by Lucy Goodman | 30 Aug, 2024 | Resources
Key messages:
Eye health surveys generate essential information for planning new services. Some surveys specifically target underserved groups (e.g. people living in rural areas), while many exclude some groups (e.g. those without housing). In future, researchers can consider ways they can better consider underserved groups when planning their survey.
Read the published paper and download the plain language summary of the findings.
Why do a population-based eye health survey?
Eye health surveys are used to gather information about the number of people in a population who have eye health conditions and to identify any groups of people who have unmet need for eye health services. This evidence can be used to develop more equitable eye care services.
Why did we do this research?
Our aim was to summarise the different ways that previous eye health surveys have included underserved groups. This information can be used in future eye health surveys that wish to better include these groups.
What did we do?
We identified all eye health surveys published globally since the year 2000 that estimated the number of people with impaired vision. Underserved groups were defined according to pre-determined criteria (examples included women, people living in rural areas, and unemployed people). We summarised the different ways that underserved groups were considered in the way the survey was designed, conducted, or how the results were reported.
What did we find?
Almost all surveys considered underserved groups in some way, and the number of groups considered within each survey has increased over this time. Most surveys considered groups retrospectively, such as by comparing prevalence estimates between different groups. Very few surveys prospectively considered underserved groups when designing the survey (e.g. by using recruitment strategies that enabled underserved groups to participate). Some underserved groups were actively excluded from surveys, particularly those without stable housing.
What are the implications of this research?
Some population groups with large unmet eye health needs are rendered invisible by commonly used survey methods. Small surveys of specific underserved groups are needed to supplement large national-level surveys, so that policy makers have information about the eye health needs of everyone in the population.
Citation: Goodman L, Reis T, Zhang JH, et al. Underserved groups could be better considered within population-based eye health surveys: A methodological study. J. Clin. Epidemiol. 27 June 2024. doi: 10.1016/J.JCLINEPI.2024.111444. Available here.
Funding: This work was not funded by a specific grant from the public, commercial, or not-for-profit sectors.
by Lucy Goodman | 16 Jun, 2024 | Resources
Key messages:
Countries concerned with eye health should consider strategies to improve access to spectacles. In Australia and New Zealand, eye health experts identified Indigenous people as the population group to be prioritized in efforts to improve access to refractive error services. Reducing out-of-pocket costs via public funding for refractive error correction was the most promising strategy identified by these experts to improve access.
Read the published paper and download the plain language summary of the findings.
About refractive error:
Throughout the world, the most common cause of impaired vision is uncorrected refractive error—a condition where the eye cannot focus light correctly, leading to blurry eyesight. Refractive error can (usually) be corrected with spectacles or contact lenses. However, even in countries where spectacles are readily available, they are often unaffordable for some people. Improving access to spectacles is one of the most effective ways that a country can reduce the number of people experiencing impaired vision.
Why did we do this research?
We conducted this research to identify different ways that countries in the Western Pacific could improve access to spectacles.
What did we do?
This study gathered opinions from eye care experts in 17 countries within the Western Pacific region. Experts provided their opinions on the population groups that faced the most barriers to refractive error services, and the strategies they believed would be more effective to provide these services. The experts provided multiple rounds of feedback to prioritise the important strategies in each region.
What did we find in Australasia?
Of the 75 experts, 15 were from Australia or New Zealand. Many of the population groups and strategies identified by these experts were unique to this region. Australasian experts identified Indigenous people as the population group to whom services were least accessible.
Reducing out-of-pocket costs by providing publicly funded services to certain population groups (e.g. elderly, low-income groups, and children) was the most promising strategy to improve access to eye examinations or spectacles.
Other strategies to improve access to eye examinations included:
- Improving cultural safety of the services so that people feel comfortable using the service.
- Establishing refractive services in regions where they are most needed, and incentivising optometrist to work there.
Other strategies to improve access to spectacles included:
- Health promotion to raise awareness and acceptance of spectacle wear.
- Using readymade spectacles where suitable (alongside messaging of the importance of regular eye checks).
