BoSS Library

• Aguwa UT, Srikumaran D, Green LK, et al. Analysis of sex diversity trends among ophthalmology match applicants, residents, and clinical faculty. JAMA Ophthalmol 2021; 139:11841190.

This study found that the percentage of women in the field of ophthalmology remains lower than percentages in other specialties, and the percentage of female ophthalmology residents has decreased in recent years. More efforts are needed to improve female representation in ophthalmology.

• Gill HK, Niederer RL, Shriver EM, et al. An eye on gender equality: a review of the evolving role and representation of women in ophthalmology. Am J Ophthalmol 2022; 236:232240. 

  This perspective review (published 2022; data spanning 1969–2020) summarizes trends in gender representation in ophthalmology, noting that women increased from 4% of U.S. ophthalmologists in 1969 to 27% in 2019, and now comprise 35%–45% of trainees, yet remain underrepresented in leadership and senior academic ranks. Women held only 18% of department chair positions, received 25.3% of major society awards (1970–2020), and earned on average 12.5%–36% less than men, highlighting persistent gender inequities in leadership, compensation, and career advancement.

• 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. PMID: 38236584.
  

  A systematic review (1990–May 2022) of 91 studies (87 cross-sectional, 4 cohort) examining sex disparities in ophthalmology found that women performed up to 12.5% fewer cataract surgeries and 15.7% fewer total procedures during residency, earned 12.5%–36% less income than male ophthalmologists, and remained underrepresented in leadership roles. Although women comprised up to 35%–45% of ophthalmology trainees and demonstrated greater scholarly impact after approximately 30 years of publication experience, inequities in advancement, subspecialization, and compensation persisted within the field.

• Burton MJ, Ramke J, Marques AP, et al. The Lancet Global Health Commission on global eye health: vision beyond 2020. Lancet Glob Health. 2021;9(4):e489-e551. DOI:10.1016/S2214-109X(20)30488-5

The Lancet Global Health Commission on Global Eye Health reported that change is required to improve equity, diversity, and inclusion for females in ophthalmology.

• Linz MO, Jun AS, Clever SL, Lawson SM, Sanyal A, Scott AW. Evaluation of medical students’ perception of an ophthalmology career. Ophthalmology. 2018;125(3):461-462. DOI:10.1016/j.ophtha.2017.10.032

*A 2018 single-center survey (n = 89) found that more students who were underrepresented in medicine (URM) (2 of 8 females [25%]; 0 of 8 males) than students who were not URM (0 of 73, including 34 females; P = .03) cited insufficient same-sex role models or mentors as a reason for not pursuing ophthalmology. 

• Lin F, Oh SK, Gordon LK, Pineles SL, Rosenberg JB, Tsui I. Gender-based differences in letters of recommendation written for ophthalmology residency applicants. BMC Med Educ. 2019;19(1):476. DOI:10.1186/s12909-019-1910-6

In a single-center analysis12 of 440 applicants in the 2017 to 2018 SF Match, terminology used in reference letters written for females vs males was different despite applicants having similar academic and service achievements, and sex distribution of letter writers.

• Tuli SS. Status of women in academic ophthalmology. J Acad Ophthalmol. 2019;11(02):e59-e64. DOI:10.1055/s-0039-3401849

The percentage of female ophthalmology residents in 2017 was 41.0% (593 of 1446); this has been mostly constant between 2007 and 2017. Females in academic ophthalmology increased from 24% to 34% between 2003 and 2017, mostly at the assistant professor rank (44% female); 19% of professors and 12% of chairs were female.

• Gong D, Winn BJ, Beal CJ, et al. Gender differences in case volume among ophthalmology residents. JAMA Ophthalmol. 2019;137(9):1015-1020. DOI:10.1001/jamaophthalmol.2019.2427

An analysis of resident case logs (n = 1271) in 24 US programs between 2005 and 2017 revealed that females performed a mean (SD) of 451.3 (158.8) total procedures, whereas males performed 509.4 (208.6) procedures (MD, 58.1; 95% CI, 36.0-80.2; P < .001). There was no sex difference in the increase of cataract volumes in this period (β = −1.6; 95% CI, −3.7 to 0.4; P = .11); however, male surgical volumes increased more for total procedures (β = −8.0; 95% CI, −14.0 to −2.1; P = .008). 

• Gill HK, Niederer RL, Danesh-Meyer HV. Gender differences in surgical case volume among ophthalmology trainees. Clin Exp Ophthalmol. 2021;49(7):664-671. DOI:10.1111/ceo.13969

Similar results were observed in a cohort analysis from Australia and New Zealand of resident logbooks (n = 241) between 2008 and 2020.17 A subanalysis in this study using 2020 data of 181 residents who performed 32 992 surgical procedures found no association between complication rate and trainee sex. 

• McAlister C, Jin YP, Braga-Mele R, DesMarchais BF, Buys YM. Comparison of lifestyle and practice patterns between male and female Canadian ophthalmologists. Can J Ophthalmol. 2014;49(3):287-290. DOI:10.1016/j.jcjo.2014.02.007

A 2012 survey of 385 ophthalmologists reported that 50 of 102 females (49%) vs 181 of 283 males (64%; P = .001) had 2 or more operating room days per month.

• Feng PW, Ahluwalia A, Adelman RA, Chow JH. Gender differences in surgical volume among cataract surgeons. Ophthalmology. 2021;128(5):795-796. DOI:10.1016/j.ophtha.2020.09.031

In a 2017 population-based study of 8620 ophthalmologists (1829 females [21.2%]) who performed cataracts for Medicare beneficiaries, multivariate analysis revealed that males performed an estimated 101.1 more cataract surgeries (95% CI, 67.9-134.2; P < .001), after controlling for clinical productivity and number of years in practice.

• Fountain TR. Ophthalmic malpractice and physician gender: a claims data analysis (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2014;112:38-49.

*In an analysis of 2251 claims, males were sued 54% more than females between 1990 and 2008 (claim frequency was 5.69% [SD, 0.13%] for males vs 3.70% [SD, 0.25%] for females) and were 1.7 times more likely to have claims associated with permanent injury (616 of 35 773 males [1.72%] vs 58 of 5811 females [1.0%]) and nearly 8 times more likely to have claims associated with death (48 of 35 773 males [0.13%] vs 1 of 5811 females [0.02%]). However, females paid 47.4% more in indemnity for treatment and procedural claims ($190 185 vs $100 099).

• Ahmad S, Ramulu P, Akpek E, Deobhakta A, Klawe J. Gender-specific trends in ophthalmologist Medicare collections. Am J Ophthalmol. 2020;214:32-39. DOI:10.1016/j.ajo.2019.12.024

After adjusting for subspecialty, the average female collected $133 289 (42%) less than males in Medicare payments between 2012 and 2015, with the median male ophthalmologist out-earning the 75th percentile of female ophthalmologists in all subspecialties.

