Women in Ophthalmology: Looking Gender Disparities in the Eye

Authors: Nikki Rousta, Isra M. Hussein, Radha P. Kohly.   

Author Disclosures:   N. Rousta:  None.  I.M. Hussein:  None.  R.P. Kohly:   Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Bayer, Novartis. Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Bayer, Novartis. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Bayer, Novartis.

Abstract Body:

Purpose: Gender‐based research in medicine has revealed widespread inequities against women on almost every metric and at almost every career stage; ophthalmology is no exception. By understanding the landscape of women in ophthalmology (WiO), we hope to glean insights into gender‐based issues that require further attention and action. This study aims to describe the experiences of women in ophthalmology in high‐income countries.   

Study Design:   Systematic Review   

Methods:   PubMed, MEDLINE, and Embase electronic databases were searched for English‐language studies relating to women in ophthalmology within high‐income countries. Handsearching of the Journal of Academic Ophthalmology was performed to capture relevant studies, as this journal was not indexed in the above databases. Two independent reviewers screened abstracts and full texts for eligibility. Quality of individual studies was rated from 1‐5 using a scale modified from the Oxford Centre for Evidence‐Based Medicine. Studies were organized across the timeline of WiO’s stages in their career, starting in medical school when an interest in ophthalmology is first expressed and extending up to retirement. The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses 
(PRISMA) reporting guidelines.   

Results:   Ninety‐two studies, 82 cross‐sectional, 9 cohort, and 1 retrospective pre‐post were included with only the retrospective pre‐post study investigating an intervention in addressing gender disparities. In medical school, mentorship of women medical students and recruitment into ophthalmology is influenced by gender bias, with less women applying to ophthalmology as a first choice and reference letters for women systematically differing from reference letters for men. In residency, women have unequal learning opportunities, with significantly lower surgical case volumes than men trainees. Women are also less likely to pursue fellowships in lucrative subspecialties. These gender disparities persist in practice, with women having lower incomes, reduced academic success, and poor representation in leadership roles. Women ultimately have an equivalent or greater scholarly impact factor than men after 31‐40 years of publication experience. Women experience more sexual harassment than men, from both patients and colleagues throughout their training and practice.   

Conclusions:   Although women are entering ophthalmology at increasing rates, gender disparities persist across all domains. It is critical to ensure women are supported throughout their training and careers. The impact of women mentors and women leaders is frequently cited as crucial mitigating factors to gender disparities. Gender disparities in ophthalmology must be met with interventions embedded into institutions at all stages, from medical school to retirement.