- Regular screening of adults who are likely to need near vision correction (~>40 years), e.g. during medical examinations in the workplace
Citation: McCormick I, Tong K, Abdullah N, et al. Strategies to address inequity of uncorrected refractive error in the Western Pacific: A modified Delphi process. Ophthalmic and Physiological Optics. Published Online First: 16 June 2024. doi: 10.1111/opo.13348
Funding: This work was not funded by a specific grant from the public, commercial, or not-for-profit sectors.
by Lucy Goodman | 26 Mar, 2024 | Resources
Key messages
New Zealand has very little evidence describing vision impairment or access to eye care services. Reassuringly, recent studies often compare their findings between Māori and Pacific People and other ethnic groups. The evidence we do have consistently reports that eye care services are less accessible to Māori and Pacific People compared to other ethnic groups.
Read the published paper and download the plain language summary of the findings.
Inequities in eye health
Health inequities are common in Aotearoa New Zealand. In particular, Māori experience poorer access to services and subsequently poorer health compared to other population groups in New Zealand. However, we don’t know if this is the case for eye health services, and eye health has received little attention by policy makers. To improve eye health, policy makers need to know the number of people and the population groups who are most in need of eye health services. While further research may be needed to answer these questions, some of the information could be identified from existing evidence.
Why did we do this research?
We wanted to identify and summarise all the existing evidence of inequities in eye health between different population groups—particularly between Māori and other ethnic groups. This will help us identify what types of research is still needed.
What did we do?
We looked for all published studies about eye health in New Zealand. Studies were eligible if they reported the number of people with impaired vision, or access to an eye care service (such as the number of people attending a vision screening service). We did this in a systematic way, by searching databases for published evidence and carefully screening the results using pre-defined criteria.
What did we find?
New Zealand has very little published evidence describing the prevalence of vision impairment or access to eye health services. We found 47 relevant studies published since 1960. Almost all this evidence comes from data collected from health facilities (e.g. hospitals), which means the information is not relevant to everyone in the population. Many studies were about diabetic retinopathy (an eye condition resulting from diabetes), or cataract. Since the year 2000, studies have consistently compared their findings between Māori or Pacific People and one or more other ethnic groups. These studies reported that Māori and Pacific People experienced worse access to services compared to other groups.
What’s next?
Future eye health services need to address barriers and enablers to eye care services experienced by Māori and Pacific People. In addition, we need more evidence describing the number of people with vision impairment in the general population, and access to services for all major eye conditions.
Citation: Rogers JT, Black J, Harwood M, et al. Vision impairment and differential access to eye health services in Aotearoa New Zealand: a scoping review. BMJ Public Health. 2024;2:e000313. doi: 10.1136/BMJPH-2023-000313.
Funding: This work was not funded by a specific grant from the public, commercial, or not-for-profit sectors.
by Lucy Goodman | 13 Dec, 2023 | Resources
Key messages
Limited evidence exists to describe access to eye care in New Zealand. This research has identified two major barriers that make eye health services inaccessible for some people in Aotearoa: the cost, and the lack of nearby services or transport options to reach these services
Read the published paper and download a plain language summary of the findings.
Inequities in eye health
Throughout the world, services systematically underserve some groups of people which leads to worse eye health. In Aotearoa New Zealand, the Ministry of Health has committed to addressing health inequities that are experienced by Māori, Pacific people, and people living in areas with high levels of deprivation. However, this remains a work in progress. For example, New Zealand has very little public funding for eye care services, meaning that eye care is less accessible for people who are unable to pay. Very little evidence is available describing access to eye care in New Zealand. We need this evidence so that we know how to develop services that are more accessible to everyone.
Why did we do this research?
We did this research to better understand the reasons that New Zealand’s eye care services may be difficult to use (the barriers), and ways that services may be made easier to use (the enablers), from the perspective of people who have been historically underserved.
What did we do?
We interviewed 25 people with vision problems about their opinions and experiences using eye care services. The participants all lived in an Auckland suburb that has a high level of social and economic deprivation, and most were Pacific Peoples or Māori.
What did we find?
Barriers to eye care: Most participants reported that the cost of eye care services prevented them from accessing care. Many people had to prioritise other essential costs before eye care. To overcome the cost, some had used a government loan to purchase spectacles, or purchased low-cost, premade reading glasses. Participants expressed the opinion that the government should do more to fund eye care. The distance to services and lack of transport were other commonly reported reasons participants found it difficult to reach eye care services.