• Sedhom JA, Patnaik JL, McCourt EA, et al. Physician burnout in ophthalmology: US survey. J Cataract Refract Surg. 2022;48(6):723-729. DOI:10.1097/j.jcrs.0000000000000837

In an early 2020 survey, female ophthalmologists had almost twice the odds of reporting burnout (odds ratio, 1.9; 95% CI, 1.3-2.7; P <.001) and were more likely to report feeling high work-related stress (125 of 199 [62.8%] vs 168 of 342 [49.1%]; P = .002). 

• Goldstein T, Lessen S, Moon JY, Tsui I, Rosenberg JB. The significance of female faculty and department leadership to the gender balance of ophthalmology residents. Am J Ophthalmol. 2022;238:181-186. DOI:10.1016/j.ajo.2022.01.022

*A more recent US study found that 18 of 108 chairs (16.7%) were female, and 43 of 117 programs (37.7%) had female program directors in 2020 to 2021. Greater female faculty increased the odds of having more female residents (OR, 1.19; 95% CI, 1.08-1.3; P < .001); department chair sex did not correlate with proportions of female faculty or residents.

• Pinho-Gomes AC, Vassallo A, Thompson K, Womersley K, Norton R, Woodward M. Representation of women among editors in chief of leading medical journals. JAMA Netw Open. 2021;4(9):e2123026-e2123026. DOI:10.1001/jamanetworkopen.2021.23026

*In a review exploring editors-in-chief of the top 5 high-impact journals in 2011, ophthalmology was among the 5 specialties that had no female editor-in-chief; females represented less than 35% of board members.

• Camacci ML, Lu A, Lehman EB, Scott IU, Bowie E, Pantanelli SM.  Association between sex composition and publication productivity of journal editorial and professional society board members in ophthalmology. JAMA Ophthalmol. 2020;138(5):451-458. DOI:10.1001/jamaophthalmol.2020.0164

*In 2018, 1 of 24 editors-in-chief (4.2%) of the 20 highest-ranked ophthalmology journals was female. Two of the 15 professional society presidents (13.3%) were female. 

• Patel SH, Truong T, Tsui I, Moon JY, Rosenberg JB. Gender of presenters at ophthalmology conferences between 2015 and 2017. Am J Ophthalmol. 2020;213:120-124. DOI:10.1016/j.ajo.2020.01.018

*Of 14 214 speakers in 9 conferences between 2015 and 2017, 4335 (30.5%) were female, 1435 of 4335 females (33.1%) gave a paper presentation, and 1236 of 4335 females (28.5%) gave a non-paper presentation; this was higher than the American Board–certified Ophthalmologists (ABO) sex ratio of 25.4% (P < .001 for all).

• Sridhar J, Kuriyan AE, Yonekawa Y, et al. Representation of women in vitreoretinal meeting faculty roles from 2015 through 2019.  Am J Ophthalmol. 2021;221:131-136. DOI:10.1016/j.ajo.2020.09.001.

*Vitreoretinal meetings between 2015 and 2019 with at least 1 female committee member had more female invited speakers (23.1% vs 17.0%; P =.02) and invited moderators and panelists (28.3% vs 22.7%; P =.02) but no sex association for noninvited abstract speakers (21.2% vs 21.7%; P =.77). 

• Shah DN, Huang J, Ying GS, Pietrobon R, O’Brien JM.  Trends in female representation in published ophthalmology literature, 2000-2009. Digit J Ophthalmol. 2013;19(4):50-55. DOI:10.5693/djo.01.2013.07.002

*Between 2000 and 2009, female first and last authorship increased in American Journal of Ophthalmology, Archives of Ophthalmology, and Ophthalmology when considered together (from 21.0%-34.2%; P < .001 and from 18.5%-20.5%; P = .005, respectively). When considered individually, first authorship increased in all 3 journals; last authorship increased only in Ophthalmology. 

• Franco-Cardenas V, Rosenberg J, Ramirez A, Lin J, Tsui I.  Decade-long profile of women in ophthalmic publications. JAMA Ophthalmol. 2015;133(3):255-259. DOI:10.1001/jamaophthalmol.2014.4447

*Similar sex findings were reported in another 2000 to 2010 authorship review; however, 13% of editorials (5 of 38) were written by females in 2000, compared with 10% (5 of 51) in 2010.

• Amarasekera DC, Lam SS, Rapuano CJ, Syed ZA. Trends in female authorship in cornea from 2007 to 2019. Cornea. 2021;40(9):1152-1157. DOI:10.1097/ICO.0000000000002598

*A 2015 to 2019 review of 17 100 articles contradicts earlier findings whereby female last authorship increased for general (P = .007) and subspecialty journals (P = .03).

• Lopez SA, Svider PF, Misra P, Bhagat N, Langer PD, Eloy JA. Gender differences in promotion and scholarly impact: an analysis of 1460 academic ophthalmologists. J Surg Educ. 2014;71(6):851-859. DOI:10.1016/j.jsurg.2014.03.015

*In a 2013 rank and scholarly impact factor analysis of 1460 academic ophthalmologists, females were underrepresented among senior academic positions (147 of 419 females had senior rank vs 697 of 1041 males; P < .001).47 Females had lower median h-indices (scholarly productivity and citation impact) early in their publishing careers but had equal or greater h-indices than their male counterparts in later career stages (31-40 years publication experience; h-index = 20.4 vs 15.7; P = .05). 

• Kalavar M, Watane A, Balaji N, et al. Authorship gender composition in the ophthalmology literature from 2015 to 2019. Ophthalmology. 2021;128(4):617-619. DOI:10.1016/j.ophtha.2020.08.032

*A 2015 to 2019 review of 17 100 articles contradicts earlier findings whereby female last authorship increased for general (P = .007) and subspecialty journals (P = .03). 

• Svider PF, D’Aguillo CM, White PE, et al. Gender differences in successful National Institutes of Health funding in ophthalmology. J Surg Educ. 2014;71(5):680-688. DOI:10.1016/j.jsurg.2014.01.020

*A cross-sectional analysis48 of 590 National Institutes of Health (NIH) grants awarded between 2011 and 2013 found that females had lower mean awards (mean award value, $353 170 vs $418 605; P = .005). 

• Chiam M, Camacci ML, Lehman EB, Chen MC, Vora GK, Pantanelli SM. Sex differences in academic rank, scholarly productivity, National Institutes of Health funding, and industry ties among academic cornea specialists in the US. Am J Ophthalmol. 2021;222:285-291. DOI:10.1016/j.ajo.2020.09.011

*An association between sex and the median amount of NIH awards granted to cornea specialists was not identified, despite most female cornea specialists being in early stages of their careers.

• Reddy AK, Bounds GW, Bakri SJ, et al. Representation of women with industry ties in ophthalmology. JAMA Ophthalmol. 2016;134(6):636-643. DOI:10.1001/jamaophthalmol.2016.0552

*Sex differences among 21 531 ophthalmologists in 2014 found that industry payments were less for females (255 of 4352 [6%] vs 1263 of 17 179 [7.4%]; P < .001).

• Nguyen AXL, Ratan S, Biyani A, et al. Gender of award recipients in major ophthalmology societies. Am J Ophthalmol. 2021;231:120-133. DOI:10.1016/j.ajo.2021.05.021

*Society awards granted from 1970 to 2020 increased from 0% to 33.2% (121 of 364; P < .001) for female recipients. 

