Seventy-year-old Peter Marsh found out the hard way that where you live in New Zealand could determine how well you can see.
When he and his wife Margaret moved to Tauranga last year he assumed sight-saving treatment for his eye condition would continue, just as it had at Greenlane Clinic in Auckland.
He was shocked to find out he does not meet the criteria to receive publicly funded Avastin injections in Tauranga - though he did in Auckland.
"We were gobsmacked," Mrs Marsh said.
They were told Mr Marsh would have to pay almost $800 per injection out of their own pocket or get private health insurance - unaffordable for the retired couple.
It had been 18-months since Mr Marsh's last Avastin injection in Auckland and he said his eyesight was deteriorating.
"If I look at people's faces it's like looking in one of those fun-fair mirrors - it's all distorted. I've just got peripheral vision now really," he said.
He described his vision like looking at a giant crossword where all the lines in the middle became "squiggly" and merged into an amorphous mass.
Mr Marsh said people in the Bay were essentially going blind because of under funding - "if you can't pay you can't stay".
Tauranga Eye Specialists ophthalmologist Andrew Thompson's report Where you live can determine how well you can see found access to publicly funded Avastin injections varied widely between health boards across the country.
The Bay of Plenty District Health Board was found to underfund Avastin treatments.
"If somebody comes in to our clinic privately, they can get whatever they want, more or less. If they come through the public system we have a certain number of Avastin treatments we can give a month - and we can't treat everybody," Dr Thompson said.
Each health board around the country individually determined how much funding would go to Avastin treatments for conditions like macular degeneration.
Recently the Bay health board upped its number of funded Avastin treatments by 225, to a total 968 Avastin procedures per annum but according to Dr Thompson there were 1025 Avastin injections needed for macular degeneration alone.
He arrived at this number by multiplying the number of patients with wet macular degeneration by the average number of injections required per year.
Tauranga Eye Specialists were able to treat almost all of macular degeneration patients with Avastin but there was no funding to treat other sight-loss conditions like branch retinal vein occlusion or macular edema due to diabetic retinopathy which would benefit from Avastin.
"We're here for the patients and want the best for them but our hands are tied by funding," Dr Thompson said.
When there was no funding people were forced to either pay out of their own pocket - more than $700 per injection and most patients required about six injections per year - or lose their vision.
To try and manage the under funding issue Tauranga Eye Specialists set clinical criteria - which Mr Marsh did not meet.
Where you live in the country should not matter, Dr Thompson said.
"I personally don't think people should have to pay, I think if you can get it at one DHB you should be able to get it in another," he said.
"If you lived in Timaru you could get twice as many Avastin treatments as here."
Dr Thompson said the cost of blindness far outweighed the cost of treatment.
"The government will pay more repairing your hip fracture that you got because you fell over because your vision is poor."
Dr Thompson said funding for Avastin was a huge problem as population grew in Tauranga and more retirees came to the city.
"For equitable access to Avastin treatment there needs to be a national planning strategy from the Ministry of Health.
"This isn't a third world country, everyone should have the same access no matter where you live."
BOPDHB business leader surgical, anaesthesia and radiology services Bronwyn Anstis said the recent increase in the number of funded Avastin injections was to support improved publicly-funded access to the treatment.
She said a range of eye conditions that had the potential to benefit from Avastin treatment, it was important to ensure those with the highest clinical need were given priority.
Ms Anstis said having the same prioritisations criteria used in all health boards around the country would help ensure fairness to access to Avastin.
WHAT IS AVASTIN
- Avastin is an anti-Vascular Endothelial Growth Factor (anti-VEGF) agent used to treat wet macular degeneration among other eye conditions
- NZ has the lowest public funding of anti-VEGF drugs of all the OECD countries
- Funding for Avastin is determined autonomously by each health board rather than by the Ministry of Health directly
- DHBs loosely adhere to a standardised intervention rate of 40 injections per 10,000 population- which fails to account for difference in the rate of macular degeneration between DHBs
WHAT IS MACULAR DEGENERATION
- An age-related chronic eye disease affecting people over the age of 45 years
- Results in progressive loss of central vision while leaving peripheral vision intact
- Two forms, dry macular degeneration is more common and is slowly progressive while wet, is more severe and without treatment can result in sudden loss of vision
- MD is the leading cause of vision loss in people over 50 years
- MD is more common than dementia and half as common as diabetes