Buchanan Charitable Foundation Postdoctoral Fellow Dr Pushkar Silwal (middle) pictured with team members A/Prof Jacqueline Ramke (left) and Dr Braden Te Ao (right).
Pushkar Silwal, a member of the School of Optometry and Vision Science’s Community Eye Health team and the inaugural Buchanan Charitable Foundation’s Postdoctoral Fellow hopes that our transforming health system will better support eye care services that are accessible to everyone.
Although 1.1 billion people experience impaired vision globally, eye health is often overlooked as a public health concern. The ongoing health sector reforms that began in mid-2022 provide a unique opportunity for Pushkar and his colleagues to build on previous research findings and generate much-needed evidence on how eye care services can be more accessible and equitable in New Zealand.
In February 2023, Pushkar began a three-year postdoctoral fellowship funded by the Buchanan Charitable Foundation—a home-grown, philanthropic foundation that supports community development. During his Fellowship, Pushkar will undertake a series of research projects that will investigate how to strengthen our health system, with the goal of improving eye care services in Aotearoa. He will also engage with academics, programme managers, and policy makers to identify opportunities to promote the inclusion of eye health in health system monitoring.
“We hope this will allow us to translate the knowledge we generate into practice,” says Pushkar.
This work will follow on from Pushkar’s PhD research, where he examined whether the measures we use to monitor our health system are appropriate. During his Fellowship, Pushkar will maintain an honorary appointment within the School of Population Health and will be mentored by A/Prof Jacqueline (Jacqui) Ramke from the School of Optometry and Vision Science (SOVS) and Dr Braden Te Ao from SOPH.
“We are very excited to have Pushkar commence his fellowship with us and welcome his commitment to generate evidence to support equity-focused decision-making in eye health. We are very fortunate for this ongoing support from The Buchanan Charitable Foundation and thank them for their commitment to improve eye health for all New Zealanders”, says Jacqui.
To advocate for improved eye care, Pushkar will draw on a growing body of evidence that New Zealand eye care services are lacking. Last year, he co-authored a report titled “Eye care in Aotearoa New Zealand 2022” that found a range of areas where our eye care services could be strengthened. Commissioned by Eye Health Aotearoa and funded by Blind Low Vision New Zealand, the report systematically assessed our eye care services using an analysis tool developed by the World Health Organization. Importantly, the report provided a list of 81 recommended actions for policy makers to improve our eye care services.
“Our report shows that access to eye care services needs major strengthening,” he says.
Pushkar has a long-standing interest in health systems research. He completed his Master of Public Health in 2016 at The University of Auckland under the Manaaki New Zealand Scholarships Programme and has actively contributed to teaching public policy and health systems at The University of Auckland. This will continue during his fellowship when Pushkar, alongside Jacqui, will integrate a new public health teaching module within The University of Auckland’s Bachelor of Optometry programme. He hopes that this will help build eye health in Aotearoa from the ground up, so that future optometrists can advocate for and deliver accessible eye health services for everyone.
A collaboration between the Fred Hollows Foundation and The University of Auckland’s Centre for Pacific and Global Health and School of Optometry and Vision Science aims to assess the state of eye health in the Pacific using locally-driven research.
In July 2021, the Community Eye Health team conducted a pilot eye health survey in the Glen Innes, Panmure and Ōrākei areas of Auckland. This survey gave us the opportunity to collect information about the state of eye health in a small group of New Zealanders, before we embark on our more ambitious population-based eye health survey in 2023.
Lead Optometrist and PhD candidate Jaymie Rodgers played a key role in the day-to-day operations of this pilot study.
“As part of my research project, I am delivering comprehensive eye examinations to people in this community where we believe there may be unmet eye health needs. In particular, we want to know if there are any differences in access to eye care,” says Jaymie.
Throughout the pilot study, Jaymie together with Optometrist and Professional Teaching Fellow Veeran Morar supervised a team of clinical optometry students as they conducted eye examinations at the Te Whare Piringa community centre in Glen Innes.
Watch Jaymie and team set up the eye clinic at Te Whare Piringa community centre in Glen Innes, above.