• Meyer JA, Troutbeck R, Oliver GF, Gordon LK, Danesh-Meyer HV. Bullying, harassment, and sexual discrimination among ophthalmologists in Australia and New Zealand. Clin Exp Ophthalmol. 2021;49(1):15-24. DOI:10.1111/ceo.13886

*In a survey of over 1400 ophthalmologists and trainees in 2015 and 2018, females experienced 3 times more discrimination and up to 6 times more sexual harassment compared with males; this harassment was more severe and most commonly reported in training.

• Scruggs BA, Hock LE, Cabrera MT, et al.  A US survey of sexual harassment in ophthalmology training using a novel standardized scale. J Acad Ophthalmol (2017). 2020;12(1):e27-e35. DOI:10.1055/s-0040-1705092

*In a 2017 survey of 112 ophthalmologists, 29 of 53 females (54.7%) and 18 of 59 males (30.5%) reported experiencing sexual harassment weekly (95% CI, 1.29-5.71; P = .01).

• Chiam M, Camacci ML, Khan A, Lehman EB, Pantanelli SM. Sex disparities in productivity among oculoplastic surgeons. J Acad Ophthalmol. 2021;13(02):e210-e215. DOI:10.1055/s-0041-1740312

*Sex differences in academic ranks and h-indices are likely due to the smaller proportion of females with long career durations. ASOPRS membership may confer opportunities for increased scholarly output.

• Felfeli T, Canizares M, Jin YP, Buys YM. Pay gap among female and male ophthalmologists compared with other specialties. Ophthalmology. 2022;129(1):111-113. DOI:10.1016/j.ophtha.2021.06.015

*The trends identified suggest that female ophthalmologists are comparatively productive to male ophthalmologists, but despite this, disparity in median payments for female ophthalmologists exists and is more prominent than in any other specialty groups. 

• Jia JS, Lazzaro A, Lidder AK, et al. Gender compensation gap for ophthalmologists in the first year of clinical practice. Ophthalmology. 2021;128(7):971-980. DOI:10.1016/j.ophtha.2020.11.022

*Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables.

• Watane A, Kalavar M, Patel M, et al. A 5-year analysis of physician-industry interactions, physician gender, and anti-VEGF use in US ophthalmologists. Semin Ophthalmol. 2021;36(8):804-811. DOI:10.1080/08820538.2021.1922710

*Men were more likely to receive industry payments (P = .01), receive >5 payments (P = .003), and receive payments totaling >$1000 (P = .008). Men administered more injections on average than women when receiving >3 industry payments (P < .001) or when receiving >$100 (P < .01).

• Charlson ES, Tsai L, Yonkers MA, Tao JP. Diversity in the American Society of Ophthalmic Plastic and Reconstructive Surgery. Ophthalmic Plast Reconstr Surg. 2019;35(1):29-32. DOI:10.1097/IOP.0000000000001127

*The authors identified 617 living ASOPRS members as of June 2017. Of these, 109 (17.7%) were female and 58 (9.4%) were URMs.

• Hucko L, Robles-Holmes H, Watane A, et al. Trends in gender representation at the American Academy of Ophthalmology annual meeting. Ophthalmology. 2022;129(7):831-833. DOI:10.1016/j.ophtha.2022.02.028

*The AAO Annual Meeting had 38.7% female faculty member representation in 2021, a record. Although this is a positive finding for the field, there remains room for improvement to encourage equitable representation for female ophthalmologists in academic settings. The majority of U.S. ophthalmology residency program directors (72%) are male, and female physicians are less likely to receive promotions to leadership positions in academic medicine, even after adjustment for publication-related productivity. 

• Kramer PW, Kohnen T, Groneberg DA, Bendels MHK. Sex disparities in ophthalmic research: a descriptive bibliometric study on scientific authorships. JAMA Ophthalmol. 2019;137(11):1223-1231. DOI:10.1001/jamaophthalmol.2019.3095

*Bibliometric data were abstracted from 87 640 original articles published in 248 ophthalmologic journals. Of 344 433 total authorships, female scholars held 34.9% (120 305 of 344 433) of all authorships, 37.1% (24 924 of 67 226) of first authorships, 36.7% (77 295 of 210 372) of co-authorships, and 27.1% (18 086 of 66 835) of last authorships. 

• Chien JL, Wu BP, Nayer Z, et al. Trends in authorship of original scientific articles in Journal of Glaucoma: an analysis of 25 years since the initiation of the journal.  J Glaucoma. 2020;29(7):561-566. DOI:10.1097/IJG.0000000000001503

*Consistent with authorship trends across various other medical specialties, glaucoma has seen an increase in the number of authors and disclosures per article, authors with dual degrees, and authors from the “Far East” and “Other” regions. However, contributions of women to articles published in Journal of Glaucoma remain low.

• Hsiehchen D, Hsieh A, Espinoza M. Prevalence of female authors in case reports published in the medical literature. JAMA Netw Open. 2019;2(5):e195000. DOI:10.1001/jamanetworkopen.2019.5000

* In this cross-sectional study of 20 427 case reports, female first (36%) and last (25%) authors were underrepresented in nonresearch publications, and female first authors were associated with female last authors and academic environments. Bibliometric data was abstracted from 20 427 case reports published across 2538 journals. A total of 7252 (36%) and 4825 (25%) case reports had a female first and last author, respectively. In comparison, 44% and 34% of US trainees and physicians, respectively, were female in 2015. 

• Wong MYH, Tan NYQ, Sabanayagam C. Time trends, disease patterns and gender imbalance in the top 100 most cited articles in ophthalmology. Br J Ophthalmol. 2019;103(1):18-25. DOI:10.1136/bjophthalmol-2018-312388

*For first authorship, excluding group authorships (n=10 for T100-Eye, n=2 for T100-Gen), 84% (n=76) of the first authors in T100-Eye, and 73% (n=72) in T100-Gen were men (table 3). For last authorship, 78% (n=70) in the T100-Eye and 81% (n=79) in the T100-Gen were men. 

• Aguwa UT, Srikumaran D, Green LK, et al. Analysis of sex diversity trends among ophthalmology match applicants, residents, and clinical faculty. JAMA Ophthalmol. 2021;139(11):1184-1190. DOI:10.1001/jamaophthalmol.2021.3729

*This study found that the percentage of women in the field of ophthalmology remains lower than percentages in other specialties, and the percentage of female ophthalmology residents has decreased in recent years. More efforts are needed to improve female representation in ophthalmology.

• Patel M, Salazar H, Watane A, et al. Representation of women in ophthalmology receiving private industry funding 2015-2018.  Am J Ophthalmol. 2022;235:56-62. DOI:10.1016/j.ajo.2021.09.001

*Female ophthalmologists remain underrepresented in terms of the percentage of women who receive private industry funding and dollar value of the funding.

• .     Iwasaki A, Kato N, Morita Y, Onouchi H, Itakura M, Kunimi K, Manabe Y. Gender differences among ophthalmology faculty members in Japanese Medical Schools: An Institution-based cross-sectional study. Medicine (Baltimore). 2026 Jan 23;105(4):e47327. DOI:10.1097/MD.0000000000047327. PMID: 41578572; PMCID: PMC12851662.
  
