Is visual impairment more prevalent in women?
While it may seem that diseases don’t discriminate, avoidable blindness does. When gender differences limit access to proper eye care services, women are at greater risk of developing eye diseases that are otherwise treatable and preventable.
Recent studies published in The Lancet Global Health in 2020 revealed that women carry the greater burden of visual impairment. Globally, more women than men have impaired vision due to cataracts, age-related macular degeneration (AMD), and dry eye disease.
The publication reported that approximately 510 million people are suffering from untreated vision impairments — 90% of those living in low and middle-income countries. In addition, one in four women is at risk of vision impairment compared with just one in eight men.
Is there gender inequality in healthcare?
Blindness is a gender issue. According to the IAPB (International Agency for the Prevention of Blindness) Vision Atlas, girls and women account for 55% of those living with vision loss. Women are:
- 8% more likely to be blind
- 15% more likely to have moderate to severe vision impairment
- 12% more likely to have mild vision impairment
- 11% more likely to have near vision impairment
Additional statistics support this pattern of women having worse vision health than men:
- According to the National Center for Chronic Disease Prevention and Health Promotion, approximately 12 million people in the United States, age 40 and older, are visually impaired or blind — more than half of them are women.
- According to the Royal National Institute of Blind People, women constitute 64.5% of the world’s visually impaired.
- Worldwide there are 112 million more women than men living with vision loss.
Why does a gender gap exist in eye health?
Eye health is synonymous with well-being. Women’s eye health is subject to many barriers including:
Economic barriers to eye healthcare
Globally, women often have limited access to financial resources to pay for eye care, as their primary responsibilities in the home. Almost 90% of women who are blind live in poverty and are not able to access eye health services.
Community-based service delivery models are effective in tackling the financial barrier, by providing access to free or low-cost eye care.
Place of residence
Where a woman lives plays a role in determining whether she will have access to eye care. People living in rural and/or low-income areas generally have poorer outcomes compared with higher-income city dwellers. Many eye health professionals are closer to the cities — meaning rural and remote areas are underserved.
In addition, women often have limited access to transportation needed to access vision services compared with men. In poor areas, family members may also be unable to provide the transportation women need, especially older women.
Lack of information and resources
Cultural traditions that inform gender roles are major determinants of access to eye care. Men are traditionally the breadwinners while women manage domestic tasks and are the caregivers at home in rural areas. Limited mobility results in a lack of information and resources.
Due to their assigned role in the home, women may have a lack of education; literacy rates are lower for women than for men. As a result, women are less likely to know about their treatment possibilities and where to go to receive it.
Research in South India supports this and shows that the literacy levels of visually impaired individuals predicts the number of women receiving cataract surgery. A man in rural South Asia is 46% more likely to receive cataract surgery than a woman.
Why do women have higher rates of eye disease?
The Journal of Ophthalmology review suggests that social, biological, and cultural differences between women and men are contributing factors to gender disparity in eye health.
Age
Women bear a higher burden of eye disease due to a longer life expectancy than men. So, they are more likely to experience serious, age-related diseases like AMD. But, even when adjusted for age, women still bear the burden of vision loss for AMD.
In low and middle-income countries, older people often believe their vision loss is a part of the normal aging process and that it’s unavoidable. They are unaware that many eye conditions can be treated, so they don’t seek medical advice.
Biological differences
Normal biological processes in the female body throughout life can cause vision changes.
Puberty
During puberty, there is an increase in estrogen in the body that may lead to myopia (nearsightedness).
Pregnancy
During pregnancy, there are fluctuations in estrogen and progesterone levels that can cause blurry vision and problems focusing.
Menopause
A women’s estrogen and progesterone levels dramatically decrease in menopause, which may impact vision. Menopausal women can experience a build-up of intraocular pressure, which is linked to glaucoma.
Intraocular pressure can lead to optic nerve damage, which causes vision loss. Dry Eye Disorder is also common in postmenopausal women due to substantially decreased hormone levels.
Traditional gender roles
Trachoma is a highly contagious bacterial infection of the outer eye experienced in childhood. It is the world’s leading infectious cause of blindness and affects more women than men. This is due to traditional gender roles — women carry a larger share of child-rearing responsibilities.
Trachoma can lead to trachoma trichiasis in the later stages of infection. Repeated trachoma infections cause the upper eyelid to turn inward (trichiasis) so the eyelashes scrape the eyeball. This causes excruciating pain and permanent scarring of the cornea. If left untreated, it will lead to blindness.
Women make up 70% of those affected with trachoma trichiasis.
Societal expectations
Women experience societal pressures to main physical appearances — which often include the use of makeup and personal care products. The use of cosmetics harms women’s eye health because:
- The cosmetic industry is under-regulated, and this adversely affects women’s eye health — resulting in dermatitis, bacterial infections, dry eye disorder (DED), and other eye conditions.
- Retinoids in anti-aging creams have negative effects on the oil glands around the eye and can contribute to dry eye disorder. Some synthetic ingredients have been linked to symptoms of dry eye and dysfunction of the large sebaceous glands in the eyelids.
- These eye products are sold over the counter and are not subject to the same FDA regulatory and reporting standards as prescribed medications. Users are exposed to undisclosed ingredients, warnings, and/or side effects.
Can telehealth (online healthcare) bring about gender equality in eye health?
Telehealth became a necessity during the coronavirus pandemic. To ensure eye care patients are not left behind, telehealth has been implemented all over the world.
Telehealth allows women with vision impairment to receive eye care without being in the physical presence of the eye care provider. Women can continue accessing diagnostics and treatment services despite the pandemic and geographic challenges.
Can gender equity eye programs close the gap?
Implementing gender equity programs in low to middle-income communities is a must to achieve equitable access for women. Suggestions have been made by officials from universities in China, Australia, and the World Health Organization (WHO) that may reduce the gender gap for cataract surgery in low-income countries.
In low-income areas, establishing and expanding partnerships for support is essential for the sustainability of eye health programs. This will ensure that quality services are accessible to all and limit the gender disparities in healthcare.
Educating health care providers and the public about gender inequity in women’s eye health is essential for early intervention, decreasing the prevalence of eye disease, and improving quality of life.
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As a member of an elite group of only 3000 retina-vitreous specialists in the United States, Stanford trained Dr. Pilyugina brings to AGEI a unique skill set in the treatment and surgery of retinal disease. Her academic credentials include numerous research papers, conference presentations, medical publications, and clinical trials.
In recognition of her expertise, Dr. Pilyugina was asked to serve as Chief Editor for New Retinal Physician, a supplement published by the Retinal Physician Journal.
