New Zealand glaucoma care shows progress, yet gaps in treatment remain
New Zealand’s glaucoma treatment rates have improved over a decade, but significant disparities in care persist for Māori and Pasifika populations, according to new research findings.
Glaucoma treatment disparities
A Decade of Shifting Treatment Patterns in New Zealand
Glaucoma remains one of the leading causes of irreversible blindness worldwide, yet access to effective treatment continues to vary significantly across different populations. A comprehensive 10-year analysis of New Zealand’s pharmacy dispensing data reveals important trends in how glaucoma medications are being prescribed—and some troubling gaps in equitable care.
Researchers from Te Whatu Ora Health New Zealand and the University of Auckland’s Department of Ophthalmology examined national pharmacy records from 2012 to 2021, tracking prescriptions for 11 different glaucoma medications. The findings, published in the Asia-Pacific Journal of Ophthalmology, paint a picture of progress tempered by persistent inequality.
Overall Treatment Growth Outpaces Population Increases
The number of New Zealanders receiving pharmacological glaucoma treatment climbed substantially during the study period. The patient population grew from 39,725 individuals in 2012 to 50,048 in 2021—a 25.9% increase. This growth notably outpaced the country’s population expansion of 15.9% over the same decade.
The estimated prevalence of pharmacologically treated glaucoma or ocular hypertension increased from 0.90% to 0.98%. The annual incidence of newly treated patients reached approximately 125 per 100,000 people per year, suggesting that detection and treatment initiation have improved overall.
Latanoprost Becomes the Dominant First-Line Agent
Over the entire study period, pharmacies dispensed more than 3 million glaucoma prescriptions across the nation, representing 27.6% of all ocular medications dispensed. One medication emerged as the clear leader: latanoprost accounted for 40% of all glaucoma prescriptions and 11% of all eye medication prescriptions.
This dominance marks a significant shift from earlier prescribing patterns. Beta-blocker medications like timolol, which historically were prescribed most frequently, declined in relative use. The change reflects lifted funding constraints on prostaglandin analogues—the drug class to which latanoprost belongs—that had previously limited their availability.
The medication rankings reveal timolol in second place at 13% of prescriptions, followed by bimatoprost at 11%. Other medications included in the analysis were travoprost, betaxolol, brimonidine tartrate, pilocarpine hydrochloride, dorzolamide hydrochloride, brinzolamide, and two fixed-dose combination drops.
Most agents showed increasing dispensing trends from 2012 to 2021, though bimatoprost, travoprost, betaxolol, pilocarpine, and dorzolamide experienced declines. A notable spike in prescriptions occurred in 2020 across nearly all medications, which researchers linked to patient stockpiling in preparation for nationwide COVID-19 lockdowns.
Striking Ethnic Disparities in Treatment Access
While overall treatment numbers improved, a troubling pattern emerged when the data was analyzed by ethnicity. Europeans, representing 67.8% of New Zealand’s population, received 87% of all glaucoma prescriptions. Their age-adjusted dispensing rate reached 34.7 per 1,000 people—substantially higher than other populations.
In stark contrast, Māori and Pasifika peoples—who together constitute 26.7% of the New Zealand population—received dramatically fewer prescriptions. Māori patients, making up 17.8% of the population, received only 1.9% of all glaucoma prescriptions, with an age-adjusted rate of 8.5 per 1,000 people. Pasifika patients, comprising 8.9% of the population, received just 1.4% of prescriptions, translating to an age-adjusted rate of 14.5 per 1,000 people.
These disparities were statistically significant across all 11 medications studied. The differences persisted even after researchers adjusted for age, suggesting that age alone does not account for the treatment gap.
Understanding the Root Causes of Unequal Access
The research team acknowledged a critical limitation: no population-based prevalence data specifically measure glaucoma occurrence in Māori or Pasifika communities. This gap makes it impossible to determine whether the low dispensing rates reflect genuinely lower disease rates or whether they represent inequitable access to diagnosis and care.
However, the researchers identified several likely contributors to the disparity. Socioeconomic factors, cultural barriers, and communication challenges within the health care system may all play a role. The authors also noted the potential influence of implicit bias within clinical settings. These barriers mirror broader patterns of inequitable health care documented across other chronic conditions affecting Māori and Pasifika New Zealanders.
What the Data Reveals and Its Limitations
While national pharmacy dispensing data provides a robust population-level perspective, it lacks important clinical details. The dataset does not include information about disease severity, specific glaucoma subtypes, visual field progression, or patient adherence to prescribed medications. These clinical factors could significantly influence prescribing decisions and treatment outcomes.
Additionally, several fixed-dose combination therapies were excluded from the analysis due to funding status changes occurring during the study period. This means the analysis may underestimate the true extent of combination therapy use in New Zealand.
Ethnicity classification relied on self-reported data, which may be subject to misclassification or underreporting in some cases. Despite these limitations, the study fills an important gap by documenting comprehensive national prescribing trends over an entire decade.
Implications for Future Research and Clinical Practice
The findings align with international guidelines positioning latanoprost and other prostaglandin analogues as effective first-line treatments for glaucoma. The shift toward these medications in New Zealand reflects international clinical consensus.
However, the ethnic disparities demand attention. Researchers called for future studies that integrate clinical and pharmacy dispensing datasets to enable more detailed assessment of treatment effectiveness and the underlying causes of inequity. Understanding whether disparities stem from lower disease detection, reduced access to care, differential treatment decisions, or other factors requires more granular data.
The research team also noted the value of repeating this analysis as minimally invasive glaucoma surgery uptake continues to expand. As treatment options diversify beyond medications, comprehensive monitoring of usage patterns and equity remains essential.
When to Seek Eye Care
If you have risk factors for glaucoma—such as elevated eye pressure, a family history of glaucoma, advanced age, or certain ethnic backgrounds—regular comprehensive eye exams are essential. Early glaucoma often produces no symptoms, making detection through routine screening critical.
Schedule an appointment with an eye care professional if you experience gradual vision loss, particularly in your peripheral vision, or if you have a family member with glaucoma. Those already diagnosed with glaucoma should maintain consistent follow-up appointments and medication adherence as prescribed by their ophthalmologist, since consistent treatment helps prevent progression and vision loss.
