Assessment of variations in access to a tertiary first specialist assessment keratoconus and crosslinking service in Auckland

Lize Angelo, Akilesh Gokul, Mohammed Ziaei, Simone Freundlich, Charles McGhee

Meeting:  2022 RANZCO


Date:      -


Session Time:      -

Purpose: Determine the barriers to gaining access to the crosslinking service in Auckland particularly among M-aori and Pacific Peoples.

Method: Data from patient records at Auckland District Health Board currently being collected prospectively over 12 months includes; age, gender, body mass index, ethnicity, New Zealand Deprivation score of residence (NZDep; area based measure of socioeconomic status, 1 = low deprivation – 10 = high deprivation), disease severity (maximum keratometry and thinnest corneal thickness), attendance, distance travelled to clinic and visual outcomes.

Results: Twenty-nine subjects seen over a 3-month period had a mean age 23.5 ± 1.1 years, mean body mass index 29.8 ± 4.9 and 50% were female. The mean distance travelled was 12.9 ± 9.5 km and mean NZDep was 7.3 ± 2.9, with an attendance of 47.9%. Pacific People consisted of 44% of the population, M-aori 31%, Europeans 22%, Asian 3% and MELAA 0%. Mean visual acuity at attendance was 0.264 ± 0.06 logMAR (20/36.7 snellen). There was a significant difference in total attendance between ethnicity with Pacific people having the lowest rates (21.43%) and Asians the highest rates (100%) (p = 0.019), with no significant difference in time from referral to offered or attended appointment. There was no significant difference between ethnicity and NZDep, or ethnicity and age of presentation, severity of disease or visual acuity.

Conclusion: A low rate of attendance was seen in this patient cohort attending a keratoconus clinic. Most absentees were Pacific People and M-aori, despite consisting 75% of our clinic population. Further studies are required to investigate the underlying reasons for poor attendance.