Barriers to Eye Health: Seeing a Way Forward

Q. What gaps do you see in our eye care system?

Australia has an excellent eye healthcare system, but some patients still struggle to access timely elective treatment.

Public ophthalmology departments provide outstanding care for acute, complex, and vulnerable patients, while increasing demand from an ageing population and other factors continues to place pressure on outpatient services and surgical capacity.

Private ophthalmology performs the majority of cataract surgery in Australia and is a critical part of the overall system, with many practices already providing collaborative and low-gap models of care.

As a consultant ophthalmologist working across three public hospitals in Sydney, I often see patients whose cataracts are not severe enough to be considered urgent but are significant enough to affect their quality of life. They may stop driving, lose confidence, or become less independent, yet still face a significant wait for public treatment. For some, private surgery is simply not affordable.

These patients can sometimes find themselves caught between the public and private systems.

Q. What do you see among patients caught between these systems?

Many patients do not fit neatly into either the public or private healthcare pathway.

While their cataracts may be significantly affecting their quality of life, patients may face a significant wait for public treatment and may not feel private surgery is financially achievable. Others have private health insurance but remain uncertain about the likely out-of-pocket costs.

As a result, they often continue to live with the effects of reduced vision while waiting for surgery, including difficulty driving, reduced independence, limitations at work or home, and a loss of confidence in day-to-day activities.

The challenge is ensuring patients can access surgery before those impacts become more significant.

Q. How significant can the impact of waiting for cataract surgery be?

The impact can be profound. Cataracts affect much more than visual acuity. Patients may stop driving, avoid going out at night, struggle to read, lose confidence, or become increasingly dependent on family.

For older Australians, reduced vision can contribute to social isolation, loss of independence, and falls risk. For those working or caring for family, it can also affect employment and daily responsibilities.

One retired gentleman in his 70s had significant posterior subcapsular cataracts (Figures 1–3). His visual acuity remained around 6/12, but severe glare had effectively left him housebound. Following surgery, his visual function improved dramatically. At follow-up, he told me: “I feel like I’ve got my life back.”

That captures the true value of cataract surgery. Vision is more than a number on an eye chart: glare, contrast sensitivity, confidence, independence, and participation in life also matter.

Q. Is this what prompted you to establish a new accessible, low-cost clinic?

Over many years, I have seen patients like him – patients whose vision and quality of life deteriorated while they navigated the gap between public and private care.

Some were facing a wait for public treatment, while others needed surgery but felt private care was beyond their reach. These were the patients we hoped to help.

Access Eye Centre was established not to replace public or private services, but to provide an additional pathway focused on accessibility, quality, safety, and collaborative care. While there is already considerable diversity within private ophthalmology, including practices offering low-gap and collaborative models, we wanted to create another option for patients whose cataracts were affecting their quality of life. We wanted to improve equitable access to care and complement existing public and private services by helping more patients access treatment when they need it.

Q. What is different about your care model, and how does it improve affordability without compromising safety or quality?

Affordability should never come at the expense of quality or safety.

We developed a deliberately lean model that makes the best use of the complementary skills of optometrists and ophthalmologists. By organising care differently, we can improve efficiency and affordability while maintaining specialist oversight and contemporary clinical standards.

Our model is built around clearly defined clinical responsibilities and a streamlined patient pathway. I work closely with optometrist Michael Yapp, who undertakes comprehensive assessment, diagnostic testing, patient education, and monitoring, while I provide specialist medical assessment, surgical planning, and surgical care. This allows each practitioner to contribute their respective expertise within a coordinated pathway, reducing duplication where clinically appropriate, and helping us operate with a lean service structure. It is designed around a defined cohort and streamlined pathway.

As part of our model, we have chosen to publish fee information on our website so patients can make an early, informed decision about whether the pathway is appropriate for them.

Importantly, efficiency does not change professional standards. Informed consent, patient selection, surgical planning, surgery, postoperative management, and clinical governance remain subject to contemporary ophthalmic standards.

Our goal is to create a sustainable model that could expand access to high-quality ophthalmic care without compromising safety or quality.

Q. Who is the clinic primarily designed to help?

Access Eye Centre is designed for patients whose cataracts are affecting their quality of life and who may otherwise find themselves caught between the public and private systems.

This includes insured and uninsured patients for whom the private options available to them may not be financially achievable and who may benefit from an alternative pathway to treatment.

Consultations are bulk billed for pensioners and Health Care Card holders to help reduce barriers to specialist assessment.

Q. Could lower-cost private models reduce demand on public cataract waiting lists?

Potentially, yes, although no single model will solve the access challenge.

Rather than viewing public and private services as competing systems, I see them as complementary. If more patients are able to access safe and affordable private care when appropriate, it may help preserve public resources for those with the greatest need – although this will need to be evaluated with time.

Any such approach should occur alongside continued investment in public services, surgical theatres and outpatient capacity, collaborative care, and funding arrangements that support sustainable access to eye care.

Q. Where is the greatest bottleneck in cataract care?

There is no single bottleneck. Demand continues to grow as Australia’s population ages, placing pressure on outpatient clinics, theatre access, and overall capacity. Continued investment in public eye services is essential.

Access to specialist assessment, outpatient capacity, and surgical capacity all influence how quickly patients can receive treatment. Addressing access, therefore, requires several complementary solutions.

Q. Is there an opportunity for closer collaboration between optometrists, ophthalmologists, and the public health system?

Absolutely. Effective collaboration allows patients to be identified earlier, referred appropriately, and managed in the most suitable setting.

When clinical roles are clearly defined, patients can move between settings according to clinical need while maintaining appropriate ophthalmologist involvement.

An ideal model delivers the right care, in the right place and at the right time, supported by strong communication among optometrists, ophthalmologists, GPs, and public services.

Q. What needs to change over the next five to 10 years?

As Australia’s population grows, we will need continued investment in public eye services, improved outpatient and surgical capacity, and stronger collaborative care models.

We will also need sustainable funding models that include private ophthalmology to support equitable access to care, alongside ongoing efforts to improve efficiency, reduce costs, and deliver care more sustainably.

Technology can support collaboration through better diagnostic imaging, communication, and information sharing, but the objective remains safe care, appropriate oversight, informed choice, and easier access.

No single solution will meet future demand. Success will depend on continued collaboration between public services, private providers, optometrists, and ophthalmologists.

Q. What would you most like optometrists referring cataract patients to understand about your clinic?

Access Eye Centre is intended to complement existing public and private pathways, not replace them.

Our model combines close collaboration between optometry and ophthalmology, clearly defined clinical responsibilities, specialist oversight, and continuity of care. By adopting a lean service structure, we aim to improve accessibility while maintaining high clinical standards.

Consultations are bulk billed for pensioners and Health Care Card holders, and patients are provided with clear information about likely costs before proceeding with treatment.

We also apply the same collaborative model to the management of glaucoma and retinal disease requiring intravitreal injections.

Whatever pathway a patient chooses, the priority remains the same: safe, appropriate, and timely care focused on achieving the best possible patient outcomes.

Dr Jason Cheng MBBS BSc FRCOphth FRANZCO FAMS FEBO is a Sydney-based ophthalmologist with more than 10 years’ experience in cataract and glaucoma care. He is Head of Ophthalmology at St George Hospital and is a consultant ophthalmologist at Sydney Eye Hospital and Liverpool Hospital. He serves on the Royal Australian and New Zealand College of Ophthalmologists Collaborative Care Glaucoma Working Group and Global Eye Health Committee, and has spoken nationally and internationally.

Dr Cheng is a co-founder of Access Eye Centre in Woolloomooloo, inner-city Sydney.