  *An institution-based cross-sectional study of Japanese ophthalmology faculty (data collected November 1–15, 2023) including 1,574 members across 81 departments found women comprised 28.8% overall but only 9.9% of professors and 21.9% of associate professors, with men having 4.41 times higher odds of professorship (P<.0001). Female research associates were more often part-time (53.2% vs 35.4%, P=.0169), and departments with female chairs had more female professors (23.1% vs 7.7%; P<.0001)

• .     Arline A, Bala S, Bellanda VCF, Mammo DA, Babiuch A. Gender Disparities and Characteristics of Industry Payments Among Pediatric Ophthalmologists. J Pediatr Ophthalmol Strabismus. 2026 Feb 10:1-10. DOI: 10.3928/01913913-20251106-01. Epub ahead of print. PMID: 41671151.
  

*A cross-sectional retrospective analysis of U.S. pediatric ophthalmologists (2017–2023) showed that although men comprised 58.1% of the workforce, they received 74.6% ($317,894.59) of $426,405.25 in industry payments, while women received 25.4%, with no difference in median payment ($112.02 vs $138.20; P=.242). Only 24% received payments, the top 10 earned 81.8% of total funds, and public research funding went predominantly to men (66.1% of 186 investigators; $279,545,982).

• .        Yaïci R. et al. Formation à la chirurgie de la cataracte en France : analyse des résultats de l’enquête de l’European Board of Ophthalmology dans la cohorte française [Cataract surgery training in France: Analysis of the results of the European Board of Ophthalmology survey in the French cohort]. J Fr Ophtalmol. 2025 Feb;48(2):104383. French. DOI: 10.1016/j.jfo.2024.104383. Epub 2024 Dec 18. PMID: 39700890.
  
  A cross-sectional survey analysis of French ophthalmology residents (EBO candidates, 2018–2022; n=122, 50% women) found no statistically significant gender differences in number of cataract surgeries performed (partial: 132.1±98.4 women vs 116.2±91.3 men, p=0.360; total: 94.5±94.6 vs 98.3±92.1, p=0.822) or confidence scores. However, women reported fewer procedures in absolute numbers and slightly lower confidence in simple and complex surgery, highlighting subtle persistent disparities despite a “surgery for all” model.

•      Uner OE, Sadhar B, Huang L, Breakstone M, Berry JL, Gombos DS, Mruthyunjaya P, Skalet AH. Female Representation in Ophthalmic Oncology and Pathology: An Analysis of Scholarship and Leadership. Ocul Oncol Pathol. 2025 Apr;11(1):21-29. DOI: 10.1159/000542560. Epub 2024 Dec 20. PMID: 40225966; PMCID: PMC11991721.

*This bibliometric and leadership analysis of ophthalmic oncology and pathology (2011–2022 for authorship; leadership data up to 2022) found female overall authorship increased from 35% to 40% (p<0.001), with female last authors rising from 26% to 33% (p<0.001), yet males remained predominant as first (52–67%) and last authors (69–76%). Female first authors were more likely to publish with female last authors in retinoblastoma (OR 1.72, p<0.001) and Ocular Oncology and Pathology (OR 2.04, p=0.01), while most society leaders (e.g., 75% male in AAOOP 1979–2005) and named lecture awardees (only 13% AAOOP; 29% ISOO female) were male.

• Sirivolu S, Pike S, Reid MW, Berry JL, Chang MY, Nguyen AM. Discrimination Within the US Ophthalmology Workforce. JAMA Ophthalmol. 2025 Jan 1;143(1):73-77. DOI: 10.1001/jamaophthalmol.2024.5139. PMID: 39636619; PMCID: PMC11622101.

*This cross-sectional survey of US ophthalmologists and trainees (May–July 2022; n=463, 53.8% women) found that 41.9% experienced workplace discrimination, with women much more likely than men to report gender-based discrimination (67.6% vs 9.5%, P<.001), often related to pregnancy (25.0%) and maternity (11.1%). Discrimination was linked to lower job satisfaction (3.9 vs 4.3/5, P<.001), lower career goal achievement (3.9 vs 4.3/5, P<.001), and income loss reported only by women (23.1%).

• .        Reisinger A, Brücher VC, Krepler K, Liekfeld A. Die gläserne Decke in der Ophthalmologie [The glass ceiling in ophthalmology]. Ophthalmologie. 2025 Feb;122(2):85-90. German. DOI: 10.1007/s00347-024-02152-z. Epub 2024 Dec 9. PMID: 39653864.

A narrative review of gender disparities in ophthalmology (contemporary data) reports that although approximately two thirds of medical students are female, women remain underrepresented in leadership, senior authorship, and surgical subspecialties such as vitreoretinal, refractive, and corneal surgery, with lower operative volumes during residency—particularly in cataract surgery—and documented gender bias in grant funding. The review highlights the disproportionate family and household burden on female ophthalmologists and recommends structural measures such as mentoring programs and professional networks to promote gender equity.

• .      Regueira SP, Araújo TMC, Santiago JMS, Gameiro GR, Barboza WL, Ventura CV. Trends in female participation at the Brazilian Congress of Ophthalmology, 2016-2023. Arq Bras Oftalmol. 2025 Oct 10;88(6):e20240333. DOI: 10.5935/0004-2749.2024-0333. PMID: 41092204.

This retrospective descriptive-analytical study of the Brazilian Congress of Ophthalmology (2016–2023) found female participation increased from 33% (n=218) in 2016 to 42% in 2023, with a significant annual growth of 1.33% (p<0.001), closely matching the 43% proportion of practicing female ophthalmologists in Brazil in 2023. Female representation rose significantly in coordinator roles (22% to 40%, slope 2.00, p<0.001) and speaker roles (34% to 44%, slope 1.50, p<0.001), while subspecialty differences were not statistically significant.

• Piccini A, Khan A, Solomon D. 25-year analysis of gender and professional trends in authorship of highly cited articles in leading ophthalmology journals. Eur J Ophthalmol. 2025 Oct 21:11206721251388307. DOI: 10.1177/11206721251388307. Epub ahead of print. PMID: 41117402.

A retrospective bibliometric analysis of 443 authors publishing the most-cited ophthalmology articles (2000–2024) found female first authorship increased by 38.11%, overall female authorship by 43.73%, and female last authorship by 53.63%, although women remained least represented in senior authorship positions. Male first-authored papers received more citations (p=0.011) and were 9.36 times more likely to have same-gender mentorship pairings (95% CI 4.56–19.23; p<0.00001), while women more frequently held non-MD advanced degrees (p=0.0036), highlighting persistent visibility and mentorship gaps.

• Phulke S, Kumar A, Madaan P, Hans A, Malhotra N. A Seven-Decade Analysis: What Does the Gender Breakdown of Award Recipients in the All India Ophthalmological Society Reveal? Cureus. 2025 May 19;17(5):e84438. DOI: 10.7759/cureus.84438. PMID: 40539142; PMCID: PMC12177209.

