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 Open14, e081123 (2024). Read the published protocol here.
Members of the Community Eye Health Team on the first day of the Whakaaturanga Rangahau Wiki Hauora (Health Week Research Expo) at Kia Aroha Campus: Left to right: Joanna Black, Jaymie Rodgers, Sachi Rathod, Jacqui Ramke, Telusila Vea
In May 2024, the Community Eye Health team took part in the Whakaaturanga Rangahau Wiki Hauora (Health Week Research Expo) at Kia Aroha Campus in South Auckland.
Kia Aroha school offers a learning approach that encourages Year 1 to 13 students’ Māori and Pacific cultural identify. As an initiative of Iwi United Engaged—an organisation committed to advancing Maori health and wellbeing—the Health Research Expo aims to bring together health research with tamariki and their whanau within the wider community.
The event was engaging for both students and the visiting kairangahau (researchers), with over twenty different interactive displays on offer. Over the three-day event, the Vision Bus Aotearoa staff and students provided free vision screening services and follow-up care to Year 9 children, alongside other wellness checks. Meanwhile, other Community Eye Health team members were busy engaging with tamariki about eyes and vision, and the students were excited to take home their own pair of 3D glasses and some information packs about “eye health”.
We thank Kia Aroha school for inviting us to participate in this event, and we hope to see you again next year.
Renata is renowned for her work in indigenous eye health in Aotearoa. Her presentation titled “Indigenous Voice from Aotearoa – A kōrero about what we can learn from one another.”was well received by the 240 delegates, including the more than 100 First Nations representatives from all corners of Australia.
The conference served as a valuable platform to promote equitable outcomes for Aboriginal and Torres Strait Islander communities. The conference theme, “Our Vision in Our Hands: Finding Our Voice,” emphasised the importance of emerging and future First Nations leaders while acknowledging our current leaders’ and esteemed Elders’ pivotal previous work.
During her presentation, Renata delved into the similarities and differences between Aboriginal & Torres Strait Islander and Māori cultures, explored the role of Te Tiriti, and highlighted the vital role health practitioners play in achieving equitable outcomes for Indigenous Peoples.
Overall, the National Aboriginal and Torres Strait Islander Eye Health Conference proved to be a momentous occasion, fostering collaboration and understanding among delegates, and paving the way for future progress in achieving equitable outcomes for all.
See here for a detailed summary of the National Aboriginal and Torres Strait Islander Eye Health Conference 2023.
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 May 2023, Renata Watene was honoured as the first International Keynote Speaker at the prestigious 
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.
