The Vision Bus Aotearoa (VBA) is an initiative of the School of Optometry and Vision Science that provides comprehensive mobile eye care services to underserved schools, primarily in the South Auckland region. Recently we said farewell (but hopefully not goodbye) to our two most recent VBA staff—Sachi Rathod and Germaine Joblin—as they move on to new adventures.

It’s an early start for our Vision Bus Aotearoa staff. They’ve negotiated their way through peak hour traffic towards South Auckland in a 5-metre-long vehicle carrying expensive medical equipment. Everything on board has been painstakingly secured and double checked, because anything that can roll around, will.

After they’re let in to the school by the caretaker and navigated the inconveniently sized carpark, next comes the task of unpacking, setting up, and triple checking that the bus isn’t going to roll away unexpectedly.

It’s definitely not something I love doing on a Monday morning,” says Sachi Rathod wryly. Together with Germaine Joblin, the two have been the driving force (both figuratively and literally) behind the Vision Bus activities this past year.

But Sachi clearly loves it. As a recent graduate with a developing interest in rural healthcare and paediatric optometry, working on the Vision Bus was a perfect progression along her evolving career path, and one that has given her the autonomy and flexibility that many young optometrists can only dream of. She isn’t restricted by her job title, and describes her role as optometrist, teacher, administrator, support person, and of course, bus driver.

“It’s lots of fun,” says Sachi, “You can’t just arrive on site and start work like you would in a regular optometry clinic,” she explains. “Every day presents a completely different challenge and a completely different lot of kids.”

A need for children’s eye care in Aotearoa

But it’s the challenges that the kids face that have kept the wheels on the Vision Bus rolling this past couple of years. The underlying objective is to improve learning opportunities for Kiwi children, and that starts with addressing eye health in those who may not otherwise have access to eye care.

The cause of this problem is (largely) the significant cost of eye care services in this country. While New Zealand has some public funding for children’s eye care (via the Enable subsidy), this is not accessible to everyone who needs it, and many children go to school without corrected vision. These children face additional challenges, which can follow them into their adult lives.

Germaine Joblin is the other half of the Vision Bus’s 2024 optometry staff, and she describes the most rewarding part of this role as giving children the opportunity to read, participate in class, and hopefully go on to achieve their potential.

“Being able to see the smiles on their faces when they get their glasses, oh, that’s great,” she says.

Germaine is a long-term supporter of mobile eye care services, a passion that began when completing an advocacy project for the World Council of Optometry centred around a vision bus concept. For her, the opportunity to work on The School of Optometry and Vision Science’s VBA felt more like a calling.

“I had heard about it, but I didn’t realize it was actually created and on the road. So it was just a perfect pairing,” she recalls.

Germaine spends the rest of her time in private practice optometry and caring for her child (the latter being the harder role, she laughs), but it was her prior experiences as a volunteer optometrist in Africa, Mongolia, Nepal, and the Pacific Islands that have given her an appreciation for the unmet need for eye care that exists throughout the world. Her comparison with the situation in New Zealand is striking.

“What I’ve discovered on the Vision Bus, is the need—there’s a greater need here. I’ve done a lot of volunteer work overseas but to be honest, I think a lot of that volunteer work needs to be here,” she says.

What shocked her the most is the large number of young children presenting on the Vision Bus with keratoconus—a progressive thinning of the tissue at the front of the eye—which is more typically diagnosed during the teenage years and can lead to permanent vision loss if left untreated. While New Zealand currently has no population-based data describing how many children are affected, the condition is more common in Māori children, which may lead to the growing body of evidence describing inequities in eye health. Fortunately, the treatment options are both effective and publicly funded in New Zealand, if detected early.

Bringing uncorrected refractive error into focus

Aside from the disproportionately high rates of keratoconus, the most common diagnosis given on the VBA is refractive error—a condition where the image does not focus clearly on the retina at the back of the eye, making it difficult to see clearly. Often children and their parents may not realise there is a problem.

“It’s hard to detect because a lot of children can just get away with it and not realise that they can’t see things clearly all the time,” explains Sachi. “If everything’s a little bit fuzzy at all distances and you’ve just grown-up thinking that, you’re never really going to complain.”

Germaine explains how uncorrected refractive error in children can lead to permanent vision loss because the visual system hasn’t been stimulated at any early enough age. Importantly, a type of refractive error that’s particularly common on the Vision Bus is astigmatism, which when combined with other comorbidities that encourage eye rubbing (such as eczema and allergies) can push a child towards developing keratoconus.

Regular, comprehensive eye examinations by an optometrist are important to help identify and treat these problems early in a child’s life.

Germaine believes that New Zealand needs more vision buses out in schools and communities delivering eye examinations to children who are unlikely to have access to eyecare, and who may have vision problems that are not detected by New Zealand’s national B4 School Check vision screening programme.

“The problem with the B4 school screening is it doesn’t check for refractive error or the need for glasses,” says Germaine. “That’s a big problem. The other problem is it doesn’t check for keratoconus, and that’s huge.”

Helping children to wear their glasses

While the rates of refractive error are high, fortunately this condition can usually be corrected effectively with glasses, and reducing the rates of uncorrected refractive error remains the key focus of the Vision Bus.

