Dunedin School of Medicine

Clinical

Dunedin Hospital Eye Department serves a population of about 300,000 and over 20,000 people are seen annually by the service either at Dunedin Hospital Eye Clinic or at clinics in Oamaru or Alexandra.

The Eye Clinic runs two screening programmes: the Otago Diabetic Eye Monitoring Service and strabismus photoscreening.

Otago Diabetic Eye Monitoring Service

The Otago Diabetic Eye Monitoring Service (ODEMS) was established in 1983 under the umbrella of the Dunedin Hospital Eye Department, and and was one of the first such programmes in New Zealand. A mobile service to outlying rural hospitals was added in 1990. This service now monitors about 9,000 people with diabetes in the region. People with diabetes are typically referred to this service by their general practitioner and the photographic grading is overseen by an ophthalmologist. The Service runs mobile screening clinics in Queenstown, Te Anau, Gore, Clyde, Oamaru and Balclutha.

An analysis of the ODEMS in 2001 found a very low incidence of blindness in diabetic patients in the Otago region and an even smaller incidence of blindness due to diabetic eye disease in the Otago region. This study concluded that the ODEMS was contributing to the low incidence of blindness due to diabetic eye disease in Otago and Southland.

Strabismus Photoscreening

The Eye Service at Dunedin Hospital operates the only strabismus photoscreening programme in New Zealand using the Otago Photoscreener. Photoscreening is a quick and efficient screening tool for detecting strabismus, amblyopia and refractive errors at any age. Corneal reflections and retinal reflexes are assessed in the photos to detect the presence of a squint or unequal focussing. Photoscreening is used mainly with children, as they are generally more difficult to perform vision assessments on. Photoscreening takes only about 3 minutes to complete, requires no drops and is effective on children aged 5 to 6 months and older.

Photoscreening is used as a secondary screening tool following referral from a general practitioner, a Plunket nurse or a vision and hearing tester as well as a monitoring tool during treatment to follow progress.

The photoscreening programme has over 25 years of experience and is overseen by the orthoptist who analyses all the photographs. The service is available both in the Eye Clinic and in satellite clinics.

The Otago Photoscreener has been well researched. See for example:

  • Molteno ACB, Hoare-Nairne J, Sanderson GF, Peart DA, Hodgkinson IJ. Reliability of the Otago photoscreener. A study of a thousand cases. Australian and New Zealand Journal of Ophthalmology 1993; 21: 257-65.
  • Molteno ACB, Hodgkinson IJ, Hewitt CJ, Sanderson GF. The development of fixing and focusing behaviour in normal human infants as observed with the Otago photoscreener. Australian and New Zealand Journal of Ophthalmology 1992; 20: 197-205.
  • Kennedy RA, Sheps SB. A comparison of photoscreening techniques for amblyogenic factors in children. Canadian Journal of Ophthalmology 1989; 24: 259-64.
  • Molteno ACB, Sanderson GF, Hoare-Nairne J. Clinical experience with the Otago photoscreener. Australian and New Zealand Journal of Ophthalmology 1985;13: 49-58.
  • Molteno ACB, Hoare-Nairne J, Parr JC, Simpson A, Hodgkinson IJ, O’Brien NE, Watts SD. The Otago photoscreener, a method for the mass screening of infants to detect squint and refractive errors. Transactions of the Ophthalmological Society of New Zealand 1983; 35: 43-9.