Glaucoma treatment rates climb in New Zealand, but disparities persist for Māori and Pasifika patients

How equitably are glaucoma medications being dispensed across a universal health care system, and how have prescribing patterns shifted over the past decade? A retrospective study drawing on 10 years of national pharmacy dispensing data from New Zealand found that the number of pharmacologically treated patients grew substantially between 2012 and 2021, yet Māori and Pasifika populations remained markedly under-represented among those receiving treatment—even after adjusting for age—according to findings published in the Asia-Pacific Journal of Ophthalmology.¹

Study design

Shi and colleagues, of Te Whatu Ora Health New Zealand and the Department of Ophthalmology at the University of Auckland, conducted a retrospective observational study using de-identified national pharmacy dispensing data obtained from the New Zealand Ministry of Health covering the period 2012 to 2021.¹ Dispensing trends for 11 publicly funded glaucoma medications were analysed by year, medication, sex and self-identified ethnicity. Eleven agents were included across five drug classes: prostaglandin analogues (latanoprost, bimatoprost and travoprost), beta-blockers (timolol and betaxolol), the alpha-agonist brimonidine tartrate, the muscarinic agonist pilocarpine hydrochloride, carbonic anhydrase inhibitors (dorzolamide hydrochloride and brinzolamide) and two fixed-dose combination drops. Age-adjusted per capita dispensing rates were compared using analysis of variance (ANOVA) with post-hoc Tukey analysis.

Treated prevalence rose, outpacing population growth

Over the study period, 3,021,885 glaucoma prescriptions were dispensed, representing 27.6% of all ocular medications.¹ The number of individuals receiving treatment rose from 39,725 in 2012 to 50,048 in 2021, a 25.9% increase that outpaced the 15.9% growth in the New Zealand population over the same period. The estimated prevalence of pharmacologically treated glaucoma or ocular hypertension increased from 0.90% to 0.98%, and the annual incidence of newly treated patients was estimated at 125 per 100,000 people per year.

Latanoprost emerged as the most frequently dispensed medication, accounting for 40% of all glaucoma prescriptions and 11% of all ocular prescriptions, followed by timolol (13%) and bimatoprost (11%).¹ Prior to this shift, beta-blockers had been the more commonly dispensed class, a pattern the authors linked to historical funding constraints on prostaglandin analogues that have since been lifted. Increasing dispensing trends were observed for latanoprost, timolol, brinzolamide, brimonidine tartrate and both combination drops, while bimatoprost, travoprost, betaxolol, pilocarpine and dorzolamide declined. A notable peak in prescriptions was recorded in 2020 across almost all agents, which the authors suggested may be partly attributable to patient preparation for nationwide lockdown during the COVID-19 pandemic.¹

Disparities in access to treatment

The most striking finding concerned ethnic disparities in dispensing.¹ Despite comprising 67.8% of the New Zealand population, Europeans received 87% of all glaucoma prescriptions and had an age-adjusted prescribing rate of 34.7 per 1000 people. By contrast, Māori and Pasifika peoples—who represent 17.8% and 8.9% of the population respectively—received only 1.9% and 1.4% of prescriptions, with age-adjusted rates of 8.5 and 14.5 per 1000. These differences were statistically significant across all 11 medications (P < .001). The authors highlighted that no population-based prevalence data exist specifically for glaucoma in Māori or Pasifika peoples, making it difficult to determine whether lower dispensing rates reflect true differences in disease burden or inequitable access to care. They pointed to socioeconomic factors, cultural barriers, communication challenges and potential implicit bias within the health care system as likely contributors, and noted that these disparities mirror broader patterns of inequitable health care access documented across other chronic conditions in New Zealand.¹

Limitations and clinical implications

The authors acknowledged that national dispensing data, while offering a robust population-level view, lack clinical detail including disease severity, glaucoma subtype, visual field progression and adherence to therapy.¹ The exclusion of several fixed-dose combination therapies due to funding status changes during the study period may also understate the true volume of combination therapy use. Ethnicity data derived from self-reported records may be subject to misclassification or underreporting.

The authors concluded that the study fills a significant gap in the literature by documenting national glaucoma treatment patterns across a full decade, with latanoprost consolidated as the dominant first-line agent consistent with international guidelines.¹ They called for future research integrating clinical and dispensing datasets to enable more nuanced assessment of treatment effectiveness and the drivers of inequity, and noted the value of repeating this analysis as minimally invasive glaucoma surgery uptake continues to rise.²

The authors declared no competing interests. Ethics approval was obtained from the Auckland Health Research Ethics Committee, Waikato Hospital Research Office and Te Puna Oranga.

References

1. Shi J, Singh V, Nunns B, Danesh-Meyer H, McKelvie J. Glaucoma prevalence and prescribing trends in New Zealand: a 10-year study. Asia Pac J Ophthalmol (Phila). doi:10.1016/j.apjo.2026.100350

2. Carroll SC, Gaskin BJ, Goldberg I, Danesh-Meyer HV. Glaucoma prescribing trends in Australia and New Zealand. Clin Exp Ophthalmol. 2006;34(3):213-218. doi:10.1111/j.1442-9071.2006.01196.x