Female ophthalmologists in the United States and other high-income countries still face discrimination and unequal treatment at almost every career stage, from training through practice, according to a systematic review of research published recently in the journal JAMA Ophthalmology.1 The data revealed that an increase in the proportion of females in the field over the past 34 years was not associated with an increase in female representation in leadership positions, and it identified sex disparities in the experiences of females in ophthalmology at all career stages.
Canadian researchers Nikki Rousta, MD; Isra M. Hussein, MD; and Radha P. Kohly, MD, reviewed English-language studies relating to women in ophthalmology that were published between January 1990 and May 2022. They searched the PubMed, Medline, and Embase electronic databases, as well as the Journal of Academic Ophthalmology. The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) reporting guidelines. The review included 87 cross-sectional studies and 4 cohort studies.
Among their findings was that in medical school, mentorship and recruitment of female students into ophthalmology was influenced by sex bias, with fewer females identifying with ophthalmologist mentors and gender stereotypes perpetuated in reference letters written by both male and female referees. In residency, females had unequal learning opportunities, with lower surgical case volumes than male trainees, and fewer females pursued fellowships in lucrative subspecialties. In practice, female ophthalmologists had lower incomes, less academic success, and poorer representation in leadership roles. Females also were more likely to report experiencing sexual harassment, from both patients and colleagues, throughout all stages of training and practice. The systematic review found that female ophthalmologists had a greater scholarly impact factor than their male counterparts—but only after approximately 30 years of publication experience.
Despite these disparities, some studies found that females reported equal overall career satisfaction rating with males in ophthalmology, whereas others suggested higher burnout rates.
Findings of relevance to the vitreoretinal specialty include: during fellowship, females had lower volumes for specific procedures—namely internal limiting membrane peel, scleral buckle, and cryoretinopexy. Also, vitreoretinal meetings with at least 1 female committee member had more female invited speakers and invited moderators and panelists. The researchers concluded that there is a need for active interventions to address sex disparities in ophthalmology to improve equity in this field.
Recent Survey Highlights Inequalities that Female Ophthalmologists Face
The Women in Ophthalmology Survey, conducted by Ipsos and released by Johnson & Johnson last fall, highlighted some inequities and barriers faced by female ophthalmologists today. Among the notable responses by female ophthalmologists were the following:
• 36% agree that there are barriers that prevent them from reaching their career aspirations.
• 32% have had their competence questioned due to their gender;
•32% have had patients disrespect or harass them; 11% said that faculty, staff, or fellow students were disrespectful or harassed them during medical school;
• 34% believe their medical school experience could have been different had they been male; and
•66% say their professional experience would be better if they had received mentorship from other female ophthalmologists.
“Results from the Women in Ophthalmology Survey highlight the inequities disproportionately faced by women ophthalmologists today which is unacceptable,” said Lori Tierney, president, Americas, Johnson & Johnson Vision, in a press release.
These findings highlight the need for diversity, equity, and inclusion (DEI) policies, said Mitul Mehta, MD, MS, the vice president of the American Retina Forum (ARF). Such policies are intended to foster an environment where all individuals—irrespective of gender, race, ethnicity, religion, or sexual identity—receive equal opportunities and access to resources and are valued for their unique perspectives and contributions.
“The ARF was created to lower the barriers for the spread of retinal education,” said Dr. Mehta. “With the publication of this magazine, our online community, and our national meetings, we strive to help retina specialists with diverse backgrounds communicate the best ways to take care of our patients.” NRP
References
1. Rousta N, Hussein IM, Kohly RP. Sex disparities in ophthalmology from training through practice: a systematic review. JAMA Ophthalmol. 2024;142(2):146-154. doi:10.1001/jamaophthalmol.2023.6118