A seven-decade observational retrospective analysis of AIOS award recipients (1949–2022; n=452) found that women comprised only 28.5% (129/452) of awardees, while men received 71.5%, with marked disparities in contribution to society/lifetime achievement awards (96.7% men vs 3.3% women; p<0.01). Female representation improved from 13.5% before 2000 to 32.6% after 2000 (p<0.01), but society-nominated awards remained predominantly male (96.7% men; p<0.01), highlighting persistent inequities in recognition.

• Onouchi H, Iwasaki A, Morita Y, Itakura M, Kunimi K, Manabe Y, Kato N. Gender disparities in ophthalmology academic conferences in Japan. Medicine (Baltimore). 2025 Jul 4;104(27):e43057. DOI: 10.1097/MD.0000000000043057. PMID: 40629659; PMCID: PMC12237381.

This retrospective observational study of 24 Japanese ophthalmology congresses (2023; n=5,258 presenters) found women comprised 25.2% overall, including 27.2% of first presenters (1,116/4,098) and only 18.0% of moderators (209/1,160), despite women representing 37–42% of practicing ophthalmologists nationally. Female participation was highest in free paper/poster sessions (31.4% first presenters; 21.6% moderators) and lowest in award lectures (20.7% and 11.4%), highlighting underrepresentation in senior academic roles.

• Killeen OJ, Ding L, Enyedi L, Sun G, Cabrera MT. Sexual Harassment in Ophthalmology. JAMA Ophthalmol. 2025 Apr 1;143(4):348-353. DOI: 10.1001/jamaophthalmol.2024.6489. PMID: 39976952; PMCID: PMC11843456.
  

A cross-sectional survey study of U.S. and Canadian ophthalmologists/trainees (2023; n=289, 97.9% women) found 59.5% reported experiencing sexual harassment—similar to 59.3% in 2018 (P=.95)—with 62.2% of affected respondents experiencing harassment within the past 5 years (vs 47.2% in 2018; P<.001) and only 24.1% reporting the most severe incident. Additionally, 85.0% (244/287) reported gender discrimination, underscoring persistent inequities in ophthalmology despite institutional initiatives.

• Katovich H, Singh V, Michael E, McKelvie J. Gender disparity and the impact of COVID-19 on surgical training in New Zealand ophthalmology. N Z Med J. 2025 Sep 19;138(1622):56-65. DOI: 10.26635/6965.7003. PMID: 40966699.

A retrospective logbook analysis of New Zealand RANZCO trainees (2017–2022; 41,370 surgeries) found trainee-performed surgeries declined 11.8% during the COVID-19 pandemic, driven by a significant gender disparity (p=0.045), with a 24.9% reduction for female trainees while male volumes remained stable (+0.74%). The decline was concentrated in urban centers, and case-mix shifted toward more glaucoma (+27.6%) and fewer oculoplastic surgeries (−20.8%), highlighting inequitable surgical exposure.

• Englmaier VA et al. [Academics in ophthalmology : An analysis of the gender distribution at German university hospitals and the Clinician Scientist Program]. Ophthalmologie. 2025 Feb;122(2):91-99. German. DOI: 10.1007/s00347-024-02153-y. Epub 2024 Dec 20. PMID: 39706980.

This cross-sectional web-based analysis of German university ophthalmology departments (August 2023) with data from the Clinician Scientist Program from 2021–2022 found only 2 female chief physicians (5%) at the university eye clinics and fewer female senior physicians (40.1% vs 59.9% men), despite women comprising 56.9% of residents and 58.6% of specialists. While habilitation rates were similar (p=0.554), women were more likely to hold a doctorate among specialists (p=0.037), yet only 41.8% of Clinician Scientist starters and 39.7% of graduates in 2021 were female (46.6% applicants in 2022), indicating persistent leadership gaps.

• Culican SM, Syed MF, Park YS, Hogan SO. Gender Differences in Case Volume Among Ophthalmology Resident Graduates, 2014-2023. JAMA Ophthalmol. 2025 Jun 1;143(6):490-497. DOI: 10.1001/jamaophthalmol.2025.0935. PMID: 40310612; PMCID: PMC12046517.

A national retrospective longitudinal cohort study of all US ACGME ophthalmology resident graduates (2014–2023; n=4,811, 41.6% women) found female residents performed 4.4% fewer cataract surgeries (−8.3 cases; P<.001) and 7.4% fewer total procedures (−43.4 cases; P<.001) than male residents, with disparities across multiple subspecialties. URiM trainees (7.1%) reported 5.3% fewer total procedures than non-URiM peers (−31.5 cases; P=.02), highlighting persistent inequities in surgical training exposure.

• Cohen SA, Tseng VL, Sridhar J, Coleman AL. A New Era of Ophthalmology Leadership? A Descriptive and Comparative Analysis of Ophthalmology Department Chairs in 2024. Am J Ophthalmol. 2025 Jan;269:373-380. DOI: 10.1016/j.ajo.2024.09.020. Epub 2024 Sep 21. PMID: 39313085.

This cross-sectional analysis of 107 U.S. academic ophthalmology department chairs (January 2024) found that 83.2% (89/107) were male and only 16.8% (18/107) were female, despite women comprising approximately 35–40% of the ophthalmology workforce. Among chairs appointed since 2017 (n=47), 21.2% were women (vs 13.3% before 2017; P=.276), indicating modest improvement but persistent underrepresentation in top leadership roles.

• Choi A, Haystead A, Thompson C, Kundu A, Stinnett SS, Vajzovic L, Fekrat S. Characteristics Associated With Endowed Chair Titles Among U.S. Academic Ophthalmologists. Cureus. 2025 Jun 10;17(6):e85716. DOI: 10.7759/cureus.85716. PMID: 40642663; PMCID: PMC12244438.

A cross-sectional analysis of 2,262 faculty at 41 U.S. academic ophthalmology institutions (2022 data) found that only 24% (59/246) of endowed chair holders were women, although women comprised 38% (860/2,262) of faculty; on univariable analysis, men had twice the odds of holding an endowed chair (OR 2.09, p<0.001), but this was not significant after adjustment (p=0.107). Endowed chair status was independently associated with full professorship (OR 13.21, p<0.001), PhD degree (OR 3.19, p<0.001), ≥2 additional titles (OR 4.63–4.92, p<0.001), Southern region, and retina/uveitis subspecialty.

• Bondok M, Bondok MS, Knafo M, Law C, Nathoo N, Grimm LJ, Mishra A. Exploring the gender gap in Canadian ophthalmology applicants: a mixed methods study. Can J Ophthalmol. 2025 Dec 26:S0008-4182(25)00476-4. DOI: 10.1016/j.jcjo.2025.11.011. Epub ahead of print. PMID: 41330434.

An explanatory sequential mixed-methods survey of Canadian medical students (2024; n=314, 67.8% women) found that only 26.8% perceived ophthalmology as gender balanced and 30.9% as racially diverse, while negative perceptions of the specialty increased from 29.9% at medical school entry to 45.5% at survey time (p=0.007). Women and underrepresented students identified barriers including intense competitiveness, limited early exposure, high research expectations, mentorship gaps, and gender-based concerns (e.g., maternity leave), contributing to persistent underrepresentation in Canadian ophthalmology.

