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Key messages:

New Zealand has a solid foundation for good quality eye care services. However, there is room for improvement in the way we plan and deliver eye care services to ensure all New Zealanders can access the services they need. The report provides a detailed list of 81 recommended actions that may help strengthen eye care services in New Zealand.

Read the published report and download the plain language summary of the findings. 

Why did we do this research?

Accessible, good quality eye care services are essential for New Zealanders to maintain good eye health. To improve eye care services, we must first understand the strengths and weaknesses of current services. ECSAT is one of four tools in the WHO Guide for Action that supports countries to strengthen their eye care services.

What did we do?

We established a Technical Working Group of people with experience in optometry, ophthalmology, primary care, rehabilitation, Māori health, and lived experience of eye conditions. We used information gathered from published documents, and also interviewed people with detailed knowledge of eye care services to assess Aotearoa’s situation in 31 areas (‘items’) across each of the ECSAT’s six health system building blocks. The Working Group reached consensus on each item, and the recommended actions to strengthen eye care services

Conclusions: 

Service delivery-quality and workforce & infrastructure are generally “strong” or only “need minor strengthening”. Leadership & governance, access to services, financing, and information generally “need major strengthening”.

Citation: Silwal P, Watene R, Cowan C, Cunningham W, Harwood M, Korau J, Sue W, Wilson G, Ramke J. Eye care in Aotearoa New Zealand 2022: Eye care situation analysis tool (ECSAT). Auckland: University of Auckland, 2022. Available at: https://osf.io/r75zs/

Funding: The report was prepared for Eye Health Aotearoa, with funding from Blind Low Vision New Zealand.

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 download 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.

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.
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Other strategies to improve access to spectacles included:

• Health promotion to raise awareness and acceptance of spectacle wear.
• Use readymade spectacles where suitable.
• 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.

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.

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

Key messages:

Travel distance is unlikely to be a barrier to accessing eye health services for most New Zealanders. However, there are communities in the most deprived areas that also have long distances to travel to eye clinics. These communities are often in areas with relatively more Māori. Making eye health services more accessible for these communities should be prioritised if we are to improve eye health in New Zealand equitably.

Read the published research paper and download a plain language summary of the findings. 

Why did we do this research?

Some New Zealanders face many barriers to good eye health. One of these barriers could be the distance they must travel to reach services. To make eye health services more accessible, we need to understand which communities have furthest to travel, especially when those communities may already be under resourced.

In 2022, Community Eye Health researchers published their research reporting how far New Zealanders need to travel to reach their closest eye care provider. The research showed that people living in the most deprived areas of New Zealand sometimes have the longest distances to travel to eye clinics. To achieve equity in eye care, we need to make these services more accessible.

What was the aim of this research? 

The aim of this research was to find out how far people need to travel to eye clinics (optometrists and ophthalmologists) across Aotearoa New Zealand. The researchers also identified communities in the most deprived areas that were more than 50 kilometres from eye clinics, because these communities might benefit from closer services.

What did we do? 

To understand how far people travel for eye health services, our researchers used data held by Stats NZ Tatauranga Aotearoa to count and locate all New Zealanders. They then used the addresses of all optometry and ophthalmology clinics in Aotearoa to calculate the travel distance—along our road network—between each clinic and the population. They also calculated the proportion of New Zealanders living more than 50 kilometres from clinics, and looked at distances for people living in different districts and levels of area deprivation.

What are the main results? 

The researchers found 344 optometry, 46 public ophthalmology and 90 private ophthalmology clinics. Three-quarters of New Zealanders lived within 10 km of an optometry clinic and half lived within 10 km of an ophthalmology clinic. Nationally, approximately 1 in 35 people lived further than 50km from an optometry clinic compared to 1 in 14 and 1 in 10 living further than 50km from public and private ophthalmology. The researchers identified communities with high area-level deprivation that were more than 50km from eye health services. These communities were predominantly in Tairāwhiti and Northland, but there were also some in Whanganui, Hawke’s Bay, Bay of Plenty and Waikato.

Citation: Ramke J, Zhao J, Wilson O, et al. Geographic access to eye health services in Aotearoa New Zealand: which communities are being left behind? Clin Exp Optom. 2023;106:158–64. doi: 10.1080/08164622.2022.2102410

Funding: Blind Low Vision New Zealand.

Key messages:

The B4 School Check (B4SC) vision screening service is successfully delivered to most New Zealand preschool children. However, for some groups of children, the B4SC is less accessible and more likely to deliver an incomplete test measurement. This includes Māori and Pacific children, and those living in areas of higher deprivation or in particular regions of New Zealand.

Read the published paper and download a plain language summary of the findings.

About preschool vision screening

Preschool vision screening helps to identify children with eye problems. Early treatment can then prevent permanent vision loss and difficulties at school. In Aotearoa New Zealand, all children 4 years of age are offered a free vision screening test as part of the national B4SC screening programme, and children identified for further testing are referred to eye clinics for treatment. In principle, all children in New Zealand can participate in the B4SC. However, the B4SC is inaccessible for some children, for various reasons such as difficulties in scheduling an appointment. Sometimes the vision screening test is unable to be completed (for example, due to language barriers).

Why did we do this research? 

We conducted this research to understand whether there are any inequities in the B4SC vision screening programme between children from different ethnicities, or living in areas with different levels of deprivation or in particular regions of New Zealand.

What did we do? 

Using information from the Statistics New Zealand database, we counted the number of children in New Zealand aged 4 years between 1st July 2011 and 30th June 2015. For each child, we recorded their ethnicity, and the level of deprivation of the area they lived and the health district where they live. We calculated how many of these children accessed vision screening (the screening “coverage”), and how often the screening test was performed successfully (the screening “testability).

What did we find?

Screening coverage: Nearly 90% of children could access the B4SC. The B4SC was less accessible to children of Māori, Pacific, Asian, or other minority ethnicities, or living in more deprived areas. This service was also less accessible for children in the Capital and Coast health districts than those in other regions.

Screening testability: The test was successfully completed for almost all the children who participated (97.7%). Completed testing was lowest for children of Māori or Pacific ethnicity, or living in more deprived areas. Children in the Whanganui health district were more likely to have an unsuccessful screening test compared to other regions.

What’s next? 

We need improve the way the B4SC vision screening programme is delivered so that it is equally accessible to all groups of children. In particular, this should involve consultation with Māori. Future research should examine why there are regional differences in screening rates across New Zealand.

Citation: Findlay R, Hamm L, Anstice N, et al. Vision screening in New Zealand pre-school children: Is it equitable? J Paediatr Child Health. 2021;57:1594–9. doi: 10.1111/jpc.15548.

Funding: A Better Start – National Science Challenge