CORPORATE OFFICE
Level 1
32 Oxford Terrace
Telephone:  0064 3 364 4160
Christchurch Central

          Fax:  0064 3 364 4165
CHRISTCHURCH 8011

        [email address]

22 September 2020

Renoh Chalakkal

Email: [FYI request #13621 email]

Dear Renoh

RE Official information request CDHB 10403

I refer to your email dated 31 August 2020 requesting the following information under the Official
Information Act from Canterbury DHB. Specifically:

1.  How are the ophthalmology referrals prioritized?
Ophthalmology receives referrals via E-triage and paper. These items are reviewed based on date
received and urgency. If the referral is flagged as acute or urgent our policy is to review same day.  All
other referrals are managed during the week as triagers have allocated time.

2. Is there any automatic referral system in place?
E triage is an electronic referral system that GPs and Optometrist use to refer into us. Currently, any
internal referrals from other department within the hospital are done via paper and we still have the
occasional external referrals on paper.  External referrers are encouraged to use electronic system.

2.  Are there any standards or operating procedures that are followed while placing referrals from
GPs/primary care providers?

All referrals received are reviewed first by our administration team to ensure the appropriate
information is attached and uploaded into our system. They are then submitted to the triaging medical
team for review. There are several Consultants who triage within the service and they have a set of
triage criteria that they follow.

Much of this information is on www.healthinfo.org.nz/ so the community is aware of what will be
accepted.  It also has some information as to how soon patients are seen based on their condition.

3.  Can private eye care providers (Specsavers/OPSM etc.) refer a patient to specialist
ophthalmologists in CDHB?

Ophthalmology will triage referrals received from all private eye care providers.

5. Can a patient consult with a specialist ophthalmologist at the ED directly without an appointment?
If not, can a GP immediately refer a patient to a specialist ophthalmologist at the hospital? Are there
any specialist ophthalmologists available at ED 24*7?

The Ophthalmology Service has an acute service which runs Monday – Friday 8:00 - 16.00. During these
times GP’s and outside referrers can contact the acute team and it will be decided as to whether the
patient needs to be reviewed in our service and the timeframe. In cases in which the patient presents to
ED directly, the ED department will triage and provide immediate care then follow the same process and
contact the acute team.

Outside of theses hours there is an acute registrar and Consultant on call who will deal with any patients
that need to have an acute Ophthalmology review.

6. What criteria are followed in prioritizing the ophthalmology referrals?

There is guidance for Clinicians on HealthPathways1.

Please refer to Appendix 1 (attached).

1 HealthPathways is designed and written for use during a clinical consultation. Each pathway provides clear and
concise guidance for assessing and managing a patient with a particular symptom or condition. Pathways also
include information about making requests to services in the local health system.  Content is developed
collaboratively by general practitioners, hospital clinicians, and a wide range of other health professionals. Each
pathway is evidence-informed, but also reflects local reality, and aims to preserve clinical autonomy and patient
choice. HealthPathways serves to reduce unwarranted variation and accelerate evidence into practice. Note: This
information is not publicly available.

7. In 2019-2020, what is the average time taken for a GP referral for different types (serious,
moderately serious, and not serious, etc.) Priorities to get an appointment with a specialist
ophthalmologist/optometrist?

The table below shows the average waiting time taken for GP referrals to reach First Specialist
Assessment (FSA), according to each referral prioritisation category.

Average Wait Time between 01 July 2019 - 30 June 2020
Prioritisation Category
Average Wait Time (Days)
Number of Patients
Immediate
5
5
Urgent
26
55
Semi-Urgent
53
166
Routine
117
327
Low Priority
30
16

8. How many specialist ophthalmologists and optometrists are practicing in CDHB separately?

There are 14 Consultant Ophthalmologists and two Optometrists practising in Canterbury DHB.

9. How many registered ophthalmologists/optometrists are there in whole New Zealand?

There are 169 registered and practising Ophthalmologists within NZ (information from Medical Council
of NZ 15/09/2020). There are 791 registered as having a current certificate within NZ (information from
optometrist and dispensing opticians board 16/09/2020).

