Aucklanders with eye conditions including cataracts and glaucoma could soon get similar care no matter which of the city's three DHBs they are served by.
Counties Manukau, Auckland and Waitematā DHBs have confirmed work on merging ophthalmology services, which would reduce huge differences in how people are currently treated, according to where they live.
Cases of so-called "postcode" care previously detailed by the Herald include cataract patients in Counties Manukau having to give up driving and struggling with everyday activities, and still not meeting the threshold for surgery. Those same patients would have their cataracts removed if they lived up the motorway in Auckland central.
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Those differences could soon be lessened. An Auckland DHB spokeswoman said the region's three DHBs were working "to establish a pathway for regional ophthalmology services, in alignment with the northern region long-term investment plan".
"As this is still in the development phase, and future arrangements are not confirmed, we are unable to provide further comment at this time."
Demand for eye services has boomed as Kiwis age and sicken with conditions including diabetes, which if not well controlled can destroy sight. New treatments such as injections for age-related wet macular degeneration have saved the sight of tens of thousands, but can be needed monthly and have put huge strain on resources.
DHBs including Southern and Counties Manukau have been particularly affected. The Herald previously reported on the case of an 11-year-old girl in South Auckland who went blind in one eye after her case was buried amid a huge backlog.
The situation in Auckland has been called by hospital ophthalmologists a "economic and largely racial divide" through the middle of the city, with those to the south suffering worse treatment.
Dr Peter Hadden, chair of the New Zealand branch of the Royal Australian and NZ College of Ophthalmologists, said clinicians had been pushing for a regional service.
This was hampered by the DHB structure, and even if achieved there would still likely be differences. For example, currently Auckland and Waitematā DHBs use the same ophthalmology department, but it's still easier to get cataract surgery if you live in central Auckland.
However, Hadden said those in South Auckland faced a much worse situation.
"There is still a postcode lottery for cataract surgery ... essentially in ADHB and Waitematā DHB you have to be nearly going to lose your licence for driving before you can get surgery, but in Counties Manukau DHB you have to have lost your license."
There were also differences in overdue follow-up numbers. However, the situation in Auckland was far better than in some other regions, particularly Southern DHB.
"The overdue follow-ups had been reduced a couple of years ago using one-off funding for extra after-hours clinics, for instance, but are now rising again as infrastructure to continue to see increased numbers had not been put in place," Hadden said.
Each of the country's 20 district health boards decide their own threshold for cataract surgery, set according to demand and capacity. Patients are given a priority score from 0 to 100, based on clinical and social need.
People who don't meet the threshold are sent away, and don't show on waiting lists. Those that clear the lofty thresholds get surgery within four months. A Herald investigation last year found big differences in local thresholds for cataract surgery: a priority score of 45 out of 100 got surgery at Auckland DHB, but 61 points were needed for Southern DHB residents.
The NZ Association of Optometrists (NZAO) has called for an end to unequal access , saying the situation was affecting people's quality of life, and ability to do everyday activities like move around safely, read or do the crossword.
That concern was shared by ophthalmologists, Hadden said.
"Clinicians around the country feel that the differences in access to care is unfair but the current structure of individual DHBs commissioning differing levels of care makes it very hard to change.
"The Ministry of Health is aware of this problem and there are people at a high level who are promising to address it."
The DHB model - and the differences in care it produces - will be a focus in a wide-ranging review of the entire health system, chaired by Heather Simpson. An interim report is due by the end of July.