Glaucoma treatment in New Zealand: What 10 years of national data tells us
Glaucoma is a leading cause of irreversible blindness, and lowering intraocular pressure remains the only proven way to slow disease progression. Yet until now, there has been no comprehensive national analysis of how glaucoma medications are actually dispensed in New Zealand. Our study examined ten years of Ministry of Health pharmacy dispensing data, from 2012 to 2021, to better understand how glaucoma treatment has changed over time and whether access to treatment differs between population groups.
More than 3 million glaucoma prescriptions were dispensed during the study period, accounting for 27.6% of all ocular medications. The number of people receiving glaucoma medication increased from 39,725 in 2012 to 50,048 in 2021 — a 25.9% rise, which was faster than population growth over the same period. This suggests a growing burden of treated glaucoma and ocular hypertension, likely influenced in part by New Zealand’s ageing population. Around three-quarters of people receiving glaucoma medications were aged 65 years or older.
The study also showed a clear shift in the medicines used to manage glaucoma. Latanoprost was the most frequently dispensed medication, accounting for about 40% of all glaucoma prescriptions, followed by timolol and bimatoprost. This reflects the modern role of prostaglandin analogues as commonly used first-line therapy, supported by their effectiveness, safety profile and convenient once-daily dosing. Compared with older New Zealand data, this marks a move away from beta-blockers such as timolol as the dominant treatment.
One of the most important findings was the marked difference in glaucoma medication dispensing between ethnic groups. Europeans received 87% of all glaucoma prescriptions. By comparison, Māori received 1.9% and Pasifika peoples 1.4%, despite making up substantially larger proportions of the New Zealand population. These differences remained significant after adjusting for age. The study cannot determine exactly why these disparities exist, and differences in the true prevalence of glaucoma between ethnic groups may contribute. However, the size of the gap raises important questions about access to eye care, referral pathways, cost, communication, cultural barriers and other health-system factors.
There are important limitations. Pharmacy dispensing data do not include details such as glaucoma subtype, disease severity, visual field progression or whether medications were actually used. Some glaucoma medicines may also be prescribed for ocular hypertension or other indications. For this reason, the prevalence figures should be interpreted as pharmacologically treated glaucoma or ocular hypertension, rather than confirmed glaucoma prevalence.
Overall, this study provides the most comprehensive picture to date of glaucoma medication use in New Zealand. It highlights both the increasing demand for glaucoma care and the need to better understand and address inequities in access to treatment. We hope these findings help inform future research, service planning and efforts to ensure equitable glaucoma care for all New Zealanders.
Want to read the ful article? Find it in the Asia-Pacific Journal of Ophthalmology (APJO) online.