Children who need glasses are given their first pair free of charge via the Community Spectacle Scheme and parents are advised how to access the Enable subsidy for their child’s eye care in future. The bus is equipped with a spectacle dispensary and employs a qualified dispensing optician (Emily Benefer) so that the children with refractive error can receive the treatment that they need on site, without having to seek care elsewhere. Germaine describes the selection of glasses “pretty groovy”.

However, building trust with children, whānau, and communities is the key factor in enabling children to wear their glasses. Unlike private practice optometry where glasses can be sold for high prices, the Vision Bus has an advantage as a neutral platform unaffiliated with commercial optometry, and Germaine recalls disbelief from many parents that the service is fully subsidised.

“People aren’t going to come and see us and get their eyes tested and think they’re going to be sold something,” says Germaine, “So that is powerful.”

When Germaine encounters reluctance from parents for their child to wear glasses, she tries to build trust by relating as a parent herself.

“It was taking a different approach to the way we communicated. Just coming across as a mother, not just as an optometrist, to hopefully get the importance across of not only having the eyes checked but to wear glasses.”

Community Coordinator Telusila Vea often plays a key role in communicating with families, drawing on her knowledge of public health and her experiences working with Pacific communities.

Sachi emphasises that the simple stressors of life, particularly in large family groups, make it more difficult for children to wear their glasses. She believes that optometrists should play a role in enabling children to wear their glasses.

“You cannot blame children for the system that they are born into and brought up in,” says Sachi. “They haven’t had a say in it. You have to talk to every single adult that exists around the child.”

Not one to stand idly by, Sachi describes some of the initiatives she and the other Vision Bus Aotearoa staff have put in place over the last year to improve communication so that children are better supported to wear their glasses. The staff accompany children back to class to explain the situation to the teacher, encourage the glasses to remain on school property to prevent them becoming lost in transit—particularly for children who live across multiple homes, and make extra efforts to contact parents who cannot be reached by phone.

“We send a giant Excel spreadsheet to every school at the end of our visit. We’re saying ‘Here are all the kids, here’s who needs glasses full time, here’s who needs glasses part-time, here’s who’s being referred to hospital.’ And that information gets passed down to school leaders, teachers, nurses, and also learning support people. So really, it’s just communicating to everyone through every means possible,” says Sachi.

And it appears to be working.

“We go back on follow-up day and so many more kids [are wearing glasses], their parents are more engaged, their teachers know that they should be wearing glasses,” she says.

Driving forward the next generation of optometrists

Measuring the effectiveness of the Vision Bus goes deeper than counting children or spectacles or referrals. To make eye care more accessible to all children (and adults) will require a future workforce that is well-versed in equity and willing to take responsibility for changing the status quo.

The VBA is a step in this direction. As a teaching platform, the service allows Bachelor of Optometry students the opportunity to work with children from a range of different socioeconomic backgrounds, learning to navigate the challenges this presents with resilience and creativity. While the efficiency of a service delivered by trainee optometry students may be reduced compared to a conventional clinic, this is outweighed by the long-term benefits to the future optometry profession.

“It’s exposing these optometry students to real world inequities,” says Germaine, “They’re seeing not just children without glasses, they’re seeing children without lunches. Quite a real-world learning experience, which I think is awesome. The students need a bit more of that than what’s currently available.”

Germaine wonders whether more opportunities for current and future optometrists to experience the unmet need for eye care in New Zealand that exists outside of private practice would build up the optometry profession and ignite a passion for improving eye health.

“I do wonder if they’re exposed to this need, and again this sense of purpose and helping. I think that perhaps we’d get a greater love for optometry.”

But as she points out, changing the optometry workforce starts decades earlier, in the children who will grow up to become the eye care providers of the future. By delivering vision services to young children living in underserved communities, the Vision Bus is opening their eyes to optometry and seeding this profession in their minds as a future career option.  

“These kids have been exposed to optometry, and I think that’s wonderful too because we’re going to see more Māori and Pacific optometrists and that will bode well for the future,” she says.

On a personal level, Germaine clearly feels a deep sense of purpose and satisfaction in her work that shines through her eyes.

“I’ve been practicing for almost 24 years, and I love what I do still, and I think that’s because I have a great sense of purpose when I work. And I think possibly, that’s from my years of advocacy. You really get more of a sense of purpose like you’ve done something good. It’s a feel-good experience.”

The next stop is…

As 2024 drew to a close, Sachi and Germaine parked the bus back in the driveway and are now moving on to new adventures.

Inspired by her experiences in a research environment, Sachi aspires towards a PhD in public health and policy.

“I don’t want to let it go. It’s been such a cool job, it’s fantastic,” she says, “[But] I think after a year of changing processes on the bus, I think I’m just the kind of person who can’t stand it when things are not efficient. So, I really want to see what a better vision screening—better nationwide government-funded program—would look like for children.”

Meanwhile, Germaine seeks new opportunities to apply her advocacy skills, and she begins by advocating for the Vision Bus to continue along the road towards better eye health in Aotearoa.   

“I think one, it needs to continue and two, it needs to expand,” she says. “That’s perhaps the one frustration I had. I felt like we were only just helping a very small portion of children. I think we need to grow it. We need to have more buses.”

“I’ve just been so lucky to be in the forefront of this whole bus experience and advocating for children,” she says.

We welcome back Veeran Morar who returns as Professional Teaching Fellow on the VBA from 2025.