10. Were there any steps taken by DHBs across New Zealand (or at least by Auckland DHB) to conduct
the ophthalmology clinics remotely over tele platforms so that patients get necessary eye care during
the different stages of lockdown in New Zealand?

There were 214 telehealth appointments (and 7,414 in person appointments) conducted by Canterbury
DHB during the period 1st March 2020 to 31st May 2020. This data covers Ashburton, Burwood and
Christchurch Hospitals. Although some telehealth appointments took place during this time, Retinal
Screening and Avastin appointments must occur in person.

I trust this satisfies your interest in this matter.

Please note that this response, or an edited version of this response, may be published on the
Canterbury DHB website after your receipt of this response.

Yours sincerely

Ralph La Salle
Acting Executive Director
Planning, Funding & Decision Support

APPENDIX 1
Acute Ophthalmology Assessment
Request
Christchurch Hospital Ophthalmology Department
1. Check criteria and wait times.
Seen immediately
•
Chemical burns
•
Instantaneous loss of vision, i.e. possible central retinal artery occlusion
•
Significant penetrating eye injury
•
Acute glaucoma
•
Retrobulbar haemorrhage
Seen within 24 hours
ACT - NOT PUBLICLY AVAILABLE
•
Red flag symptoms or signs
•
Painful red eye
•
Sudden vision loss
•
Infection threatening visionINFORMATION
•
Painful acute diplopia
•
Trauma
•
Surgical trauma to ocular structures
•
Penetrating eye injuries or blunt trauma
•
Corneal foreign bodies
•
Ortbital blowout fracture
•
Corneal abrasions
•
Sudden vision loss
•
Ischemic ocular conditions, e.g. temporal arteritis
•
Optic neuritis
•
Some retinal detachments
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•
Vitreous haemorrhage
•
Painful red eye with loss of vision
•
Corneal ulcer

•  Iritis
•  Herpes zoster / simplex
•  Neurological conditions
•  Painful acute diplopia, e.g. third nerve palsy
•  Disc oedema
•  Other cranial nerve palsy
•  Acute field defects
•  Infective conditions
•  Orbital cellulitis
•  Acute dacryocystitis
2.  Contact the on-call ophthalmology registrar, phone 0800-472-424 and record the advice
given under "reason for referral".
3.  Give the patient Acute Referral Clinic information.
4.  Inform the patient the ARC nurse, who sees the patients initially, will instil dilating drops
ACT - NOT PUBLICLY AVAILABLE
in the eyes if needed.
5.  Send a request via:
•
ERMS: Acute > Acute Ophthalmology Referral, or
•  fax to (03) 364-1479.
Ashburton Hospital
INFORMATION
Ashburton Hospital does not have specialist ophthalmology services but acute cases of
eye injuries and corneal foreign bodies are seen.
To request acute assessment:
1.  Contact the on-call medical officer at Ashburton Hospital, phone (03) 307-8450.
2.  Send a request via:
•
ERMS: Acute > Acute Ophthalmology Referral, or
•  fax to (03) 307-8472.
3.  Where indicated, patients will be referred on to Christchurch Hospital Ophthalmology
Department. If transferring to Christchurch Hospital for assessment, patients with eye
conditions must not drive.
Private
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1.  Contact the provider directly.
Private providers for acute ophthalmology assessment

•  Southern Eye Specialists accept acute adult ophthalmology requests.
Phone (03) 355-6397.
•  St George's Eye Care accept acute adult ophthalmology requests.
Phone (03) 375-6333.
•  Dallison Eye Specialist – some capacity on certain days. Phone (03) 355-8770 to
confirm.
•  Elder Eye Specialist – some capacity on certain days. Phone (03) 356-1512 to
confirm.
•  McKellar Eye Specialist – some capacity on certain days. Phone (03) 343-6033 to
confirm.
2.  Disclaimer
Disclaimer
The inclusion of links to websites or health providers in HealthPathways and ERMS is
not a recommendation or endorsement of any health provider, health professional, or
their services. Use of services featured in these websites is undertaken at the user's
own risk.
ACT - NOT PUBLICLY AVAILABLE
This may not be a complete list of providers with interest, skills or experience in this
area. If you wish to be added, send your contact details using the Send Feedback
button in the top right of this page.
Some providers may only take referrals by phone and are therefore not listed in ERMS.

