Land of the Long White Cloud: The Spectrum of Uveitis at a Tertiary Referral Center in New Zealand.

PURPOSE: To investigate the patterns of uveitis at a tertiary referral center in New Zealand. METHODS: Retrospective data were collected for 1260 patients presenting to uveitis clinics in Auckland, New Zealand, between January 2008 and April 2014. Demographics, disease characteristics, and uveitis subtype were analyzed for all patients. RESULTS: Among 1148 patients, 70.3% had anterior uveitis. The most common diagnosis causing anterior uveitis was HLA B27-associated disease. Toxoplasmosis was the most common cause of posterior uveitis, and sarcoidosis featured prominently in cases of panuveitis. Infectious etiologies represented 19.6% of all cases. Ethnic variations were noted, such as an increased prevalence of panuveitis in Pacific Islanders, TB-related uveitis in Indian patients, and Posner-Schlossman uveitis in East Asians. Patients over the age of 60 showed an increased prevalence of herpetic anterior uveitis and drug-induced uveitis. CONCLUSIONS: New Zealand has a multicultural population with a wide spectrum of ocular inflammation that varies with ethnicity and age.

The impact of a glaucoma nurse specialist role on glaucoma waiting lists.

Over the last two decades there has been an increasing demand on health care services. This has led to increased waiting lists and waiting times to access public hospital services. In ophthalmic practice an aging population and technological advances have been major contributors to this situation. The challenge for health care providers is how to manage waiting lists within the resources provided and targets set by Elective Services, a department of the Ministry of Health (MoH). The Ministerial Taskforce on Nursing (1998) highlighted that nurses are an underutilised resource. Subsequent to the Ministerial Taskforce, the availability of interim funding from Elective Services and a skilled speciality nursing workforce the Ophthalmology Department at a large metropolitan hospital was able to implement an advanced nursing role with respect to glaucoma management. Early diagnosis is important in reducing the risk of permanent visual impairment from primary open angle glaucoma; therefore the length of time to diagnosis can have long term implications for the patient. Patients for the 'nurse-led' glaucoma clinic were recruited from specific categories of glaucoma patients on the waiting list. An audit of the impact on the waiting list was undertaken periodically over a two year period. The audit following the introduction of the clinical nurse specialist clinic shows a marked reduction in waiting list numbers and length of time waiting for first specialist assessment for glaucoma. The implementation of this role proved to be successful and has subsequently become a permanent nurse specialist position in the ophthalmology department.

What do people with glaucoma know about their condition? A comparative cross-sectional incidence and prevalence survey.

PURPOSE: To assess and compare glaucoma knowledge between patients with established glaucoma, newly diagnosed glaucoma and the general population. METHODS: 208 glaucoma patients, 100 newly diagnosed glaucoma patients from three clinical centres and 100 controls from non-ophthalmology outpatient clinics, were recruited and completed a validated self-administered true/false questionnaire assessing glaucoma knowledge. Demographic data were also recorded. Glaucoma knowledge score, out of a maximum of 22, and odds ratios (OR) with 95% confidence intervals (CI) of survey characteristics associated with falling in the lowest quartile of the overall knowledge score was evaluated for each study group. RESULTS: Established glaucoma patients had (median 17, interquartile range 15-19) marginally but significantly (P < 0.05) greater glaucoma knowledge scores than new patients (median 16, interquartile range 13-18). Both of these groups scored significantly better than the control population (median 13, interquartile range 10-14, P < 0.05). Significant misconceptions regarding glaucoma include: 80% of all participants thought that topical medications could not have systemic side-effects, 48% of established glaucoma patients believed symptoms would warn them of disease progression. One-third of new patients considered blindness to be a common outcome of having glaucoma. For established patients, factors associated (P < 0.05) with a lesser likelihood of scoring in the lowest quartile of the total score included having family (OR 0.33, 95% CI 0.11-0.98) or friends (OR 0.28, 95% CI 0.06-0.97) with glaucoma, being referred by an optometrist compared with general practitioner (OR 0.21, 95% CI 0.08-0.57), speaking English at home (OR 0.13, 95% CI 0.04-0.49) and being seen in the private health-care sector (OR 0.13, 95% CI 0.04-0.42). CONCLUSION: Patients with established glaucoma have only slightly greater knowledge than newly diagnosed patients, with both patient groups harbouring significant misconceptions regarding glaucoma. Educational programmes and material should be tailored to address these misconceptions.