by Lucy Goodman | 15 Nov, 2024 | News, Student
Ngā Puhi | Tainui | PhD candidate
Renata Watene (Ngā Puhi, Tainui) is an Optometrist and advocate of Māori eye healthcare in Aotearoa. In 2023 she began her PhD in the Community Eye Health team, where she is exploring existing Indigenous models of eye care. Here she reflects on the challenges she has faced after her first year of doctoral studies.
Seek to discover, Discover to know, Know and become enlightened
Why did you decide to do a PhD?
I would say the PhD chose me. I have been working in the optics space for more than 20 years now, and I have seen in the impacts of a privately funded health care model that creates inequities for consumers of Optometry services. In my own clinics I witnessed vast difference in services and outcomes for Māori patients. There is a large knowledge gap around Māori eyecare and use of Kaupapa Māori in Optometry in particular. With some intervention from my tupuna (grandmother) this path felt like the next step in making a meaningful impact in Optometry.
What’s the most challenging part of your studies so far?
The biggest challenge has been returning to academia from a clinical position and multiple community and governance roles. I was fortunate enough to secure a Clinical Research Fellowship through Health Research Council which contributed significantly by reducing the financial deficit that clinicians usually face if they return to do postgraduate studies.
As an alternative pathway applicant, I have had an incredible year of learning opportunities as I get up to speed with my other research colleagues. I think the feeling of imposter syndrome is very real in this space and it was comforting to learn that even those with significant research background still experience the same concerns that I do around progress of projects and validity of their research.
Working in Indigenous research adds another layer of complexity. Ensuring that the research meets the academic rigour of the Western system while being relationally accountable to our research partners and communities is at times near impossible. Working with Indigenous communities means that all processes and should be culturally appropriate and respected and that there is space for ceremony and tikanga. It is critical that I be very intentional to centre Māori and whānau voice as well, as Maori worldviews are important if we are to develop intergenerational strategies that address inequities. The western concept and indigenous concepts of time have been at odds during this process. ‘Mā te wā’ or all in good time.
What’s the most rewarding part?
The most rewarding part has been the opportunity to meet and learn from experts in equity and Indigenous eye health research. There is an obvious appetite from the local and global community toward more equitable outcomes for Māori and Indigenous Peoples, and it has been rewarding to contribute to conversations that address this. It’s a reminder of why I started this journey in the first place.
What was it like officially completing the first year of your PhD?
Giving my confirmation talk and looking back at what was completed during my first year gave me an immense sense of achievement and a clearer sense of direction for my work. But preparing for my provisional year review was challenging! Reprioritising my time and stepping back from several roles has helped me refine my focus and objectives into achievable goals for the remainder of the PhD journey. Like many processes in a PhD, you learn a lot and know how you would do things differently next time.
What are you focusing on now as you head into your second year?
Building on the strong foundation of my first year, I look forward to the next phases of my research and elevating the voices of our Māori, whānau, students, and practitioners in eyecare. I’m focusing on connecting with Indigenous Eyecare experts (and hopefully finding some more along the way!) to help inform a new eye health system that may lead to changes in how eyecare is delivered.
by Lucy Goodman | 30 Aug, 2024 | Resources
Key messages:
Eye health surveys generate essential information for planning new services. Some surveys specifically target underserved groups (e.g. people living in rural areas), while many exclude some groups (e.g. those without housing). In future, researchers can consider ways they can better consider underserved groups when planning their survey.
Read the published paper and download the plain language summary of the findings.
Why do a population-based eye health survey?
Eye health surveys are used to gather information about the number of people in a population who have eye health conditions and to identify any groups of people who have unmet need for eye health services. This evidence can be used to develop more equitable eye care services.
Why did we do this research?
Our aim was to summarise the different ways that previous eye health surveys have included underserved groups. This information can be used in future eye health surveys that wish to better include these groups.
What did we do?
We identified all eye health surveys published globally since the year 2000 that estimated the number of people with impaired vision. Underserved groups were defined according to pre-determined criteria (examples included women, people living in rural areas, and unemployed people). We summarised the different ways that underserved groups were considered in the way the survey was designed, conducted, or how the results were reported.
