Across the Pacific region, it’s estimated that over 1.2 million people live with blindness or vision impairment – and 90 per cent of this vision loss is avoidable or treatable.
But for many years, the full extent of avoidable blindness in the Pacific has remained largely hidden. Dr Audrey Aumua, Chief Executive Officer of The Fred Hollows Foundation NZ, says eye health has remained under-resourced in many Pacific health systems because the evidence has often been incomplete, outdated or missing altogether.
“Addressing the impacts of avoidable blindness and vision impairment is a major challenge for Pacific Island countries because they have traditionally had limited information on the scale, nature, and distribution of this important public health issue,” she says.
Through the State of Eye Health Research Programme, The Foundation is working with partners to build a clearer picture of avoidable blindness in the region. Using the World Health Organization’s tools like the Rapid Assessment of Avoidable Blindness (RAAB), and the Eye Care Situation Analysis Tool (ECSAT), the programme supports Pacific-led research, evidence, and planning so governments can see where services are most needed and where investment will have the greatest impact on eye health.
A RAAB survey provides population-based evidence on the prevalence and causes of blindness and vision impairment among people aged 50 and over. It also measures cataract surgical coverage, quality of care, barriers to accessing care, and, in some countries, the prevalence of diabetes and diabetic retinopathy (DR). The ECSAT looks at the wider eye healthcare system: service delivery, leadership, governance, workforce, infrastructure, financing, products and information systems.
Collectively, these studies have shown that most vision loss in the Pacific is avoidable. Cataract remains a leading cause of blindness and severe vision impairment; uncorrected refractive error is leaving people unable to see clearly; and NCDs, including diabetes-related eye disease, are an emerging crisis. Research also shows eye care workforces are stretched, referral pathways are often weak, and in many places, eye health is still not properly integrated into primary care or diabetes services.
The findings from Vanuatu show why this matters. The country’s first RAAB survey, in 2023, found that 92 per cent of blindness and vision impairment was avoidable, with untreated cataract and uncorrected refractive error among the main causes. It also showed that rates of diabetes-related vision loss are increasing alongside the overall diabetes rate, yet 86 per cent of those with diabetes had never had a proper eye examination.
That evidence is now influencing national action. In Vanuatu, research findings have been shared with national and regional partners, helping shift eye health from a standalone issue into broader health and development planning. The country has also established a National Eye Coordinator role within the Ministry of Health, creating a dedicated mechanism to coordinate eye health nationally; and included three eye health indicators in its government health corporate plan, ensuring eye health will now be measured and reported at government level.
Dr Aumua says the progress in Vanuatu is a standout example of what can happen when a country collects its own evidence, identifies its gaps, and works in partnership to address them.
“With data now in hand, a national coordination role funded, and key indicators embedded in government systems, Vanuatu is set up for long-term improvements in eye care for its people. It’s a proud moment for the programme and a clear signal of what’s possible across the region,” she says.
Samoa also completed its first RAAB, in 2024, and the results are already being used to update the country’s national eye health plan and target outreach services to communities where barriers to accessing eye care are greatest. Samoa’s eye health team has also increased health promotion, so more people know what care is available and where to seek it.
Tonga completed its first RAAB in 2025, and a Kiribati RAAB is being planned. For smaller Pacific nations, a Small Island State Survey methodology has been developed for populations of less than 100,000 people – and is currently being piloted in the Cook Islands.
Dr Aumua says investment in eye health goes beyond restoring eyesight. Globally, evidence suggests every $1 invested in eye health delivers an average return of $28 – and in Pacific contexts, the returns can be even higher.
“It is transformative. Better eye health can reduce the unpaid care burden, and support greater participation in paid work, education, family and community life,” she says.
“Pacific governments now have a clearer picture of avoidable blindness. The next step is using that evidence to shape and respond to eye health services that reach people earlier, closer to home and in ways that last.”
The programme is a partnership between Pacific Island governments, the New Zealand Government, the University of Auckland, Ian Anderson Economics, and The Fred Hollows Foundation NZ.
