Glaucoma treatment rates New Zealand
Glaucoma treatment in NZ shows growth but disparities persist for Māori and Pasifika patients receiving care.
Glaucoma treatment disparities
Understanding the Growing Glaucoma Treatment Gap
Glaucoma affects millions of people worldwide, yet in many developed countries like New Zealand, treatment isn’t equally distributed across all populations. A comprehensive 10-year analysis examining national pharmacy records from 2012 to 2021 reveals a complex picture: while the overall number of people receiving glaucoma treatment has climbed significantly, the benefits of this progress have not reached all communities equally.
The research, published in the Asia-Pacific Journal of Ophthalmology, examined over 3 million glaucoma prescriptions across New Zealand to understand how medications are being dispensed and whether entire population groups are being left behind in care.
How Glaucoma Treatment Has Changed Over a Decade
Between 2012 and 2021, New Zealand saw substantial growth in glaucoma treatment. The number of patients receiving pharmacological treatment rose from 39,725 to 50,048—a 25.9% increase. What makes this figure striking is that it outpaced population growth during the same period, which was only 15.9%.
This means more people per capita are being diagnosed and treated for glaucoma or ocular hypertension. The estimated prevalence of pharmacologically treated cases increased from 0.90% to 0.98% of the population, with approximately 125 newly treated patients per 100,000 people annually.
The Rise of Latanoprost as First-Line Therapy
Over the decade studied, one medication dominated prescribing patterns: latanoprost, a prostaglandin analogue. This drug accounted for 40% of all glaucoma prescriptions and 11% of all ocular medications dispensed in New Zealand during the study period.
The shift toward latanoprost reflects changes in medication availability and funding. Beta-blockers like timolol were historically the most commonly prescribed class, but historical funding constraints on prostaglandin analogues have since been lifted. Today, timolol remains the second most dispensed medication at 13% of prescriptions, followed by bimatoprost at 11%.
Other medications showed varied trends. Increasing dispensing rates were observed for brinzolamide, brimonidine tartrate, and fixed-dose combination drops. Conversely, bimatoprost, travoprost, betaxolol, pilocarpine, and dorzolamide saw declining use. An interesting anomaly appeared in 2020, when prescriptions peaked across nearly all agents—likely due to patients stockpiling medications ahead of nationwide COVID-19 lockdowns.
A Troubling Pattern: Ethnic Disparities in Treatment Access
While treatment rates overall have improved, the most concerning finding centers on who receives these medications. Despite comprising 67.8% of New Zealand’s population, Europeans received 87% of all glaucoma prescriptions. Their age-adjusted prescribing rate was 34.7 per 1,000 people.
In stark contrast, Māori and Pasifika peoples—who together represent 17.8% and 8.9% of the population respectively—received only 1.9% and 1.4% of total glaucoma prescriptions. When adjusted for age, their prescribing rates were 8.5 per 1,000 and 14.5 per 1,000 respectively. These differences were statistically significant across all 11 medications studied.
The disparity raises a critical question: do these numbers reflect true differences in disease prevalence, or do they indicate inequitable access to care? Currently, no population-based data exist specifically measuring glaucoma prevalence in Māori or Pasifika populations, making it impossible to determine definitively.
What Drives These Disparities?
Researchers identified several potential contributors to the unequal treatment rates. Socioeconomic factors may limit access to healthcare services. Cultural barriers and communication challenges could prevent some patients from seeking or continuing treatment. Implicit bias within the healthcare system itself may also play a role, though this requires further investigation.
These patterns of inequitable access mirror broader health disparities documented across other chronic diseases in New Zealand, suggesting a systemic issue rather than an isolated problem within ophthalmology.
How This Research Was Conducted
Researchers from Te Whatu Ora Health New Zealand and the Department of Ophthalmology at the University of Auckland analyzed de-identified national pharmacy dispensing data covering the entire 10-year period. They tracked 11 glaucoma medications across five drug classes: prostaglandin analogues, beta-blockers, alpha-agonists, muscarinic agonists, and carbonic anhydrase inhibitors, plus combination formulations.
Dispensing patterns were examined by year, medication type, sex, and self-identified ethnicity. Age-adjusted prescription rates were compared using statistical analysis of variance with post-hoc testing to identify significant differences between groups.
What the Data Tells Us About Treatment Patterns
The study reveals important trends about how glaucoma is being managed at a population level. Across the 3,021,885 prescriptions dispensed during the decade, glaucoma medications represented 27.6% of all ocular prescriptions—confirming glaucoma’s significant place in ophthalmology practice.
The clear preference for latanoprost aligns with international treatment guidelines, where prostaglandin analogues are typically recommended as first-line therapy. However, the persistence of beta-blockers and other medication classes suggests that personalized treatment approaches remain important, since not every patient can tolerate or respond equally to the same drug.
Important Limitations of This Study
While pharmacy dispensing data provides a robust population-level view, it lacks clinical detail. The data cannot reveal disease severity, specific glaucoma subtype, visual field progression over time, or whether patients actually took their medications as prescribed. Some fixed-dose combination therapies were excluded due to funding changes during the study period, which may underestimate combination therapy use.
Additionally, ethnicity data relied on self-reported records, which can be subject to misclassification or underreporting. These limitations mean the true picture may be more nuanced than the dispensing numbers alone suggest.
What This Means for Glaucoma Care Moving Forward
The research highlights two competing realities. On one hand, New Zealand has successfully increased glaucoma treatment access and adoption of evidence-based first-line therapies. On the other hand, significant barriers remain for Māori and Pasifika patients, potentially delaying diagnosis and allowing the disease to progress unchecked in these populations.
The authors call for future research that integrates clinical records with dispensing data, allowing researchers to assess treatment effectiveness and better understand the drivers of inequity. They also note the value of repeating this analysis as minimally invasive glaucoma surgery becomes more widely adopted, which may shift prescribing patterns further.
When to See an Eye Care Professional
Glaucoma often develops without symptoms in its early stages, which is why regular screening is essential. You should schedule an appointment with an ophthalmologist or optometrist if you have a family history of glaucoma, are over 60 years old, have elevated eye pressure, or belong to populations at higher risk—including Māori and Pasifika individuals in New Zealand.
If you experience sudden eye pain, blurred vision, halos around lights, or vision loss, seek immediate medical attention. These may indicate acute angle-closure glaucoma, a medical emergency requiring prompt treatment to prevent permanent vision damage.
Beyond screening, if you’ve been diagnosed with glaucoma or prescribed glaucoma medications, maintaining regular follow-up appointments is critical. Your eye care provider will monitor your eye pressure and visual fields to ensure your current medication is effective. Don’t skip doses or stop taking prescribed medications without medical guidance, as missed doses can allow eye pressure to rise and cause irreversible damage.