What did we find?
Almost all surveys considered underserved groups in some way, and the number of groups considered within each survey has increased over this time. Most surveys considered groups retrospectively, such as by comparing prevalence estimates between different groups. Very few surveys prospectively considered underserved groups when designing the survey (e.g. by using recruitment strategies that enabled underserved groups to participate). Some underserved groups were actively excluded from surveys, particularly those without stable housing.
What are the implications of this research?
Some population groups with large unmet eye health needs are rendered invisible by commonly used survey methods. Small surveys of specific underserved groups are needed to supplement large national-level surveys, so that policy makers have information about the eye health needs of everyone in the population.
Citation: Goodman L, Reis T, Zhang JH, et al. Underserved groups could be better considered within population-based eye health surveys: A methodological study. J. Clin. Epidemiol. 27 June 2024. doi: 10.1016/J.JCLINEPI.2024.111444. Available here.
Funding: This work was not funded by a specific grant from the public, commercial, or not-for-profit sectors.
by Lucy Goodman | 29 Aug, 2024 | Diabetes, News, Student
PhD candidate Nimisha Chabba presenting her work at the IAPB conference in June 2024.
PhD candidate Nimisha Chabba from the Community Eye Health team is supporting global efforts to improve eye care by refining the way that diabetic retinopathy services are monitored and reported worldwide.
Diabetes is a public health concern, as the number of people living with the disease is expected to reach 643 million by 2030. Diabetes can cause bleeding from vessels on the retina at the back of the eye (known as diabetic retinopathy), and this is the leading cause of vision loss in people of working age. Fortunately, regular eye screening and treatment can help people with diabetes to maintain good vision.
For policymakers and clinicians working to reduce vision loss from diabetes, a key priority is to gain a better understanding of access to diabetes eye care services, and how effective these services are at preserving vision. Guided by her PhD supervisors A/Prof Jacqueline Ramke and Dr Pushkar Silwal who offer their experience in eye health and health systems research, Nimisha hopes to improve the tools available to monitor diabetic eye services globally.
“We first need to understand what types of diabetic eye services are available and how many people they are reaching,” says Nimisha. “Only then can individual countries develop new and better services for people with diabetes.”
In 2022, the World Health Organization (WHO) released an Eye Care Indicator Menu (ECIM)—as the name suggests, a series of measures (known as “indicators”) that individual countries can use to monitor their own eye care services in a consistent way. Included in the Menu was an indicator to monitor retinal screening coverage—that is, the proportion of people with diabetes who have accessed these services.
Importantly, the amount of data reporting this indicator is unknown, and the first stage of Nimisha’s PhD is to address this knowledge gap by summarising all the existing literature worldwide that reports diabetic retinopathy screening coverage.
Nimisha presented the preliminary findings of her research and the plan for her PhD at the IAPB’s 2030 IN SIGHT Live meeting in Mexico City in June 2024. Of note, Nimisha described significant variability in the way that services worldwide report retinal screening coverage, which means that access to diabetic retinopathy screening cannot be easily compared between settings.
“It’s important that we have the right measures available to help countries monitor whether diabetic retinopathy services are effectively reaching the people who need them,” says eye health researcher A/Prof Jacqueline Ramke.
Looking towards the next phases of her PhD research, Nimisha hopes to expand WHO’s existing diabetic retinopathy indicator by developing a way to measure and assess service access concurrently with quality (known as an “effective coverage” indicator for diabetic retinopathy). To do this, she plans to collect feedback from international experts and reach a consensus about how effective coverage should be defined, and then test out the new indicator using local data from Aotearoa New Zealand. This work will have global impact by supporting the efforts of WHO and IAPB to improve monitoring and reporting of eye care services worldwide, and Nimisha is well on the way towards achieving her goals.
“Strengthening the monitoring of diabetic retinopathy services can help reduce vision loss, and I’m excited to be a part of this,” she says.
