Background: To determine access to and utilization of eye health services for indigenous Australians. Design: A national, stratified, random cluster sample was drawn from 30 communities across Australia that each included about 300 indigenous people. Participants: A total of 1189 indigenous adults aged 40 and above were examined, representing 79% of the target population. Methods: Eye health services data including nature and availability of facilities and workforce supply were collected for comparison with eye health prevalence data. The data were collected in 2008. Main Outcome Measures: Low vision prevalence and coverage rate for distance refractive correction. Results: The full-time equivalent availability of an optometrist working in an Aboriginal Medical Service was significantly associated with both a decrease in the prevalence of low vision (t=-2.41, P=0.02) and an increase in the coverage rate for distance refractive correction (t=2.99, P=0.006). These associations were not replicated when comparing availability of private or hospital-based optometry in each community. Regional eye health coordinators appeared to provide an improved utilization of Aboriginal Health Services and therefore improved access to Aboriginal medical service optometry. Conclusions: Eye health services for indigenous Australians need to be provided in culturally appropriate facilities with clear links to the indigenous community to optimize access to care and reduce the prevalence of vision impairment. The adequate provision of accessible eye care services is an important component in 'closing the gap' in vision loss for indigenous Australians.