Glaucoma in Aotearoa New Zealand

WRITER Professor Dame Helen Danesh-Meyer

Glaucoma is common, quiet, and unforgiving when we miss it. For New Zealand eye care providers, that means two jobs: find it earlier and keep people in care. In this article, Professor Dame Helen Danesh-Meyer puts the focus on Aotearoa New Zealand, presents a synthesis of New Zealand prevalence/prescribing data, what’s changing in our armamentarium of treatment, why preservative-free access lags, and how Glaucoma New Zealand (GNZ) is moving the needle – plus what we can hardwire into practice.

HOW COMMON IS GLAUCOMA – REALLY?

New Zealand has no national glaucoma registry, so the best proxy comes from community dispensing of publicly funded glaucoma medicines (2012–2021). Dr Jane Shi and Professor James McKelvie presented their research findings at the Royal Australian and New Zealand College of Ophthalmology (RANZCO) branch meeting in May 2025:1 over the decade, treated prevalence rose from 0.90% to 0.98% – a 25.9% increase in unique National Health Index numbers (i.e. unique patients) treated – with more than three million prescriptions dispensed. Yet treated prevalence always undercounts the true burden: many people remain undiagnosed or are monitored but not yet medicated. International studies show that over half of glaucoma cases – often 50–60% – go undetected, and GNZ estimates that around 100,000 New Zealanders currently have glaucoma, with at least 50,000 unaware they have it. If we extrapolate global figures to our population of 5.3 million, between 20,000 and 60,000 people in New Zealand likely have undiagnosed glaucoma. Europeans are most likely to be treated, while Māori and Pasifika are markedly under-represented. The age distribution of glaucoma ensures that caseloads will only rise through the 2030s – making earlier diagnosis and equitable access to care a pressing priority.

CHANGING SHELVES, SHIFTING CHOICES

In 2006, a RANZCO survey showed New Zealand ophthalmologists still favoured beta-blockers as first-line therapy because of cost and funding restrictions on prostaglandin analogues (PGAs) – despite more than 95% indicating they would choose a PGA first-line if restrictions were lifted.2,3 Fast-forward to 2012–2021: latanoprost emerged as the most commonly prescribed glaucoma medication, followed by timolol and bimatoprost. Brinzolamide, brimonidine, and fixed combinations, such as dorzolamide/timolol and brimonidine/timolol, were also widely used.1 In contrast, older agents, including travoprost, betaxolol, pilocarpine, and dorzolamide, steadily declined over the decade. Most drugs peaked in prescribing volume during 2020, a pattern likely influenced by pandemic-related stockpiling. Today, practice in New Zealand is effectively prostaglandin-first, with latanoprost dominant and timolol still heavily used in selected contexts.1-3

The New Zealand glaucoma formulary is in flux. Some drugs are no longer available: betaxolol (Betoptic / Betoptic S) has now been discontinued – the government’s Pharmaceutical Management Agency, Pharmac (Te Pātaka Whaioranga) confirmed that the final stock was distributed in June 2025, forcing every patient still on this agent to switch therapy.4 Dorzolamide monotherapy has also disappeared from the October 2025 community schedule, though the dorzolamide /timolol fixed combination (Dortimopt) remains funded alongside brinzolamide, timolol, brimonidine, and the main prostaglandin analogues.5,6

The bigger frustration for both clinicians and patients is preservative-free (PF) glaucoma drops. Despite well-established arguments around adherence and ocular surface health, most PF formulations remain unfunded in New Zealand. GNZ lists the options – bimatoprost PF, Ganfort PF, and timolol PF – but these are available only through private purchase.7 While Medsafe has approved PF fixed combinations, such as Vizo-PF Dorzolatim (dorzolamide/ timolol PF), these too are absent from the community schedule, meaning patients face either out-of-pocket costs or hospital-only access.7,8 The lack of funded preservative-free glaucoma drops introduces a clear inequity in glaucoma management: patients intolerant of preservatives or with fragile ocular surfaces are forced to pay privately or compromise with less tolerable funded options.

Selective laser trabeculoplasty (SLT) is now a genuine first-line option for open-angle glaucoma and ocular hypertension. The LiGHT trial showed SLT matches drops for initial intraocular pressure (IOP) control, with better cost-effectiveness and lower long-term progression and surgery rates.9 Both the European Glaucoma Society and the American Academy of Ophthalmology now endorse SLT as appropriate first-line therapy, especially where adherence, side-effects, or preservative exposure are concerns.10,11

Minimally invasive glaucoma surgeries (MIGS), such as iStent and Preserflo microshunt, are also reshaping the treatment landscape. Positioned between drops/SLT and traditional surgery, MIGS offer modest pressure reduction with faster recovery and a safer risk profile. For selected patients – particularly those needing cataract surgery or struggling with drops – MIGS can provide durable control while preserving quality of life.

