By 1961 he was able to move to London for further study, working later amongst the needy in Cardiff, trying to deal with treatable conditions before they became serious problems. In 1965 he became Associate Professor at the University of N SW. A meeting with author Frank Hardy in 1968 led him to visit isolated aboriginal communities where he was shocked at living conditions and at the extent of eye diseases, which had been virtually eradicated, in western society. He worked with others to establish the Aboriginal Medical Service, both in Sydney and in the indigenous communities. As a result, the incidence of diseases such as trachoma was substantially reduced.

As a consultant to WHO, Fred visited Nepal, Burma, Sri Lanka and later Eritrea and determined to fight to reduce the cost of eye health care and treatment in the Third World. By raising funds to establish local intraocular lens factories in Nepal and Eritrea and by training local doctors, Fred's efforts were rewarded when many thousands suffering from cataracts had their sight restored at minimal cost.

In 1989 he was diagnosed with terminal cancer but, although often in pain, he continued to travel and treat patients. In 1992 the Fred Hollows Foundation was set up to continue his work which it has successfully done through sponsorships and donations. Fred died on 10 February 1993 and is buried at Bourke in the outback country that he loved and whose people loved him. Initially he refused to accept awards but realised that these could give a platform for gaining assistance for his work. Touchy, abrasive and impatient of bureaucracy and waffle, he is remembered by his patients as one who put their needs first. Perhaps he is best remembered in his own words:

The essence of being a human being is looking after others. That's what separates us from the animal kingdom. If you start thinking that your own future is the most important thing, then as a human being, you are already destroyed and might as well die.