• Bicknell BT, Rudd Zhong Manis J, Chishom H, Heo Y, Dzubinski L, Aaserud TL, Liang A, Massoumi S, Srikantha T, Goei S, Tauscher R. Progress toward gender equity in leadership and representation in academic pediatric ophthalmology. J AAPOS. 2025 Aug 20:104608. DOI: 10.1016/j.jaapos.2025.104608. Epub ahead of print. PMID: 40846049.

This cross-sectional analysis of 451 fellowship-trained academic pediatric ophthalmologists in the U.S. (August 2024) found women comprised 55.9% overall and 65.3% of post-2000 fellowship graduates (P<0.01), yet men more frequently held full professor (40.9% vs 18.0%, P<0.01) and department chair roles (6.5% vs 2.0%, P=0.02). Among post-2000 graduates, research productivity (publications, citations, h-index) and academic rank were comparable between genders (all P>0.05), suggesting narrowing disparities in newer cohorts.

• Arslan E, Brücher V, Demir G, Liekfeld A. Geschlechterverteilung bei wissenschaftlichen Beiträgen auf deutschen ophthalmologischen Kongressen – eine Bestandsaufnahme [Gender distribution of scientific contributions at German ophthalmological conferences-a baseline study]. Ophthalmologie. 2025 Feb;122(2):100-106. German. DOI: 10.1007/s00347-024-02154-x. Epub 2024 Dec 23. PMID: 39714740.

A retrospective cross-sectional analysis of five major German ophthalmology congresses (2013, 2022, 2023) found women comprised on average 25% of speakers and 17% of chairs, with female representation in program committees ranging from 0% to 17%, despite women representing ~50% of ophthalmologists nationally. Female speaker participation increased over 10 years—significantly at the DOG (p trend<0.01; up to 37%) and DOC (p trend=0.01)—but chair representation remained lower (11–26% in 2023), with significant growth only at the DOG (p trend<0.01), indicating persistent underrepresentation in congress leadership.

• AlJohani S, Khathami AA, Shehri AA. Factors influencing ophthalmology trainees' decision to pursue vitreoretinal surgery fellowship in Saudi Arabia: a cross-sectional study. BMC Ophthalmol. 2025 Sep 30;25(1):519. DOI: 10.1186/s12886-025-04360-w. PMID: 41029554; PMCID: PMC12481938.

A cross-sectional survey of Saudi ophthalmology trainees (July–December 2024; n=61) found male trainees were significantly more likely to pursue vitreoretinal surgery (88.6% vs 11.4% female in VRS group; p<0.001), with women markedly underrepresented among VRS pursuers. While 57.4% overall pursued VRS, 60% reported that having a female vitreoretinal mentor did not influence their decision (median=2), highlighting persistent gender disparities and limited female mentorship in this subspecialty.

• Wagner RS. Closing the Gap in Gender Equality in Pediatric Ophthalmology Leadership. J Pediatr Ophthalmol Strabismus. 2024 Nov-Dec;61(6):380. DOI: 10.3928/01913913-20240930-01. Epub 2024 Nov 1. PMID: 39569722.

This editorial commentary on gender equality in U.S. pediatric ophthalmology leadership (2024 data) highlights that although women comprise over 50% of pediatric ophthalmologists and nearly 50% of trainees, only 10% of academic ophthalmology chairs and 38.3% of pediatric ophthalmology department/section chiefs are female. The editorial also notes progress in representation (e.g., journal editorial board increased from 4/27 women in 2015 to 10/26 currently) but emphasizes persistent leadership gaps.

• Vought R, Vought V, Lin M, Nguyen H, Szirth B, Khouri AS, Habiel M. Gender Representation Among Ophthalmology Fellowship Directors in 2022. Am J Ophthalmol. 2024 Mar;259:166-171. DOI: 10.1016/j.ajo.2023.11.001. Epub 2023 Nov 7. PMID: 37944687.

This retrospective cross-sectional study of 358 U.S. ophthalmology fellowship directors (2022) found only 29% were women, with significant variation by subspecialty (P<0.001): pediatric ophthalmology had the highest female representation (54%), whereas oculoplastic (13%) and surgical retina (16%) had the lowest. Female directors had fewer years since residency than men (17 vs 24 years; P<0.001), indicating gradual progress but persistent leadership disparities across subspecialties.

• Thounaojam MC, Rossi GCM. Editorial: Women in science: ophthalmology 2023. Front Med (Lausanne). 2024 Jul 29;11:1454872. DOI: 10.3389/fmed.2024.1454872. PMID: 39135719; PMCID: PMC11317459.

Editorial overview of a women-led ophthalmology Research Topic (2024) highlights that although women represent ~50% of STEM undergraduates, they comprise <30% of STEM researchers globally and remain underrepresented in ophthalmology leadership. The collection features 7 peer-reviewed articles led or co-led by women, emphasizing their scientific contributions while acknowledging persistent structural barriers, pandemic-related setbacks, and the “leaky pipeline” limiting advancement in academic ophthalmology.

• Sun E, Tian J, Eltemsah L, Srikumaran D, Sun G, Chow J, Woreta F. Impact of Gender and Underrepresented in Medicine Status on Research Productivity Among Ophthalmology Residency Applicants. Am J Ophthalmol. 2024 Jan;257:1-11. DOI: 10.1016/j.ajo.2023.07.018. Epub 2023 Jul 20. PMID: 37478961; PMCID: PMC10799179.

This retrospective cohort study of 1,376 U.S. ophthalmology residency applicants (2019–2021 cycles) found women (39.1%) had similar or higher research productivity than men, with more ophthalmology publications (2.08 vs 1.73; p=0.05) and presentations (4.52 vs 4.09; p=0.01), and no gender difference in odds of first-author ophthalmology publications (OR 0.84; p=0.254). In contrast, self-identified URiM applicants (12.9%) were less likely to have ≥1 ophthalmology publication (OR 0.65; p=0.047) or first-author ophthalmology publication (OR 0.57; p=0.024), highlighting persistent racial disparities in research metrics.

• Saka N, Yamamoto N, Watanabe J, Wallis C, Jerath A, Someko H, Hayashi M, Kamijo K, Ariie T, Kuno T, Kato H, Mohamud H, Chang A, Satkunasivam R, Tsugawa Y. Comparison of Postoperative Outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis. Ann Surg. 2024 Dec 1;280(6):945-953. DOI: 10.1097/SLA.0000000000006339. Epub 2024 May 10. PMID: 38726676; PMCID: PMC11542977.

A systematic review and meta-analysis of 15 observational studies (to July 2023; 5,448,121 patients) found patients treated by female surgeons had significantly lower postoperative mortality (aOR 0.93; 95% CI 0.88–0.97; I²=27%), with similar readmission (aOR 1.20; 95% CI 0.83–1.74) and complication rates (aOR 0.94; 95% CI 0.88–1.01) compared with male surgeons. Despite women comprising only 22% of U.S. general surgeons in 2019, outcomes were equivalent or slightly better, supporting equity in surgical advancement.

