Ophthalmology Outreach: The pursuit of greater eye health for all

Last year, the Griffith Base Hospital Ophthalmology team was awarded a Murrumbidgee Local Health District (MLHD) Excellence Award for its project ‘Saving Sight is our Vision’ in the ‘Keeping People Healthy’ category.

In 2021, the project was established to improve access to eyecare services for both Indigenous and non-Indigenous people living in the MLHD.

Leading the team with his colleague and fellow ASO member Dr Dominic McCall, Associate Professor Geoffrey Painter shares how the project came to be — and you’ll discover, as we did, this is a larger story about the shared pursuit to advance eye health for all.

Long before the Griffith project, Geoffrey has been part of the charity Foresight Australia, providing eyecare to numerous underprivileged communities in the Asia Pacific region since the mid-1990s.

China, the northern Philippines, and the Solomon Islands have set the scene for numerous visits to upskill local healthcare teams and deliver sight-saving eye surgery to communities in desperate need.

Geoffrey shares that back-to-back trips to the northern Philippines over the past decade have been underpinned by a sustainable model.

“The model not only addressed waiting lists and provided specialised surgical care, but it also equipped local medical professionals and health services with the necessary training to visit outlying communities and identify people who were going blind from cataract that could be treated through surgery,” he said.

Unbeknownst to the team, this training would soon build the framework for the Griffith project, at a time when the coronavirus pandemic made the world take pause. On the back of successful trips in 2018 and 2019 — that included ASO members Dr Dominic McCall, Dr Sara Booth-Mason, Dr Richard Symes, and the late Dr Con Moshegov — the team were preparing to return in 2020.

When borders closed due to the coronavirus pandemic and travel interstate — let alone overseas — was not possible, the next visit to the Philippines was on hold. Foresight Australia decided to instead investigate how it could help Indigenous communities in New South Wales (NSW).

With the support of NSW Health, Griffith was identified as an area of need. Geoffrey, along with the Chief Executive Officer and Director of Nursing at Chatswood Private Hospital, Kerrie Legg, went to Griffith and established the Griffith Ophthalmology Project.

Believing the training model that was applied in the northern Philippines was also appropriate in the MLHD, a programme was developed to train Aboriginal Health Care Workers in ophthalmic screening.

Geoffrey recalls that this was essential, as during the course of the coronavirus pandemic, many Indigenous Australians living in regional and remote communities had been isolated and were overdue for eye checks.

After being asked by NSW Health to help reduce the surgical waiting list, and with the retirement of the local ophthalmologist — who had provided a long-standing ophthalmology service to Griffith — the initial focus needed to shift to establish a Department of Ophthalmology.

Griffith Base Hospital and the MLHD made this possible by purchasing all the retiring doctor’s equipment and transporting what was needed from Wagga to set up the clinic.

It is now one of the few public eye clinics in regional Australia. In early 2022, the team made its first clinical visit to Griffith to establish the surgical and clinic services that exist today. This was achieved with the assistance of Gordon Eye Surgery’s Business Manager, Donna Glenn.

The team visits every four weeks with usually two ophthalmologists, and on occasion, an additional oculoplastic surgeon. In a testament to public-private partnerships, Gordon Eye Surgery provides an orthoptist while Chatswood Private Hospital — with the support of Kerrie Legg, and PresMed Australia Chief Executive Officer, Matt Kelly — supplies an accredited RANZCO registrar to the team.

As Geoffrey reflects, “they [RANZCO registrar] get valuable experience in regional and Indigenous ophthalmology along with extra surgical experience”. The lives of many have been changed since the trips to Griffith began.

During its three-day visits, the team undertakes numerous consultations and intravitreal injections for conditions such as macular degeneration and diabetes as well as cataract surgery. Geoffrey says this is keeping the surgery waiting list to about four months, which is significantly reduced from a high of 15 months when the outreach visits first commenced.

He also shared that Foresight Australia has remained committed to its original training concept. The charity developed a four-day ophthalmology upskilling workshop for Griffith Aboriginal Medical Service (GAMS) as well as western MLHD doctors, nurses, and Aboriginal healthcare workers.

In addition to Geoffrey and Kerrie, Dr Dominic McCall and Dr Sophia Moshegov serve as workshop tutors. Four workshops have been delivered since October 2022, two of which have been funded through a $35,000 grant from the Australian and New Zealand Eye Foundation (ANZEF) to extend the project’s reach and impact — and there’s a third planned in early 2025.

