diabetic retinopathy) or report the use of eye health services in New Zealand among people of any age. Two authors will independently review titles, abstracts and full-text articles, and complete data extraction. Overall findings will be summarised using descriptive statistics and thematic analysis, with an emphasis on disaggregation by ethnicity where this information is available. ETHICS AND DISSEMINATION Ethical approval has not been sought as our review will only include published and publicly accessible data. We will publish the review in an open access peer-reviewed journal. We anticipate the findings will be useful to organisations and providers in New Zealand responsible to plan and deliver eye care services, as well as stakeholders in other countries with differential access to eye care. REGISTRATION DETAILS The protocol has been registered with Open Science Framework (https://osf.io/yw7xb).
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Affiliation(s)
- Jaymie Tingkham Rogers
- School of Optometry & Vision Science, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Joanna Black
- School of Optometry & Vision Science, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Matire Harwood
- General Practice & Primary Health Care, The University of Auckland School of Population Health, Auckland, New Zealand
| | - Ben Wilkinson
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- School of Optometry & Vision Science, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Hamm LM, Yashadhana A, Burn H, Black J, Grey C, Harwood M, Peiris-John R, Burton MJ, Evans JR, Ramke J. Interventions to promote access to eyecare for non-dominant ethnic groups in high-income countries: a scoping review. BMJ Glob Health 2021; 6:e006188. [PMID: 34493531 PMCID: PMC8424858 DOI: 10.1136/bmjgh-2021-006188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE People who are distinct from the dominant ethnic group within a country can experience a variety of barriers to accessing eyecare services. We conducted a scoping review to map published interventions aimed at improving access to eyecare for non-Indigenous, non-dominant ethnic groups residing in high-income countries. METHODS We searched MEDLINE, Embase and Global Health for studies that described an intervention to promote access to eyecare for the target population. Two authors independently screened titles and abstracts followed by review of the full text of potentially relevant sources. For included studies, data extraction was carried out independently by two authors. Findings were summarised using a combination of descriptive statistics and thematic analysis. RESULTS We screened 5220 titles/abstracts, of which 82 reports describing 67 studies met the inclusion criteria. Most studies were conducted in the USA (90%), attempted to improve access for Black (48%) or Latinx (28%) communities at-risk for diabetic retinopathy (42%) and glaucoma (18%). Only 30% included the target population in the design of the intervention; those that did tended to be larger, collaborative initiatives, which addressed both patient and provider components of access. Forty-eight studies (72%) evaluated whether an intervention changed an outcome measure. Among these, attendance at a follow-up eye examination after screening was the most common (n=20/48, 42%), and directly supporting patients to overcome barriers to attendance was reported as the most effective approach. Building relationships between patients and providers, running coordinated, longitudinal initiatives and supporting reduction of root causes for inequity (education and economic) were key themes highlighted for success. CONCLUSION Although research evaluating interventions for non-dominant, non-Indigenous ethnic groups exist, key gaps remain. In particular, the paucity of relevant studies outside the USA needs to be addressed, and target communities need to be involved in the design and implementation of interventions more frequently.
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Affiliation(s)
- Lisa M Hamm
- School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Aryati Yashadhana
- Centre for Health Equity Training Research & Evaluation, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Burn
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Black
- School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Corina Grey
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Performance Improvement, Auckland District Health Board, Auckland, New Zealand
| | - Matire Harwood
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Roshini Peiris-John
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Moorfields Eye Hospital, London, UK
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Burn H, Hamm L, Black J, Burnett A, Harwood M, Burton MJ, Evans JR, Ramke J. Eye care delivery models to improve access to eye care for Indigenous peoples in high-income countries: a scoping review. BMJ Glob Health 2021; 6:bmjgh-2020-004484. [PMID: 33762252 PMCID: PMC7993359 DOI: 10.1136/bmjgh-2020-004484] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Globally, there are ~370 million Indigenous peoples. Indigenous peoples typically experience worse health compared with non-Indigenous people, including higher rates of avoidable vision impairment. Much of this gap in eye health can be attributed to barriers that impede access to eye care services. We conducted a scoping review to identify and summarise service delivery models designed to improve access to eye care for Indigenous peoples in high-income countries. Methods Searches were conducted on MEDLINE, Embase and Global Health in January 2019 and updated in July 2020. All study designs were eligible if they described a model of eye care service delivery aimed at populations with over 50% Indigenous peoples. Two reviewers independently screened titles, abstracts and full-text articles and completed data charting. We extracted data on publication details, study context, service delivery interventions, outcomes and evaluations, engagement with Indigenous peoples and access dimensions targeted. We summarised findings descriptively following thematic analysis. Results We screened 2604 abstracts and 67 studies fulfilled our eligibility criteria. Studies were focused on Indigenous peoples in Australia (n=45), USA (n=11), Canada (n=7), New Zealand (n=2), Taiwan (n=1) and Greenland (n=1). The main disease focus was diabetic retinopathy (n=30, 45%), followed by ‘all eye care’ (n=16, 24%). Most studies focused on targeted interventions to increase availability of services. Fewer than one-third of studies reported involving Indigenous communities when designing the service. 41 studies reflected on whether the model improved access, but none undertook rigorous evaluation or quantitative assessment. Conclusions The geographical and clinical scope of service delivery models to improve access to eye care for Indigenous peoples in high-income countries is narrow, with most studies focused on Australia and services for diabetic retinopathy. More and better engagement with Indigenous communities is required to design and implement accessible eye care services.
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Affiliation(s)
- Helen Burn
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lisa Hamm
- School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Joanna Black
- School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anthea Burnett
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Matire Harwood
- General Practice and Primary Healthcare, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.,School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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Gertig D, Smith JR. Screening and avoidance of blindness: One cannot exist without the other. Clin Exp Ophthalmol 2020; 48:1133-1135. [PMID: 33191539 DOI: 10.1111/ceo.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Demi Gertig
- Flinders University, Adelaide, South Australia, Australia
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Coop HV. Early treatment of diabetic eye disease in New Zealand. Clin Exp Ophthalmol 2020; 48:411-412. [DOI: 10.1111/ceo.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/02/2019] [Indexed: 11/27/2022]
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