MANAGEMENT PROBLEMS WE CAN ACTUALLY FIX

Late detection is common; adherence is fragile; equity is uneven. Those problems are ours to solve. Adherence remains a stubborn challenge in glaucoma care. GNZ’s 2024 synthesis, drawing on a national patient telephone survey mapped against the World Health Organization (WHO) framework, found striking gaps: two-thirds of patients could not name their glaucoma subtype, one in four wanted help with drop instillation technique or devices, and many described system-level frictions, such as difficulties accessing appointments.12 The interventions that made a difference were simple but effective – tailored education, direct phone contact, reminder systems, and streamlined regimens. Equity concerns compound these issues: dispensing data show Māori and Pasifika are significantly under-represented in glaucoma prescribing relative to their population share, pointing to access and retention gaps that warrant active monitoring and correction in our own clinics.1

UNITING FORCES FOR GLAUCOMA PATIENTS

If glaucoma is to be managed effectively in New Zealand, ophthalmology and optometry must work in much closer partnership. The legal scope for optometrists has steadily expanded – diagnostic agents since 1996, therapeutic prescribing since 2004, and, with the 2005 Medicines Regulations, full authority to prescribe within scope, including glaucoma medical management with additional accreditation.13 Despite this, between 2012 and 2021, optometrists authored only ~1.4% of publicly funded glaucoma prescriptions, compared with 97% by doctors. This gap does not reflect a lack of capability. Optometry clinics in New Zealand are now exceptionally well equipped, with widespread access to optical coherence tomography (OCT) and visual fields, and never before have optometrists been so skilled in glaucoma diagnosis and care.

The imbalance arises from structural barriers (funding models, referral pathways) and cultural ones – habits that limit shared care. Structural barriers take time to reform, but cultural ones are ours to change. Optometry should not remain underutilised at the front line of glaucoma care, and ophthalmology must embrace closer integration. Shared-care models – where optometrists monitor stable or early glaucoma, while ophthalmologists focus on complex disease, surgical intervention, and oversight – are the only sustainable response to the rising burden of glaucoma. Building trust, clarity of referral protocols, and shared patient pathways will be essential if we are to meet the challenge ahead.

WHAT GNZ IS DOING (AND HOW TO PLUG IN)

Glaucoma New Zealand plays a critical role in supporting both patients and professionals across the glaucoma journey. For patients, the national helpline (0800 GLAUCOMA), onboarding program SightWise, and resources such as Your Eyes, and the regular Eyelights newsletter – available in both print and digital formats – help keep education and engagement ‘warm’ between clinical visits.14 For professionals, GNZ provides Optometrists and Dispensing Opticians Board (ODOB)-accredited education through an online program that earns continued professional development points, as well as an interactive one-day professional education symposium. Both are tailored to real-world optometry decision making and invaluable for team calibration and new graduates. On the adherence front, GNZ’s 2024 Lessons in drop adherence emphasises immediately actionable strategies: teaching technique, simplifying regimens, and reinforcing with reminders and phone follow-ups. And at the advocacy level, GNZ is pushing for funded PF glaucoma medications, commissioning NZ-specific evidence for Pharmac, and supplying a concise PF explainer that clinicians can use to frame discussions with patients.14-17

BUILD A FRAMEWORK THAT MAKES A DIFFERENCE

Glaucoma care needs to be deliberate. Start case-finding early, from ages 40–50, and sooner with family history, myopia, or steroid exposure. Careful optic nerve assessment and IOP should be part of routine exams, escalating to OCT/fields when indicated (either by clinical appearance or risk factors), and documenting a follow-up plan. Trust serial data, not single yellow or red OCT sectors in myopes, and make glaucoma progression analysis your anchor. Engineer adherence from day one: teach and check technique, simplify to once-daily, and preload reminders – SMS, apps, whānau cues – using GNZ’s resources and helpline. Be upfront about preservatives and funding: explain the trade-off between funded drops containing benzalkonium chloride and unfunded PF alternatives, and consider early SLT when surface disease or adherence is a problem.9 Finally, close the equity gap deliberately: track recalls and no-shows by postcode and ethnicity, invite whānau screenings, and take glaucoma to the community. The disparities are visible in dispensing data – so measure your own and improve them.