INFORMATION

RELEASED UNDER THE OFFICIAL

Non-acute Ophthalmology Assessment
See also Retinal Screening in Diabetes.
Request
Christchurch Hospital Ophthalmology Department
1.  Check criteria:
•  Seen within 4 months.
These wait times are subject to change due to demand on the department.
Within 1 week
•  Cranial nerve III palsy
•  Giant Cell Arteritis and temporal artery biopsy. ACT - NOT PUBLICLY AVAILABLE
•  Headache with ocular symptoms or signs
•  Monocular blurred vision with distortion i.e., possible wet age-related macular
degeneration
•  New onset diplopia
•  New onset flashing lights and floaters
INFORMATION
•  Rapid onset bilateral reduced vision
•  Rapidly growing orbital tumours
•  Sudden onset unilateral ptosis
•  Suspected Horner’s syndrome
•  Suspicious choroidal lesion
•  Transient loss of vision
Within 4 weeks
•  Diabetic conditions with vision loss, e.g. retinopathy, vitreous haemorrhage
•  Rapid and marked deterioration of vision, acuity not improved with pinhole,
e.g. vein occlusion, uveitis
•  Progressive invasive cancers, e.g., intraocular malignancy
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•  Infective conditions e.g., unresponsive conjunctivitis
•  Severe impairment of visual function, e.g. bilateral cataracts with hand
movements visual acuity

•  Conditions threatening permanent damage if treatment delayed e.g.,
entropion
Within 4 months
•  Reduced vision, acuity not improved with pinhole
•  Cataracts
•  Moderately progressive diabetic conditions e.g., maculopathy, pregnancy
•  Glaucoma confirmed by an optometrist
•  Keratoconus and conditions requiring cross-linking
•  Vitreoretinal conditions, e.g. macular hole
•  Low grade non-progressive neoplasms e.g., benign tumours and low grade
BCCs
•  Infective disease e.g., chronic dactrocystitis
•  Orbital disease e.g., proptosis (displacement of globe), thyroid eye disease
•  Long standing strabismus / diplopia
ACT - NOT PUBLICLY AVAILABLE
•  Intermittent diplopia, fatiguable ptosis
•  Posterior capsule opacity
•  Drug toxicity
•  Not usually seen but potentially indicated.
Not usually seen but potentially indicated
INFORMATION
•  Ectropion without risk to vision
•  Epiphora
•  Pterygium without risk to vision
•  Pinguecula
•  Severe allergic eye disease
•  Not seen:
o  Alternative service recommended – request optometry assessment
Alternative service recommended
•  Presbyopia
•  Reduced vision, acuity improves with pinhole
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•  Prescription for glasses.
o  General practice or community management.

Conditions generally suitable for general practice or community
management unless complicated or causing significant functional
impairment:
•  Blepharitis
•  Eyelid lesions
•  Longstanding amblyopia in adult
The service accepts referrals from any medical or nurse practitioner, including private
specialists and optometrists, using processes that ensure fairness and equity.
2.  Include triage information for ophthalmology assessment.
Triage information for ophthalmology assessment
•  Presence of pain or inflammation
•  Social history including impact of the visual problem
•  Visual acuity: each eye with glasses and pinhole, as applicable
•  Previous ophthalmology contacts
ACT - NOT PUBLICLY AVAILABLE
•  Colour photos, if relevant e.g., eyelid lesions
•  For cataracts, also include the CPAC prioritisation score and the complete CPAC
PDF result. See the Cataracts pathway.
In all requests, include standard patient and referrer details.
3.  Send a request for ophthalmology assessment via:
INFORMATION
•
ERMS request forms, or
•  Ophthalmology > Ophthalmology Referral
•  Ophthalmology > Cataracts Referral
•  fax to (03) 364-1479.
4.  Depending on preferences expressed in the request, clinical need, and service capacity,
the service may offer:
•  a clinic assessment,
•  advice only,
Advice only
•  A written management plan and advice is provided, based on information
included in a referral, without seeing the patient.
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•  If referral issues can be resolved with advice only, request specialised advice.
•  an opinion-only clinic assessment for a patient unlikely to receive surgery, or
Opinion-only assessment