• Rousta N, Hussein IM, Kohly RP. Sex Disparities in Ophthalmology From Training Through Practice: A Systematic Review. JAMA Ophthalmol. 2024 Feb 1;142(2):146-154. DOI: 10.1001/jamaophthalmol.2023.6118. PMID: 38236584.

This systematic review of 91 studies (1990–May 2022; 87 cross-sectional, 4 cohort) on female ophthalmologists in high-income countries found persistent sex disparities from training to practice, including lower surgical case volumes during residency, fewer women entering higher-paying subspecialties, lower income, reduced leadership representation, and greater exposure to sexual harassment. Although women achieved higher scholarly impact only after ~30 years of publishing and reported similar overall career satisfaction in some studies, leadership parity has not matched rising female workforce representation.

• Parvand M, Eslami M, Doughty N, Yeung SN, Kherani F. Closing the Gender Gap Among Canadian Ophthalmology Societies. Semin Ophthalmol. 2024 Feb;39(2):150-157. DOI: 10.1080/08820538.2023.2253898. Epub 2024 Jan 16. PMID: 37731295.

This cross-sectional analysis of 12 Canadian ophthalmology societies (n=277 executive members) found 70.5% were male and 29.1% female (p<.0001), with men more likely to hold presidential roles (39 vs 23; p=.02), although female representation in the Canadian Ophthalmological Society increased from 19.2% in 2016 to 42.3% in 2021. Leadership rank correlated with research productivity (m-index r=0.732, p<.001; h-index r=0.356, p<.05) and academic rank (r=0.536, p<.001), and while h-index and publication numbers were similar by gender, women had a higher m-index (0.67 vs 0.58; p<.05), highlighting persistent leadership gaps despite comparable academic output.

• Nguyen AX, Venkatesh DS, Biyani A, Ratan S, Youn GM, Wu AY. Research productivity and gender of research award recipients in international ophthalmology societies. BMJ Open Ophthalmol. 2024 Feb 27;9(1):e001323. DOI: 10.1136/bmjophth-2023-001323. PMID: 38417914; PMCID: PMC10900313.

A retrospective observational bibliometric study of 2,506 research award recipients from 36 international ophthalmology societies (1922–2021) found women received only 24.3% of awards (609/2,506) compared with 75.7% men, although female representation increased from 0% in 1922 to 41.0% in 2021 and 48.4% during 2011–2021. Women awardees had lower mean h-index (18.4 vs 30.9), m-quotient (1.0 vs 1.2), publications (86.9 vs 158.3), and citations (3,919.9 vs 6,526.9) than men (all adjusted p<0.001), highlighting persistent disparities in research recognition.

• McDonald HM, Cote SL, McMillan A, Sharan S. Trends in female applicants to Canadian ophthalmology residency programs from 1998-2020. Can Med Educ J. 2024 Dec 31;15(6):34-41. DOI: 10.36834/cmej.77587. PMID: 39807144; PMCID: PMC11725010.

A retrospective cross-sectional analysis of Canadian ophthalmology residency applicants (1998–2020) found female applicants ranking ophthalmology as first choice increased from 24.3% to 33.3% (p=0.001), and matched females increased from 28.6% to 40.5% (p=0.023), but growth plateaued after the early 2000s with a decline in 2017–2020 (35.9%, p=0.002). Matching success rates did not differ by gender (61.0% women vs 58.0% men; p=0.45), while practicing female ophthalmologists rose from 16.3% in 2000 to 28.3% in 2019, remaining below parity.

• Lam L, Nelson LB, Bayraktutar BN, Lee KE. Female Leadership in Pediatric Ophthalmology: A Descriptive Analysis. J Pediatr Ophthalmol Strabismus. 2024 Nov-Dec;61(6):391-396. DOI: 10.3928/01913913-20240620-01. Epub 2024 Aug 14. PMID: 39141770.

This cross-sectional analysis of U.S. pediatric ophthalmology leadership (Dec 2023–Feb 2024; 167 division chiefs, 123 residency PDs, 46 fellowship PDs) found women comprised 38.3% of division chiefs (64/167), with similar representation at children’s hospitals (40.0%) and academic centers (36.4%; P=0.69). Female representation was near parity among training leaders—42.3% of residency program directors (52/123) and 45.7% of fellowship directors (21/46; P=0.33)—yet remained below workforce composition at the chief level.

• Jiao C, Patel PA, Ibnamasud S, Patel PN, Ahmed H, Law JC. Descriptive Analysis of Vitreoretinal Surgery Fellowship Program Directors. J Vitreoretin Dis. 2024 Feb 12;8(3):280-285. DOI: 10.1177/24741264241230385. PMID: 38770078; PMCID: PMC11102720.

This cross-sectional descriptive analysis of 81 AUPO-accredited vitreoretinal surgery fellowship program directors (2022) found only 14.8% (12/81) were women, who were on average 6 years younger than men (P=.07), highlighting marked underrepresentation in this subspecialty leadership role. Programs led by women had a significantly higher proportion of female retina faculty (39.6% vs 23.5%; P=.002), suggesting the positive impact of female leadership on workforce diversity.

• Gilson AS, Adelman RA. Disparity in Medicare Reimbursement Between Female and Male Vitreoretinal Surgeons. J Vitreoretin Dis. 2023 Dec 23;8(3):286-292. DOI: 10.1177/24741264231215532. PMID: 38770068; PMCID: PMC11102712.

A retrospective Medicare reimbursement analysis of U.S. vitreoretinal surgeons (2013–2020; 2,682 surgeons in 2020, 8.4% women) found female surgeons received only 65% of male total Medicare reimbursement in 2020 ($1.66M vs $2.56M), down from 73.8% in 2013, with disparities persisting across most experience levels. Although reimbursement per service was similar (100.8%), women saw fewer patients (72.8% of male volume) and were paid less per specific CPT codes, indicating sustained compensation inequity.

• Giannakakos VP, Syed M, Culican SM, Rosenberg JB. The status of women in academic ophthalmology: Authorship of papers, presentations, and academic promotions. Clin Exp Ophthalmol. 2024 Mar;52(2):137-147. DOI: 10.1111/ceo.14333. Epub 2024 Jan 12. PMID: 38214049.

This narrative review of gender disparities in academic ophthalmology (1990–2023 literature) reports that although female authorship has increased over time, women remain underrepresented as senior (last) authors (27.1% globally, 2008–2018) and among editors-in-chief (12–15% in 2021), and receive fewer NIH grants (18–29% vs 82% to men). Women also earn 10–23% lower salaries and collect 93% of male Medicare reimbursement per service in the U.S., with persistent gaps in promotion to full professor, program director (25–38%), and department chair roles (10–17%).

• Cote SL, Nguyen A, Berry JL, Reid M, Chang J, Chen J, Nguyen A, Chang MY. Gender Disparities in Mentorship and Career Outcomes in Ophthalmology. J Womens Health (Larchmt). 2024 Aug;33(8):1120-1127. DOI: 10.1089/jwh.2023.0876. Epub 2024 Apr 18. PMID: 38634534; PMCID: PMC11807853.