Enablers to eye care: Participants were aware that good eye health is important. Some participants chose to see their GP for eye care advice. Some reported using optometry services in the past and described the experience positively. While many participants were unaware of optometry services, they were interested to understand what was involved in an eye examination. The participants also expressed how whānau (family) play an important role in their eye care.
Citation: Rogers JT, Kandel H, Harwood M, et al. Access to eye care among adults from an underserved community in Aotearoa New Zealand. Clin Exp Optom. 2023;1–9. doi: 10.1080/08164622.2023.2291527
Funding: Buchanan Charitable Foundation, The University of Auckland (Faculty Research Development Fund), Blind Low Vision New Zealand, Peter and Rae Fehl, Helen Blake QSM, Barbara Blake, and Essilor New Zealand.
by Lucy Goodman | 18 May, 2023 | Resources
Key messages:
Everyone with diabetes needs regular access to eye services, but these services are not equally accessible to everyone in Aotearoa. Underserved populations include Māori and Pacific people, younger and older age groups (compared to people in their 50s), and those living in areas with higher deprivation. To develop more equitable services we need to collect better information on service access and outcomes for different population groups
Read the published paper and download a plain language summary of the findings.
About diabetes eye care
Diabetes can cause diabetic retinopathy—damage to the blood vessels at the back of the eye, which if not treated can lead to vision loss. Fortunately, regular retinal screening can detect early changes to the retina before vision loss occurs. In Aotearoa New Zealand, retinal screening is provided by the public health system and is usually recommended once every two years. People who develop diabetic retinopathy are referred to ophthalmology services for closer monitoring, or to receive treatment with laser or injections that can slow down the disease.
Why did we do this research?
To understand whether services are accessible to New Zealanders living with diabetes. Our aim was to identify any inequities in access to diabetes services between different population groups.
What did we do?
Using routinely collected data from 14 (of 20) District Health Boards that had provided data to the Ministry of Health, we identified everyone aged 15 years or over with a scheduled appointment at a diabetes screening or ophthalmology clinic between 2006 to 2019. We calculated how often people accessed diabetes eye care appointments, and whether there were any differences between genders, age groups, ethnicity groups, deprivation levels, and regions across Aotearoa.
What did we find?
~250,000 people had at least one scheduled diabetes eye care appointment between 2006 and 2019. Less than two-thirds (62.1%) of people accessed retinal screening every two years (as recommended).
A relatively low number of people never attended any retinal screening (1.5%) or follow-up ophthalmology appointments (0.8%) once they had been scheduled. Approximately 1 in 10 people (9.4%) accessing any diabetes eye care appointments received treatment (either laser or injections) for diabetic retinopathy over the study period.
Compared with NZ Europeans, Māori were about twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, and 9% relatively less likely to receive biennial screening. Māori received the fewest anti-VEGF injections when treatment was commenced
What is missing?
The available data had several limitations, which meant we could not estimate:
- How many people were never offered an appointment.
- A population-level national diabetic retinopathy screening rate.
- Outcomes from eye service appointments or barriers to access
Citation: Silwal PR, Lee AC, Squirrell D, et al. Use of public sector diabetes eye services in New Zealand 2006–2019: Analysis of national routinely collected datasets. PLoS One. 2023;18:e0285904. doi: 10.1371/journal.pone.0285904
by Lucy Goodman | 11 Aug, 2022 | Resources
In 2020, the Government of Aotearoa New Zealand proposed free annual “eye health checks” for New Zealand’s ~700,000 SuperGold card holders aged ≥65 years. To assess the evidence for this policy, we conducted a systematic scoping review of primary eye care services in Aotearoa New Zealand and ten similar high-income countries. We found that most of the countries included in the review provided subsidised eye examinations for older people. New Zealand was the only country that did not provide any eye care services for older people.
Read the published research paper and a policy brief describing the implications of this research.
Citation: Goodman L, Hamm L, Tousignant B, et al. Primary eye health services for older adults as a component of universal health coverage: a scoping review of evidence from high income countries. Lancet Reg Health West Pac. 2023;35:100560. doi: 10.1016/j.lanwpc.2022.100560
Funding: Blind Low Vision New Zealand.