Broader collaboration also has had a role to play in helping reach more people and over a larger geographical footprint with the team working with local and visiting optometrists in the district.

Looking to the future, Geoffrey highlights a full-time ophthalmologist on the ground would be ideal to support a population of 50,000 people living across the western MLHD.

“The project is an example of a high quality sustainable model that can continue to deliver with help from everyone and may be applicable to other regional centres in Australia,” he said.

“We have shown how collective support — such as Foresight Australia, ANZEF, state and federal governments, Gordon Eye Surgery, and Chatswood Private Hospital — along with support from like minded ophthalmologists and staff can collectively deliver quality outcomes.

“Ultimately, we feel we are providing a good service to the local community.”

With a desire to continue to do more and reach more people, Geoffrey said the objective is to continue to expand the training and project’s geographic exposure.

The recent donation of a portable retinal camera for diabetic screening by Turramurra and Griffith Rotary clubs has strengthened GAMS’ Passport to Better Health project.

“Currently screening is concentrated around Griffith, but in 2025, the Passport to Better Health project will expand screening to the whole of southwest NSW,” he said.

“If we can expand patient screening, this will funnel patients with eye problems into the nearest suitable eyecare service and would mean that more remote communities would have access to quality eye screening.”

Geoffrey is not alone in his passion, with a significant number of Australian ophthalmologists dedicating their time to similar outreach projects and initiatives both locally and overseas.

The inaugural ASO International Eye Care Mission to Vietnam next September is an opportunity for such like-minded individuals to come together and venture onto the frontlines of eye surgery in Vietnam.

With the support of ASO member A/Prof Nitin Verma and ASO Vice President A/Prof Ashish Agar, you can expect wet labs, local hospital visits, and presentations on the future of ophthalmology.

Creating and cultivating careers — There’s more to A/Prof Geoffrey Painter than meets the eye.

In addition to changing the lives of patients, Geoffrey has played a pivotal role in securing funding for an accredited RANZCO ophthalmology trainee position in private practice.

Funded through the Specialist Training Programme from the Federal Government via RANZCO, it is based at Chatswood Private Hospital with time spent at Gordon Eye Surgery and other practices.

Added into the mix is a generous donor — the late Dr John Knight and the MedAid Foundation — which covers the cost of 80 surgery cases to be performed at Chatswood Private Hospital by the registrar with IOLs additionally donated by Hoya.

“These donations help our program to secure accreditation from RANZCO, and with that accreditation we can then obtain funding from the Federal Government,” Geoffrey said.

This past August marked the initiative’s tenth anniversary. In that time, the programme has enabled completion of training by up to six ophthalmologists — and counting — who are making a difference in the community.

Without this funding initiative, they might never have had the opportunity to train as an ophthalmologist. It is a timely reminder of the importance of public-private partnerships and how they can enhance healthcare services for the better.

Currently working alongside Geoffrey in this position is first year trainee, Dr Elizabeth Wong who describes her journey to date as an “enriching learning experience”.

“I have not long finished a public rotation at Liverpool Hospital, where the pathology was amazing and team and consultants supportive — and just exposed to ‘everything eyes’,” she said.

Working with A/Prof Painter in the private sector has been very different.

“I think it is rare for trainees to experience and be exposed to what private practice actually looks like so early on, or even at all, during training,” Elizabeth said.

“You become familiar with how private rooms work and gain exposure to consultants directly, including operating with and learning their techniques through mentoring and advice, which is quite different to the other terms that I have done.”

Fondly reflecting on her time so far with A/Prof Painter, Elizabeth shares “he is a really good teacher”.

“He takes time out of his schedule to go through everything, including the fundamentals, which I think is often assumed knowledge,” she said.

“When you start training anywhere else, the first question is often “did you see this sign or that sign”.

“Whereas, with A/Prof Painter, he commences from the very beginning, which I have not really experienced anywhere else.”

Looking to the future, Elizabeth has her sights on the areas where she could make the most impact — and it would seem her experiences in the Griffith Eye Clinic have made a lasting impression.

“I have always been fascinated by retina and believe it is helpful to manage anterior and posterior pathologies, so I am quite interested in surgical retina, medical retina, and uveitis,” she said.

“I am also eager to do outreach — whether that be to remote or regional communities or even overseas.

“I think having a good understanding of general ophthalmology and then having a sub-speciality interest that is applicable to overseas populations would also be helpful.”

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