Currently, Jaymie is busy analysing data from the survey pilot, and enrolling a cohort of participants for further follow-up. Her PhD research will continue within the population-based eye care survey that will begin in 2023, where she will will follow a group of participants with vision impairment over a 12-month period to understand the barriers that they face in accessing follow-up eye care services.
See inside the pop-up eye clinic, below:
Jaymie speaks with a survey participant who is picking up her new glasses
Jaymie examines a survey participant at the pop-up clinic
A student optometrist with two survey participants, who are picking up their new glasses
As part of the survey, we offer a full eye examination to all people identified with distance or near vision impairment.
The research team:
Jaymie and Veeran with BOptom students
L to R: Joanna Black, Jaymie Rogers, Jacqui Ramke and Matire Harwood
Funding:
The research team would like to acknowledge Peter and Rae Fehl, Blind Low Vision New Zealand and New Zealand Association of Optometrists for their support.
Participants in this project are benefiting from the SOVS Community Spectacle Scheme, which is supported by Helen Blake, Barbara Blake and Essilor.
In 2020, the Government of Aotearoa New Zealand proposed free annual “eye health checks” for New Zealand’s ~700,000 SuperGold card holders aged ≥65 years. To assess the evidence for this policy, we conducted a systematic scoping review of primary eye care services in Aotearoa New Zealand and ten similar high-income countries. We found that most of the countries included in the review provided subsidised eye examinations for older people. New Zealand was the only country that did not provide any eye care services for older people.
Citation: Goodman L, Hamm L, Tousignant B, et al. Primary eye health services for older adults as a component of universal health coverage: a scoping review of evidence from high income countries. Lancet Reg Health West Pac. 2023;35:100560. doi: 10.1016/j.lanwpc.2022.100560
Travel distance is unlikely to be a barrier to accessing eye health services for most New Zealanders. However, there are communities in the most deprived areas that also have long distances to travel to eye clinics. These communities are often in areas with relatively more Māori. Making eye health services more accessible for these communities should be prioritised if we are to improve eye health in New Zealand equitably.
Some New Zealanders face many barriers to good eye health. One of these barriers could be the distance they must travel to reach services. To make eye health services more accessible, we need to understand which communities have furthest to travel, especially when those communities may already be under resourced.
In 2022, Community Eye Health researchers published their research reporting how far New Zealanders need to travel to reach their closest eye care provider. The research showed that people living in the most deprived areas of New Zealand sometimes have the longest distances to travel to eye clinics. To achieve equity in eye care, we need to make these services more accessible.
What was the aim of this research?
The aim of this research was to find out how far people need to travel to eye clinics (optometrists and ophthalmologists) across Aotearoa New Zealand. The researchers also identified communities in the most deprived areas that were more than 50 kilometres from eye clinics, because these communities might benefit from closer services.
What did we do?
To understand how far people travel for eye health services, our researchers used data held by Stats NZ Tatauranga Aotearoa to count and locate all New Zealanders. They then used the addresses of all optometry and ophthalmology clinics in Aotearoa to calculate the travel distance—along our road network—between each clinic and the population. They also calculated the proportion of New Zealanders living more than 50 kilometres from clinics, and looked at distances for people living in different districts and levels of area deprivation.
What are the main results?
The researchers found 344 optometry, 46 public ophthalmology and 90 private ophthalmology clinics. Three-quarters of New Zealanders lived within 10 km of an optometry clinic and half lived within 10 km of an ophthalmology clinic. Nationally, approximately 1 in 35 people lived further than 50km from an optometry clinic compared to 1 in 14 and 1 in 10 living further than 50km from public and private ophthalmology. The researchers identified communities with high area-level deprivation that were more than 50km from eye health services. These communities were predominantly in Tairāwhiti and Northland, but there were also some in Whanganui, Hawke’s Bay, Bay of Plenty and Waikato.
Citation: Ramke J, Zhao J, Wilson O, et al. Geographic access to eye health services in Aotearoa New Zealand: which communities are being left behind? Clin Exp Optom. 2023;106:158–64. doi: 10.1080/08164622.2022.2102410
A collaboration between the Fred Hollows Foundation and The University of Auckland’s Centre for Pacific and Global Health and School of Optometry and Vision Science aims to assess the state of eye health in the Pacific using locally-driven research.
