Ramke, JacquelineHarwood, MatireKandel, HimalBlack, JoannaRogers, Jaymie Tingkham2025-03-232025-03-232025-03-25https://hdl.handle.net/2292/71710Background The leading causes of vision impairment have effective interventions, but differential access to eye health services mean some population groups experience worse eye health. Inequity in eye health has historically received little attention in New Zealand. Aim The overarching aim was to assess vision impairment and access to eye health services in New Zealand. Methods Four complementary mixed-methods studies were undertaken. First, a systematic scoping review summarised the extent of evidence on vision impairment and access to eye health services in New Zealand. The remaining studies were within a project that provided cost-subsidised eye examinations and treatment to adults from an underserved community. The second study explored eye health and previous eye health service use of this cohort. The third evaluated the impact of spectacle correction on vision related quality of life at three and 12-months after spectacle correction. Lastly, a qualitative study explored barriers and facilitators of accessing eye care. Results The scoping review highlighted that most evidence on access to eye health services in New Zealand focused on cataract or diabetic retinopathy, with Māori and Pacific people consistently underserved; few studies focused on uncorrected refractive error. A total of 242 adults (63% female, median age 64 years) participated in the community-based study (60% Pacific people, 25% Māori), most of whom had distance or near vision impairment and half of whom (53%) reported never previously accessing optometry care. Most vision impairment was caused by uncorrected refractive error (85%), yet three-quarters of participants reported never having had custom-made spectacles (73%). Among the 207 people dispensed spectacles, quality of life was significantly higher at three-months, and this was maintained at 12-months. Cost was a major barrier to accessing eye care, while patient-provider communication was an important facilitator. Conclusion Ethnic disparity in access to eye care is evident in New Zealand. This research uncovered considerable unmet need for refractive error correction in an underserved community, largely due to prohibitive cost of seeking care, while correcting this refractive error significantly improved quality of life. Equity-focused strategies are required to achieve universal health coverage for eye health, including financial protection for those unable to access eye care.Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htmOptometryVision impairmentAccess to health servicesUncorrected refractive errorNew ZealandThesisCopyright: The authorAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/