•  A limited number of appointments are available for a specialist's opinion for
patients who do not meet the current criteria for treatment.
•  General practitioners need to make the case why such an opinion will help
them provide continued care of the particular patient.
•  Examples might include significant symptoms in a frail person unfit for
treatment.
•  Referral letters need to identify the patient understands they are not going to
receive treatment as a result of the consultation.
•  This is a new service, and the demand and use will be measured, and a
survey of effectiveness undertaken on a regular basis.
•  a mobile surgical services appointment.
Mobile Surgical Services (MSS)
•  A private company working in partnership with the Ministry of Health and
district health boards, MSS provides low-risk, elective day surgery to rural
New Zealanders. The mobile surgical "blue bus":
•  travels through rural New Zealand on a 5-week cycle spending 3
weeks in the North Island and 2 weeks in the South Island, operating at
ACT - NOT PUBLICLY AVAILABLE
22 rural locations.
•  is a modern, fully equipped operating theatre that can operate
standalone or connected to a medical centre for essential services.
•  An anaesthetic technician and a clinical nurse leader travel with the bus, and
along with the "steerologist" (driver), coordinate the day, and oversee the local
nursing team.
INFORMATION
•  Each day, four rural nurses from the host site work on the bus in the roles of
scrub nurse, circulating nurse, and recovery and discharge nurses. Surgeons
and anaesthetists are privately contracted on a daily basis.
•  Latest bus schedule for Rangiora, Waikari, and Ashburton dates.
•  Patient information and brochures
•  For more information, see Mobile Health – Mobile Surgical Unit
Ashburton Hospital
1.  Check criteria:
•  Seen within 4 months.
These wait times are subject to change due to demand on the department.
Within 1 week
RELEASED UNDER THE OFFICIAL
•  Cranial nerve III palsy
•  Giant Cell Arteritis and temporal artery biopsy.

•  Headache with ocular symptoms or signs
•  Monocular blurred vision with distortion i.e., possible wet age-related macular
degeneration
•  New onset diplopia
•  New onset flashing lights and floaters
•  Rapid onset bilateral reduced vision
•  Rapidly growing orbital tumours
•  Sudden onset unilateral ptosis
•  Suspected Horner’s syndrome
•  Suspicious choroidal lesion
•  Transient loss of vision
Within 4 weeks
•  Diabetic conditions with vision loss, e.g. retinopathy, vitreous haemorrhage
•  Rapid and marked deterioration of vision, acuity not improved with pinhole,
ACT - NOT PUBLICLY AVAILABLE
e.g. vein occlusion, uveitis
•  Progressive invasive cancers, e.g., intraocular malignancy
•  Infective conditions e.g., unresponsive conjunctivitis
•  Severe impairment of visual function, e.g. bilateral cataracts with hand
movements visual acuity  INFORMATION
•  Conditions threatening permanent damage if treatment delayed e.g.,
entropion
Within 4 months
•  Reduced vision, acuity not improved with pinhole
•  Cataracts
•  Moderately progressive diabetic conditions e.g., maculopathy, pregnancy
•  Glaucoma confirmed by an optometrist
•  Keratoconus and conditions requiring cross-linking
•  Vitreoretinal conditions, e.g. macular hole
•  Low grade non-progressive neoplasms e.g., benign tumours and low grade
BCCs
RELEASED UNDER THE OFFICIAL
•  Infective disease e.g., chronic dactrocystitis
•  Orbital disease e.g., proptosis (displacement of globe), thyroid eye disease
•  Long standing strabismus / diplopia

