You are not permitted to download, save or email this image. Visit image gallery to purchase the image.
The latest revelations around ophthalmology pressures at the Southern District Health Board are confronting, and the problems are only part of the iceberg nationally.
Earlier this week, this newspaper reported patients were going partially blind while they waited for SDHB appointments. The 30 affected patients identified in the 2015-16 year are in addition to four patients identified in an adverse events report a year ago. Six of the 30 have ''severe'' loss of sight.
Problems with the service in Southland had been identified previously under the SDHB (before members were sacked and replaced by a commissioner) and resources supposedly allocated there. However, it appears the situation there has worsened, in addition to problems surfacing in Dunedin.
It transpires other DHBs are facing similar backlogs.
That is alarming. Time is of the essence in so many medical cases. Speedy diagnosis offers more chance for timely treatment, which in turn offers a better prognosis.
Fixing or managing problems can prevent issues compounding, and alleviate financial and physical pressures on the health system further down the line.
Losing one's sight must be among the most frightening experiences. It is stressful for anyone requiring any form of surgery or medical intervention to have to wait, let alone for eye issues.
Sufferers may be in pain and discomfort, limited in mobility and ability. For many, treatment will transform their lives. Hard as it is, they can at least tell themselves the wait will be worth it.
But for those who know their condition at its endpoint is irreversible, being told to ''be patient'' (as eye patients at the SDHB have reported) is surely adding to the stress.
It has transpired some patients only received appointments after they or their GPs complained about the lengthy wait. Others are still languishing.
Have the Government and the SDHB (the problem appears to be worst in the South) taken their eye off the ophthalmology ball? Has there been too much focus on age-related macular degeneration at the expense of other chronic eye problems?
Is overall health funding and planning simply not keeping pace with societal changes and requirements? And, despite assurances to the contrary, is the South suffering from not having board members who should be the eyes and ears of their community and who - in this instance - could have followed up on the work begun to address the Southland backlog?
The senior doctors' union and the Royal Australian and New Zealand College of Ophthalmologists say problems highlighted in the SDHB are widespread throughout New Zealand and the Ministry of Health was warned of the increasing inability to meet demand a year ago and has been slow to act.
Critics also say scrapping the National Health Committee (which had started to examine ophthalmology pressures) was a backward step.
The Ministry of Health says the backlogs are a result of advances in treating macular degeneration which require more resources. On the one hand, this is reassuring; patients have better outcomes nowadays, yet that is of no comfort to those missing out because supply cannot meet demand.
And there is clearly a flow-on effect to other areas of the service as the case of a young Gore man with juvenile glaucoma who went blind in one eye while on the waiting list has illustrated.
In response to the issue in Parliament, Health Minister Jonathan Coleman said there had been a need to ''get in and get involved'' and cited the sacking of the SDHB and appointment of a commissioner in June last year.
Commissioner Kathy Grant has said she has confidence in SDHB medical oversight and governance, yet the problem is such that the board is prepared for more cases of harm to emerge and has notified more than 4600 patients they have been identified as being overdue for appointments.
This all hardly inspires public confidence, particularly given recent history. Actions will speak louder than words, and health boards and the Government will know many eyes are trained keenly on their next moves.