“Saving Sight is our Vision” – An ambitious healthcare model to deliver eye care services in regional NSW.

It is well established that vision impairment decreases quality of life, adversely impacts productivity, exacerbates dementia, and increases falls, car crashes, and the need for social care. Poor vision has also substantial financial implications for individuals, families, communities, and the health care system, thus representing a heavy burden to bear both from a personal and from a societal perspective. Nonetheless, as RANZCO Fellow, Dr Kristin Bell, points out “80% of permanent visual loss can be prevented through timely access to appropriate eye treatment”. The provision of adequate and effective ophthalmic care is therefore critical to ensure the early detection, diagnosis, and treatment of preventable blindness. 

Unfortunately, however, the delivery of high quality, sustainable and regular eye services can sometimes be hindered by an array of practical difficulties such as a lack of human resources, equipment, and training, but also, and most notably, geographical barriers and cultural differences in healthcare practice. This is especially the case for several communities in regional and remote New South Wales where eye-related conditions can be extremely challenging to address due to the limited availability of eye care providers, the significant distances involved in accessing eyecare and the excessively long waitlists for ophthalmic surgery.

In the attempt to tackle this compelling issue, a team of clinicians from the Save Sight Institute led by A/Professor Geoffrey Painter from Foresight Australia and Kerrie Legg from Chatswood Private Hospital (CPH), have recently developed, with the support of Griffith Base Hospital, a comprehensive Ophthalmology Model of Care aimed at improving access to regular and culturally sensitive eye care services for all people residing within the Western Region of the Murrumbidgee Local Health District (MLHD). 

Foresight Australia, A/Professor Painter, and Kerrie Legg, along with talented and committed Australian ophthalmologists and ophthalmic nurses have been involved in long-standing Ophthalmic outreach programs dating back to the mid 1990s. These programs have been developed in association with various Non-Government Organisations such as RACS, Eyes on China, Rotary and Open Heart International and provided regular eye care services and specific teaching programs to developing communities in the Solomons Islands, China, and the Philippines. 

Fast forward to 2021 and unfortunately these international programs reached a halting point due to the travel restrictions imposed by the Covid-19 pandemic. Instead of being discouraged by the additional challenges, Foresight Australia, with the support of Gordon Eye Surgery (GES), Rotary and CPH, approached the NSW Ministry of Health who identified Griffith as an area of need. In partnership with Foresight Australia and the management team at Griffith Base Hospital an innovative model of care centred around three strategic goals was designed.

The first objective was to provide short term assistance to help reduce the waiting list for surgical activity, a goal successfully achieved as the initial waiting times for surgery in early 2022 quickly plummeted from nearly 12 months to just a few weeks. 

Secondly, the team behind this model set to deliver long term sustainable Ophthalmic care for the Western MLHD based at the Griffith Base Hospital, including a more streamlined referral, assessment, and follow-up process in close collaboration with Griffith Base Hospital Outpatients staff. This has been possible via the establishment of a fully equipped clinic and regular visits every 4 weeks by a team of clinicians led by Dr Dominic McCall since February 2022. The team consists of 2-3 consultants and an orthoptist from GES. A registrar is provided by CPH and often Residents and Medical Students are also invited to attend, thus getting exposure to regional eyecare. Importantly, the clinic has reduced waiting times for consultations and eliminated to need to travel long distances for routine Ophthalmic care.

Thirdly, an effective and sustainable eyecare outreach programme has been developed for the Aboriginal people in the region. The team has provided equipment, training, and upskilling opportunities for Aboriginal Health Care Workers to enable them to identify eyecare needs in remote communities in the Western MLHD with the ultimate goal to include other local Aboriginal Health care workers in the future.

Since its inception and establishment in February 2022, the Griffith Base Hospital Ophthalmology Model of Care has been extremely productive in improving health outcomes and access to public ophthalmology services in the Western MLHD. In recognition of these achievements, the team behind the project has recently been awarded an Excellence award in the “Keeping People Healthy” category at the 2023 MLHD Excellence Awards.

The Griffith Base Hospital Ophthalmology Model of Care is the perfect example of what happens when dedicated clinicians and external stakeholders join forces to improve the quality of life and reduce the risk of adverse eye health outcomes in regional and Indigenous communities whose access to appropriate and timely healthcare may be limited. It could even be a successful model of care, outreach and teaching in other areas of New South Wales and Australia.

Outreach programs of this calibre are difficult to implement, as there are a multitude of hurdles to overcome but as A/Professor Painter remarks:

“It is exactly in these circumstances that taking action is absolutely critical. It is beyond doubt that effective advocacy requires persistence, commitment, and patience.” 

However, when a true commitment to promoting health and wellbeing leads the way, advocacy becomes a powerful tool that can change the life of many for the better.

This article acknowledges the support of the following RANZCO fellows and trainees in this new model of care:

A/Prof. Geoffrey Painter, Dr Dominic McCall, Dr Mark Ellis, Dr Georgina Kourt, Dr Sara Booth Mason, Dr Richard Symes, Dr Carolyn Ross, Dr Kate Leahy, Dr Oliver Lau; and The Sydney Eye Hospital Training Network - Northern Sydney Private Registrar along with volunteer RMO’s and administrative support from Kerrie Legg and Donna Glenn.