•  Intermittent diplopia, fatiguable ptosis
•  Posterior capsule opacity
•  Drug toxicity
•  Not usually seen but potentially indicated.
Not usually seen but potentially indicated
•  Ectropion without risk to vision
•  Epiphora
•  Pterygium without risk to vision
•  Pinguecula
•  Severe allergic eye disease
•  Not seen:
o  Alternative service recommended – request optometry assessment.
Alternative service recommended
ACT - NOT PUBLICLY AVAILABLE
•  Presbyopia
•  Reduced vision, acuity improves with pinhole
•  Prescription for glasses.
o  General practice or community management.
Conditions generally suitable for general practice or community
INFORMATION
management unless complicated or causing significant functional
impairment:
•  Blepharitis
•  Eyelid lesions
•  Longstanding amblyopia in adult
2.  Include triage information for ophthalmology assessment.
Triage information for ophthalmology assessment
•  Presence of pain or inflammation
•  Social history including impact of the visual problem
•  Visual acuity: each eye with glasses and pinhole, as applicable
•  Previous ophthalmology contacts
RELEASED UNDER THE OFFICIAL
•  Colour photos, if relevant e.g., eyelid lesions
•  For cataracts, also include the CPAC prioritisation score and the complete CPAC
PDF result. See the Cataracts pathway.

In all requests, include standard patient and referrer details.
3.  Send a request via:
•
ERMS request forms, or
•  Ophthalmology > Ophthalmology Referral
•  Ophthalmology > Cataracts Referral
•  fax to (03) 307-8472.
4.  Depending on preferences expressed in the request, clinical need, and service capacity,
the service may offer:
•  a clinic assessment, or
•  advice only, or
Advice only
•  A written management plan and advice is provided, based on information
included in a referral, without seeing the patient.
•  If referral issues can be resolved with advice only, request specialised advice.
ACT - NOT PUBLICLY AVAILABLE
•  an opinion-only clinic assessment for a patient unlikely to receive surgery.
Opinion-only assessment
•  A limited number of appointments are available for a specialist's opinion for
patients who do not meet the current criteria for treatment.
•  General practitioners need to make the case why such an opinion will help
INFORMATION
them provide continued care of the particular patient.
•  Examples might include significant symptoms in a frail person unfit for
treatment.
•  Referral letters need to identify the patient understands they are not going to
receive treatment as a result of the consultation.
•  This is a new service, and the demand and use will be measured, and a
survey of effectiveness undertaken on a regular basis.
Private
1.  Read the disclaimer.
Disclaimer
The inclusion of links to websites or health providers in HealthPathways and ERMS is
not a recommendation or endorsement of any health provider, health professional, or
RELEASED UNDER THE OFFICIAL
their services. Use of services featured in these websites is undertaken at the user's
own risk.

This may not be a complete list of providers with interest, skills or experience in this
area. If you wish to be added, send your contact details using the Send Feedback
button in the top right of this page.
Some providers may only take referrals by phone and are therefore not listed in ERMS.
2. Send a request via:
•
ERMS: Ophthalmology > Ophthalmology Referral, or
• contact the provider directly.
Clinicians listed on:
ERMS Directory
Healthpages
Read the Disclaimer
Disclaimer
The inclusion of links to websites or health providers in HealthPathways and
ACT - NOT PUBLICLY AVAILABLE
ERMS is not a recommendation or endorsement of any health provider, health
professional, or their services. Use of services featured in these websites is
undertaken at the user's own risk.
This may not be a complete list of providers with interest, skills or experience in
this area. If you wish to be added, send your contact details using the Send
Feedback button in the top right of this page.
INFORMATION
Some providers may only take referrals by phone and are therefore not listed in
ERMS.
Offer all referral options to all patients, even if they are eligible for DHB
treatment. The HDC Code of Health and Disability Services Consumers'
Rights Regulation 1996 Clause 2 Right 7: the right to make an informed
choice and give informed consent.

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Document Outline