Dr Nic Johnston operating during the latest Covid-19 lockdown, with remote support from Glaukos’ Chris Money on monitor

Invercargill-based ophthalmologist Dr Nic Johnston recorded a Kiwi first in the last lockdown, becoming the first eye care professional to be trained and supported remotely through a single list of 12 patients waiting for dual cataract and glaucoma-control surgery.

Auckland’s second lockdown prevented Glaukos’ senior regional business manager Chris Money from visiting Invercargill to support Dr Johnston’s first surgeries implanting the iStent inject, Glaukos’ trabecular microbypass stent, designed to lower intraocular pressure by providing a direct channel between the anterior chamber and Schlemm’s canal.

Not to be thwarted, and not wishing his vulnerable Southern District Health Board (SDHB) patients to be forced to wait any longer for their much-needed surgery, the SDHB theatre team rigged up a system, so Money could attend virtually.

“I had my colleague Dr Ahmed Sadiq, who had inserted some iStents prior to moving from the UK, in the morning and Chris connected via an iPad,” explained Dr Johnston. “We positioned Chris so he could see my hands and the video screen from the microscope. It worked well as Chris was able to offer advice about technique changes to improve visualisation and ease of implantation.”

Dr Johnston said he selected the iStent for his patients as they were all elderly, had significant cataract and poorly controlled glaucoma, and the complications of trabeculectomy would likely outweigh the benefits. “The iStent was easy to use once you had sorted out a good view. The one thing was trying not to over implant the device which will be improved with the new iStent W (see related story).”

The iStent inject is funded through the public system and most health insurers in New Zealand but not the largest, Southern Cross, which Dr Johnston described as a pity. “It means that we will be either doing more extensive surgery with greater risks or sending them into an already stretched public system even though they have insurance.”

Money said it was great to see Dr Johnston’s resourcefulness despite the pandemic. “Nic went out of his way to help the eye care patients of Invercargill to assure no more delays despite the latest lockdown levels.”