Eyes wide open to sight challenges in rural areas

Rural health optometry student Nathan Lloyd is thriving in a profession he likens to detective work.

Problem-solving has proved to be an integral part of eye care for the final year student at Waipapa Taumata Rau, University of Auckland.

“You try to figure out what’s causing the problem and how you can help,” Nathan says. “Sometimes patients don’t even know there’s a problem, and you find it incidentally. You also get to use some cool equipment, which I find fascinating.”

Nathan spent six weeks on placement at a community optometry clinic in Kerikeri as part of the Te Takapau Wānanga, the Hokianga-based Rural Health Interprofessional Programme (RHIP). The programme provides students with first-hand experience in rural healthcare while living and working with peers from a range of health disciplines.

Optometry blends problem-solving with patient care, Nathan says, whether it’s removing foreign objects from patients’ eyes or uncovering the cause of blurred vision. Eye injuries among farmers, agricultural workers and labourers prove to be common.

One memorable experience was removing a tiny metal fragment from a tradesman's eye, marking the first time he had performed the procedure on a patient.

The tradesman had decided not to wear safety glasses while using a grinder to cut metal, because the task would only take two minutes, Nathan says. A metal shard flew into the man’s eye.

"Treating the injury was nerve-wracking at first, but once I followed the process, it became really rewarding,” Nathan says. “Getting the tools out and removing the fragment was quite cool, and a really good learning experience."

He recalls helping a woman who came in expecting a prescription for new glasses but was astonished to learn that severe dry eye was causing her vision to fluctuate and blur. “We had to hone in on this issue before we could prescribe her spectacles,” he says.

“She was impressed with how well her eyes were feeling after. She had no idea she was just putting up with this horrible, gritty sort of irritated eyes constantly and had adapted to that feeling.”

Patients often travelled long distances for appointments, with some trekking from the Far North to Kerikeri and others facing painstaking hours of travel to reach specialist hospital services, Nathan says. Some are forced to rely on family members for transport because it is unsafe for them to drive after treatment.

“It really opened my eyes to some of the barriers people face accessing healthcare in rural communities,” he says.

“The main thing was just how much more complicated it was for people to seek healthcare and the access barriers that they have.

“You realise how important it is to make the most of every appointment, so you want to do as much as you can while they’re here.

“We’re almost like a mini eye hospital.”

The variety of conditions and greater level of responsibility meant Nathan often worked under supervision through complex cases from start to finish, assessing patients, narrowing down possible causes and determining the best course of action.

“It's kind of on you to figure it out on the spot,” he says.

“There’s a real satisfaction in working through the whole troubleshooting process, figuring out the diagnosis and knowing how you can help that person.”

Dr Jaymie Rogers, Rural Optometry Academic Lead at the School of Optometry and Vision Science, says more optometry students are taking part in RHIP as awareness grows of the important role eye health plays in rural communities.

“These placements give students the opportunity to learn about rural healthcare provision alongside other health students from different disciplines, experience rural practice firsthand and better understand the needs of rural communities.”

Rogers says the programme helps prepare future optometrists for practice beyond New Zealand's main urban centres.

The University of Auckland trains New Zealand’s future optometrists through the country’s only professional optometry degree. Many graduates go on to provide eye care in rural and regional communities where access to care can be limited.

For Nathan, the placement has reinforced his love of rural practice and opened the door to his dream job.

“Small-town New Zealand is where I want to be.”

A referral from his mentor in Kerikeri helped secure a graduate optometrist role in New Plymouth, where Nathan will launch his career after graduation.