New Zealand is in a unique and enviable position globally with a strong sense of collaboration, collegiality and mutual support between the eye care professions of optometry and ophthalmology,” says Academic and Chair of Glaucoma New Zealand, Professor Helen Danish-Meyer. She said reasons for this were complex – both historical and due to key individuals who have worked hard to build the relationship and trust.
INSTRUMENTAL PLAYERS IN COLLABORATION
Prof. Danesh-Meyer said the late Associate Professor Gordon Sanderson (1947-2017), a UK-trained optometrist who held senior academic positions in the Department of Ophthalmology (University of Otago), was instrumental in training a generation of ophthalmologists within NZ and throughout Australia via his coordination of residential RANZCO Examination Courses. Additionally, as a Senior Lecturer in the Auckland Optometry School he encouraged better relations on both sides of the fence.
“Interestingly, Gordon’s remarkable commitment to ophthalmology training was so well-recognised by the RANZCO College that he became the only optometrist to receive an honorary fellowship of RANZCO! His teaching and influence was widely-recognised, including the Prime Minister’s Supreme Tertiary Teaching Excellence Award,” she said.
Assoc. Prof. Sanderson and his colleague Prof. Antony Molteno, also based in Otago, noted that ultimately it requires the joint efforts of ophthalmology and optometry to work in collaboration for the best interest of patients.
He has created a nurturing environment for clinical and academic activity
Prof. Danesh-Meyer said Professor Charles McGhee, Chair of the Department of Ophthalmology in Auckland since 1999, also improved collegiality between optometry and ophthalmology. “He has created a nurturing environment for clinical and academic activity. In the early 2000s, at a time when RANZCO did not encourage optometry therapeutics, he became very heavily involved in the development, teaching and examination of the optometry therapeutics course coordinated by the Department at University of Auckland. Additionally he has mentored optometrists who have successfully undertaken clinical PhDs in the Department of Ophthalmology and worked with the Ministry of Health and local district area health boards to develop pathways for shared-care and inclusion of optometry in both the hospital and community care of patients – including a glaucoma credentialing programme at the University of Auckland.”
Institutions that have been instrumental in building this strong relationship include NZ Association of Optometry (NZAO) and Glaucoma NZ. Prof. Danesh-Meyer said many of Glaucoma NZ’s activities are directed towards empowering optometrists in their management of glaucoma and building positive, supportive interactions between the professions with web-based education, and annual Glaucoma Educational Symposiums, which focus on discussing shared-care opportunities and challenges. Local initiatives that encompass both ophthalmology and optometry in glaucoma care in the community and hospitals have also helped build strong ties.
CHALLENGES OF MANAGEMENT
Prof. Danesh-Meyer said glaucoma management in NZ is not without its challenges. “There are the tensions between areas of overlap of care and boundaries with extreme opinions still being held by small vocal minorities in both professions. The RANZCO College is in the process of drawing up guidelines for collaborative care for NZ. One of the greatest risks is that these guidelines become a divisive force rather than strengthening relations. The key in preventing this will be for the guidelines to allow optometrists who are well-trained and passionate about glaucoma care enough scope to practice in accordance to their level of training. Otherwise, the guidelines could be interpreted as a means of restricting the optometry profession from being reasonably engaged in glaucoma care of their patients. Conversely, optometry should feel comfortable knowing there is a spectrum of glaucoma care they can be involved in (and not all optometrists need to be engaged at the same level). Furthermore, they need to know that they will be supported by their ophthalmology colleagues in this process of shared, collaborative care.
“We are at a critical juncture in NZ. With an aging population, the burden of the disease of glaucoma will be larger than ever. Furthermore, we hope that with increased public awareness initiatives, the nearly 50 per cent of patients with glaucoma, who are unaware of their disease will be identified. Therefore, there is no doubt that glaucoma will be a significant, if not the major, health issue in the landscape of eye diseases. It will require the united efforts of both ophthalmology and optometry so that we can jointly prevent blindness and preserve vision.”