Sources:
Chabba, N. et al. What is the coverage of retina screening services for people with diabetes? Protocol for a systematic review and meta-analysis. BMJ Open 14, e081123 (2024). Read the published protocol here.
by Lucy Goodman | 12 Aug, 2024 | Pacific Islands, Resources
Key messages
Delivering eye health services in the Pacific Islands is challenging due to the remote location, susceptibility to the impacts of climate change, and economic instability. To direct future eye health research, we have reviewed all available evidence describing eye health in the Pacific Islands since 1980. The report illustrates that not enough research is available describing the prevalence of common eye conditions or service coverage in the Pacific islands, which makes it difficult to plan new eye care services.
Read the published report here.
Below is a Q&A with co-authors Dr Lisa Hamm, Dr Iris Wainiqolo, and A/Prof Jacqueline Ramke on their recently published report.
What was the question you were hoping to answer?
Our aim was to summarise all the research about eye health in the Pacific Islands since 1980. We wanted to know what research topics have been investigated, where they were conducted, and who was involved in funding. We were also interested in whether any of these variables have changed over time. Fundamentally, we hoped that this review would highlight the gaps and guide the future direction of the research.
What is the most important finding from this research?
Our review speaks to the wider issues faced by eye care providers and policy makers who are attempting to strengthen research capacity in the Pacific Islands. We observed that previous research about eye health in this region is influenced by external funders and researchers and does not correlate well with the eye conditions that are most important for people living in the Pacific Islands.
Why was it important to do this research?
Good eye health has many benefits for the well-being of individuals and society and underlies many of the United Nation’s Sustainable Development Goals. To support these goals, individual countries need as much information as possible describing the eye health needs of their population so that they can plan and deliver better eye care services.
Unfortunately, delivering eye health services in the Pacific Islands is challenging due to the remote location, susceptibility to the impacts of climate change, and economic instability. Without the infrastructure in place, the direction of future eye health research remains unclear. By identifying the gaps in our knowledge, we see this review as the first step towards improving eye health in the Pacific islands.
What research did you find describing eye health in the Pacific Islands?
Unfortunately, there is limited up-to-date research describing the prevalence of common eye conditions or service coverage in the Pacific islands, which makes it difficult to plan new eye care services. The lack of high-quality data (e.g. population-based prevalence studies) was notable.
The research we identified was mainly concentrated on Papua New Guinea, Fiji, and Vanuatu, although reported funding sources were most often from New Zealand, Australia, or the United States, illustrating the need to expand research infrastructure in the Pacific Islands.
What does this research say about the future of eye health in the Pacific?
Research in the Pacific Islands has evolved over the past ~40 years from small prevalence studies to larger externally funded research on specific eye conditions (that may not reflect local research priorities). Considering the economic challenges that limit financial investment into research, future research should be chosen strategically to fill the knowledge gaps identified from this report. Importantly, improving eye health in the Pacific islands will rely on first strengthening research leadership in the region so that Pacific Peoples can set their own research priorities.
Citation: Hamm LM, Wainiqolo I, Pant N, et al. Research about eye health and eye health services in Pacific Island Countries and Territories: a scoping review. The Lancet Regional Health – Western Pacific. 2024; 50:101152. doi: 10.1016/j.lanwpc.2024.101152
by Lucy Goodman | 10 Jul, 2024 | Children
New Zealand children are offered publicly funded vision screening services when they begin school (via the nationwide
B4 School Check service) and again in Year 7 (ages 11-12, as part of the Well Child Tamariki Ora Programme). While these screening services are good at identifying children with certain types of eye problems, we know that many children pass these screening tests and go attend school with undiagnosed vision problems. Some children also do not receive vision screening. We are addressing this problem within our teaching and research, by
providing additional screening services to schools, and
conducting research to identify how the current school screening services could be improved
Our school screening services
The School of Optometry and Vision Science provides an ongoing vision screening service for primary school children at participating schools in the Auckland region. The service provides a valuable training opportunity for Bachelor of Optometry students, who visit schools and conduct vision screening assessments on children aged 5-19. Approximately
4,000 children are screened via this service every year. One of the most common vision problems detected is refractive error, which can be corrected with spectacles or contact lenses. The School of Optometry and Vision Science’s school screening service operates alongside the
Vision Bus Aotearoa and the
Community Spectacles Scheme, so that children who are identified with a vision problem can receive the follow-up eye care that they need, through donation.