Professor Dame Helen Danesh-Meyer CNZM FRSNZ MBChB MD PhD FRANZCO is a pioneering New Zealand ophthalmologist, internationally recognised for her expertise in glaucoma and neuro-ophthalmology. She is the first female to be appointed Professor of Ophthalmology in NZ, a leader in research and advocacy (Glaucoma NZ, Women in Vision), and a recipient of numerous high honors including being appointed Dame Companion of the NZ Order of Merit (CNZM) in 2026. She holds prominent roles, including Chair of Glaucoma NZ, President of Neuro-ophthalmology Society of Australia, and is a Fellow of the Royal Society Te Apārangi (FRSNZ).

References
1. Shi J, McKelvie J. Glaucoma prevalence and prescribing trends in New Zealand: a 10-year nationwide analysis (2012–2021). RANZCO Paper Presentation, Rotorua, New Zealand 30 May 2025.
2. Carroll SC, Gaskin BJ, Goldberg I, Danesh-Meyer HV. Glaucoma prescribing trends in Australia and New Zealand. Clin Exp Ophthalmol. 2006 Apr;34(3):213-8. doi: 10.1111/j.1442-9071.2006.01196.x.
3. Gaskin BJ, Carroll SC, Danesh-Meyer HV, et al. Glaucoma management trends in Australia and New Zealand. Clin Exp Ophthalmol. 2006 Apr;34(3):208-12. doi: 10.1111/j.1442-9071.2006.01193.x.
4. Pharmac. Betoptic and Betoptic S (betaxolol) eyedrops – discontinuation notice. 8 Jul, 2025. Available at pharmac.govt.nz [accessed Sep 2025].
5. Pharmac. Schedule update – effective 1 Oct 2025 (community funding list). Wellington: Pharmac; 2025. Available at schedule.pharmac.govt.nz/2025/09/18/SU.pdf [accessed Oct 2025].
6. Pharmac. Glaucoma preparations – prostaglandin analogues (Schedule online). Available at schedule.pharmac.govt.nz/ScheduleOnline.php?code=A310308 [accessed Sep 2025].
7. Glaucoma New Zealand. Preservative-free glaucoma eye drops: some are available but not funded. Available at glaucoma.org.nz/preservative-free-glaucoma-eye-drops-some-are-available-but-not-funded [accessed Sep 2025].
8. Medsafe. Vizo-PF Dorzolatim (dorzolamide + timolol) eye drops—Data Sheet. 1 Jun 2023. Available at medsafe.govt.nz/profs/datasheet/v/Vizo-PFDorzolatimeyedrops.pdf [accessed Sep 2025].
9. Gazzard G, Konstantakopoulou E et al;, LiGHT Trial Study Group. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019 Apr 13;393(10180):1505-1516. doi: 10.1016/S0140-6736(18)32213-X. Erratum in: Lancet. 2019 Jul 6;394(10192):e1. doi: 10.1016/S0140-6736(19)31503-X.
10. European Glaucoma Society terminology and guidelines for glaucoma, 5th Edition. Br J Ophthalmol. 2021 Jun;105(Suppl 1):1-169. doi: 10.1136/bjophthalmol-2021-egsguidelines.
11. Gedde SJ, Vinod K, Mansberger SL, et al. American Academy of Ophthalmology preferred practice pattern glaucoma panel. Primary open-angle glaucoma preferred practice pattern. Ophthalmology. 2021 Jan;128(1):P71-P150. doi: 10.1016/j.ophtha.2020.10.022.
12. Kim E. GNZ’s lessons in drop adherence. Glaucoma New Zealand; 2024 Mar. Available at glaucoma.org.nz/gnzs-lessons-in-drop-adherence [accessed Sep 2025].
13. Black JM, Jacobs RJ, Acosta ML. The changing scope of optometry in New Zealand: historical perspectives, current practice and research advances. J R Soc NZ, 49(2), 188–204. doi:10.1080/03036758.2019.1587476
14. Glaucoma New Zealand. Helpline/online support. Available at glaucoma.org.nz/care-and-support/online-support [accessed Sep 2025].
15. Glaucoma New Zealand. Professional education programme. Available at education.glaucoma.org.nz [accessed Sep 2025].
16. Glaucoma New Zealand. Eyelights newsletter (Winter 2025). Available at glaucoma.org.nz/wp-content/uploads/2025/08/Eyelights-Winter2025-web.pdf [accessed Sep 2025].
17. Glaucoma New Zealand. Professional education symposium (ODOB-accredited). Available at glaucoma.org.nz/get-involved/professionals/professional-symposium [accessed 2025 Sep 20].