Summary
The New Zealand Government is currently deliberating over the 2026 Health Budget, yet investing in eye care services remains largely overlooked. Unlike many high-income countries, Aotearoa New Zealand (NZ) has very little public funding for routine eye care, creating significant cost barriers for our population, especially Māori, Pacific Peoples, and low-income families. Recent research indicates that investing just 1.2% of the NZ health budget could fund more than two million eye examinations and more than 60,000 spectacles each year. This investment would promote healthy vision, reduce inequities, and deliver long-term economic benefits from reduced injuries, improved mental wellbeing, and stronger workforce participation.
Eye health is recognised by the World Health Organization as a public health priority,1 as vision loss has significant social and economic consequences. Poor vision threatens independence, limits educational outcomes for children and employment opportunities for adults, while increasing the risk of physical injury from falls and road crashes.2 Vision loss also reduces mental wellbeing, and increases the risk of depression, dementia, and premature death. 2 Fortunately, 90% of vision loss is preventable or treatable with access to routine eye examinations and treatments.2
At the World Health Assembly in 2020, NZ committed to improve access to eye care and prevent avoidable vision loss.3 Despite this, eye health remains a policy blind spot. Spectacles to correct refractive error (the most common cause of vision loss) are inaccessible to many Kiwis.4 Diabetic retinopathy remains a significant cause of avoidable vision loss,5 despite long-running screening programmes. Higher rates of delayed care for keratoconus in Māori and Pacific children 6 highlight inequities in service access. Glaucoma, the “silent thief of sight” remains asymptomatic in the early stages, and late presentation always leads to irreversible vision loss. The challenge in NZ is to make eye care services accessible to the people who need them.
Access to eye care should be a right, not a luxury
Cost is the main barrier to accessing routine eye examinations and spectacles.7 In NZ, routine eye care is delivered by optometrists in private practice, with very little public funding to reduce out-of-pocket costs.8 Families with a Community Services Card can access a spectacle subsidy for their children, while adults can apply for a loan from Work and Income, although this must be re-paid. Our policies compare poorly to other high-income countries, where eye examinations and spectacles are subsidised for some, if not all, of their population.8
Routine eye care delivers more than an updated spectacle prescription. In NZ, a comprehensive eye examination must include an ocular health check, to detect and manage eye conditions. Without public funding, many Kiwis delay or forgo these routine checks. As a result, people with eye disease (such as glaucoma) often present for eye care late, when treatment is complex and outcomes are poorer. Long waitlists for publicly funded treatment in hospitals further complicates the problem,9 meaning many people are living with vision loss that could have been avoided.
Despite the absence of comprehensive, population-level data,10 the available evidence consistently describes inequitable access to eye care. Collectively, our existing services are approximately 2.5 times less accessible to Māori and Pacific peoples.11 In an Auckland suburb where many Māori and Pacific People reside, more than half of the people with vision loss had never had an eye examination before.4 Together these examples illustrate how preventable vision loss is normalised, and this has reinforced existing health inequities.
Designing an equitable solution
One solution to NZ’s eye health inequities is public funding for routine, preventative eye care delivered by community optometrists. This would broaden the investment from reactive, hospital-based treatments to include early detection and management in the community.12,13 Ultimately, public funding for optometry services would reduce the negative impacts of vision loss and reduce the pressure on hospital eye departments, with associated cost-savings.
In Australia, Medicare subsidises routine eye examinations for the entire population. This is a good starting point to discuss funding models in NZ. Our preliminary estimates suggest that this could be achieved for ~$362 million per year and would fund around 2.4 million examinations and more than 60,000 spectacles, for just 1.2% of the 2025/26 health budget.14 While increasing access to primary care would also increase detection of eye conditions requiring secondary care, these initial costs would stabilise over time.15 Globally, eye care is one of the most cost-effective health interventions,16 while our estimated $362 million annual investment is comparable to the Labour Government’s 2023 policy to fund dental care for 800,000 Kiwis aged 19-30 years.17
To achieve meaningful equity gains, public funding for eye care should prioritise people who would benefit the most from subsidised care.18 This could be achieved by targeting the ~1 million Kiwis with an income-tested Community Services Card (requiring an investment of ~$102 million annually).14 Extending the current children’s spectacle subsidy to all children would also align eye care from free GP and dental services—ensuring every child has the vision that they need to learn and thrive (~$50 million annually).14 These are feasible policy interventions that would ultimately increase access for Māori and Pacific Peoples, and those with reduced incomes. Funding for older people (e.g. SuperGold card holders) would bring Aotearoa’s eye care policies in line with those of other countries,14 bringing eye care to people who are most likely to be living with vision loss (~$1.13 million annually).14
Importantly, public funding alone is unlikely to eliminate eye health inequities17 and additional strategies will be needed to improve access to eye care for underserved groups, including Māori. This could include improving cultural safety in our workforce and delivering outreach services directly within communities, alongside broader policies that address tobacco control and nutrition.
What this Briefing adds
- Vision loss has significant consequences for individuals, whānau, communities and our economy, due to reduced health and well-being, lost employment opportunities, injury-related harm, and premature death.
- Preventative eye care is underfunded in NZ compared to other high-income countries, and this makes it less accessible to some population groups.
- Public funding for routine eye examinations based on Australia’s model would deliver approximately 2.4 million eye examinations and more than 60,000 spectacles annually, for approximately 1.2% of our 2025/26 health budget.
Implications for policy and practice
- NZ needs public funding for preventative eye care, delivered by community optometrists. This preventative health strategy would increase the detection and treatment of progressive eye disease (e.g. from diabetic retinopathy and glaucoma) and would reduce the number of people living with the negative consequences of preventable vision loss.
- Funding routine, comprehensive eye examinations for people who are most in need of services would likely achieve the greatest equity gains and would bring our eye health policies in line with those of other high-income countries. Funding spectacles would address the leading cause of vision loss. Target groups could include Community Services Card holders, children, and older people.
- Funding community eye care may be cost-beneficial in the long-term and would likely reduce the pressure (and therefore spend) on hospital eye care services.
Authors' details
Dr Lucy Goodman, Research Fellow, Optometry and Vision Science, Waipapa Taumata Rau | University of Auckland
Dr Pushkar Silwal, Research Fellow, Optometry and Vision Science, Waipapa Taumata Rau | University of Auckland
Assoc Prof Philip Turnbull, Faculty of Medical and Health Sciences, Waipapa Taumata Rau | The University of Auckland; Optometrists and Dispensing Opticians Board Advisor & Researcher | Kaitohutohu Poari me te Kairangahau Poari
Inhae Park, Optometrist, Te Whatu Ora Capital, Coast and Hutt Valley
Assoc Prof Joanna Black, Deputy Head of School, Optometry and Vision Science, Faculty of Medical and Health Science, Waipapa Taumata Rau | The University of Auckland
Renata Watene, Ngā Puhi, Ngāti Hikairoa – Kaiāwhina, Faculty of Medical and Health Sciences, Waipapa Taumata Rau | The University of Auckland; President of the New Zealand Association of Optometrists; Clinical Lead, Allied Health, Scientific and Technical for Te Ikaroa, Te Whatu Ora
Assoc Prof Jacqueline Ramke, Optometry and Vision Science, Waipapa Taumata Rau | University of Auckland.
