Blind spot on eyesight treatment
Macular injections effective but sadly underfunded. By Cate Broughton.
Thousands of Kiwis are going blind from a preventable condition but treatments are not receiving appropriate funding, doctors say.
Macular degeneration (MD) is the most common cause of blindness and affects one in seven New Zealanders over the age of 50, but many are unaware effective treatment and prevention therapy is available.
Christchurch ophthalmologist Jim Borthwick regularly treats people with the more aggressive form of the disease at his private practice and at the Canterbury District Health Board (CDHB).
Injections of anti-vascular growth factor (VEGF) can radically improve sight, he said.
‘‘Twenty years ago I used to say to people, ‘sorry I can’t do anything for you’, now we treat them and they maintain their vision and they live, drive . . . live in their own homes, because of the treatment.’’
Mona Fitzgerald, 84, lost her sight to MD about 10 years ago and was told by a specialist at the time there was nothing he could do for her.
The condition forced her to abandon driving and she has gradually given up on other activities such as cooking and reading due to her loss of sight.
Told of the treatments now available for MD, the Christchurch resident shrugs her shoulders.
‘‘Oh well, that’s luck of the isn’t it?’’
Despite treatments being available, many more New Zealanders may share Fitzgerald’s experience – the prevalence of MD is expected to soar in the next 10 years.
About 184,000 people over the age of 45 have MD and that figure is expected to increase by 13 per cent by 2026, according to a 2015 study.
Loss of sight from MD has a huge effect on individuals and a flow-on economic impact.
The condition significantly increases social dependence, depression, falls, hip fractures and loss of employment, and increases health-related costs seven-fold.
Borthwick and other ophthalmologists say that without government support, many Kiwis will lose their sight unnecessarily.
New Zealand has the lowest public endothelial drugs draw funding for MD treatments in the OECD and about 40 per cent of Kiwis have no idea what the condition is.
The results of years of work to develop a national prevention and treatment strategy have been languishing at the Ministry of Health since July last year, Borthwick said.
‘‘As a group from the sector, we’re unsure why this isn’t going to the next level.’’
Access to publicly funded treatment with anti-VEGF drugs varies widely between DHBs as they set their own MD budgets, said ophthalmologist Andrew Thompson.
In his study Where you live determines how well you see, Thompson, who works for the Hawke’s Bay DHB, found 12 DHBs were not providing enough funding to meet demand for treatment.
‘‘It means that some patients in some DHBs will get treated but that same patient with the same indication for treatment might not get treatment in another DHB. There’s no equity from one DHB to another.’’
Typically a patient requires 6.7 injections over 12 months but some DHBs provided funding for only four injections.
Thompson said this forced patients to pay for the remaining injections themselves or abandon treatment altogether.
Ministry of Health acting chief medical officer Dr Andrew Simpson said further work was needed to ‘‘understand the prevention, early detection and risk stratification of the MD model of care’’.
‘‘MD is an important issue in New Zealand, however the potential final work programme around MD and awareness is still being determined.’’
DHBs are responsible for ensuring equitable and timely access to MD treatment and the proposed work by the ministry would help them to do that, Simpson said.
Thompson said the Government needed to identify the issue as a priority.
‘‘I think it actually needs a directive from a national level to ensure that each DHB provides [equitable and timely treatment] because we certainly can’t get the funding that we think we need here, and I know other DHBs are the same.’’