A prospective cross-sectional survey of ophthalmologists (n=457; 245 women, 202 men) found women reported significantly lower mentorship quality (score 2.3 vs 1.9; p=0.004), lower income (p=0.001), worse job satisfaction (2.0 vs 1.7/5; p=0.033), and lower achievement of career goals (p<0.0001). Mentorship quality mediated 29–68% of gender disparities in job satisfaction and goal achievement (all p≤0.014), highlighting mentorship inequity as a key driver of career gaps.

• Chaudry E, Cheffi N, Kundapur D, Yeo S, Bhatti A. Advancement of female representation within ophthalmology in Canada: an assessment of representation at the Canadian Ophthalmology Society annual meeting. Can J Ophthalmol. 2024 Dec;59(6):e699-e705. DOI: 10.1016/j.jcjo.2024.02.002. Epub 2024 Feb 28. PMID: 38428829.

A retrospective cross-sectional study of the Canadian Ophthalmological Society (COS) annual meetings (2003–2021; 4,239 total opportunity spots) found women filled 31.7% (1,345/4,239) of roles, increasing from 24.9% in 2003 to 43.1% in 2021 (average +0.75% per year), though only a 12.7% rise was seen when excluding duplicate individuals (27.4% to 40.1%). Female representation was highest in free workshops (43.2%) and lowest among keynote speakers (19.5%), indicating improving but persistent underrepresentation in high-visibility academic roles.

• Zimmermann CM, Kraus CL, Campbell AA, Kaleem MA, Shukla AG, McGlumphy EJ. Maternity and family leave experiences among female ophthalmologists in the United States. PLoS One. 2023 Apr 25;18(4):e0277376. DOI: 10.1371/journal.pone.0277376. PMID: 37098000; PMCID: PMC10129012.

This cross-sectional survey of U.S. female ophthalmologists (2022; n=169 unique respondents, mostly ≤10 years in practice) found 50% reported inadequate information about maternity leave and only 39% received full pay during their first leave, with desired leave (13.2 weeks) exceeding leave taken (8.6 weeks). After return, 61% reported increased burnout, 28% experienced postpartum mental health disorders, and 42% were somewhat or very dissatisfied with their first leave experience, highlighting structural and cultural gaps in family leave support.

• Sharma M, Bansal R, Nangia A, Spivey BE, Gupta S, Unadkat R, Honavar SG. The evolution of women ophthalmologists in India. Indian J Ophthalmol. 2023 Apr;71(4):1077-1079. DOI: 10.4103/IJO.IJO_743_23. PMID: 37026237; PMCID: PMC10276726.

An editorial with national survey of Indian women ophthalmologists (2023; n=529 across 37 states) found 79.5% reported motherhood temporarily paused their career (mean 10.5 months), and 49% felt career breaks negatively affected their clinical/surgical skill compared to male colleagues. Only 7.4% were department heads, 71.6% held no governing council role, 9.5% were journal editors, and 21.8% were unable to pursue fellowship due to marriage, highlighting persistent leadership and structural barriers despite strong participation in practice and training.

• Rivera PA, Atayde A, Wang L, Kombo N. Female Authorship and Ophthalmology Journal Editorial Board Membership Trends Over the Last Decade, 2012-2021. Am J Ophthalmol. 2023 Nov;255:107-114. DOI: 10.1016/j.ajo.2023.07.002. Epub 2023 Jul 16. PMID: 37463630.

A cross-sectional trend study of 4,267 articles in 3 major ophthalmology journals (2012–2021) found women comprised 36.2% of first authors (1,547/4,267) and 27.3% of senior authors (1,165/4,267), with senior female authorship increasing from 23.4% to 30.5% (P=0.0005). Female editorial board membership rose from 13.9% to 34.6% (P=0.0006) and correlated strongly with female authorship (r=0.74, P<0.0001), yet no woman served as editor-in-chief during the study period.

• Oncel D, Syal S, Oncel D, Reyes NA, Acikalin B. Gender Disparities Among Academic Vitreoretinal Specialists in the United States With Regard to Scholarly Impact and Academic Rank. Cureus. 2023 Jun 4;15(6):e39936. DOI: 10.7759/cureus.39936. PMID: 37409205; PMCID: PMC10319176.

This cross-sectional study of 467 U.S. academic vitreoretinal specialists (2022 San Francisco Match programs) found women comprised 26.1% (122/467) versus 73.9% men (p<0.001), with men more likely to be full professors (81.7% of full professors male) and women more often assistant professors (35.4% female at assistant level). Women had fewer publications (52.5 vs 90.5 on average; p<0.001) and lower h-index (12.8 vs 15.2; p=0.0004), with higher scholarly impact strongly associated with higher academic rank (p<0.001).

• Ní Dhubhghaill S, Sanogo M, Lefebvre F, Aclimandos W, Asoklis R, Atilla H, Creuzot-Garcher C, Curtin D, Cvenkel B, Flanagan L, Kivelä TT, Maino A, Martinez Costa R, Priglinger S, Prior Filipe H, Stopa M, Strong B, Sturmer J, Tassignon MJ, Ivekovic R, Bourcier T. Cataract surgical training in Europe: European Board of Ophthalmology survey. J Cataract Refract Surg. 2023 Nov 1;49(11):1120-1127. DOI: 10.1097/j.jcrs.0000000000001280. PMID: 37867285.

This cross-sectional survey of recent European ophthalmology graduates (2018–2022; n=821, 55.9% women) found female trainees performed 18% fewer complete cataract surgeries than men (73.4 vs 90.0; multivariate p=0.04) and reported lower surgical confidence (3.8 vs 4.5/10; p=0.028). Overall, 25.6% received no live cataract surgery training, and the mean number of complete procedures at residency end was 80.7, highlighting persistent gender disparities and inconsistent surgical exposure across Europe.

• Nahar A, Mahmoudzadeh R, Rama M, Soares RR, Yonekawa Y, Mehta S, Haller JA. Authorship Trends of Women in Retina: A 25-Year Analysis. Ophthalmol Retina. 2023 Feb;7(2):164-170. DOI: 10.1016/j.oret.2022.08.012. Epub 2022 Aug 13. PMID: 35973645.

A cross-sectional bibliometric study of 4,142 clinical retina articles (1995–2021) found female first authorship increased from 23% to 37.7% and female last authorship from 14.2% to 24.6% (both P<0.001), though women comprised only 17% of U.S. retina specialists in 2020. Female last authors were associated with higher female first authorship (32.5% vs 27.1% under male last authors; P=0.002), suggesting mentorship effects despite persistent senior authorship gaps.

• Kato N, Kojima T, Ouchi M, Nakamura T, Tokuda Y, Yakushiji T, Ichikawa K. Gender-based differences in the job titles and lifestyles in the cataract and refractive surgery society in Japan. Medicine (Baltimore). 2023 Oct 6;102(40):e35216. DOI: 10.1097/MD.0000000000035216. PMID: 37800820; PMCID: PMC10553083.

This retrospective cross-sectional survey of 219 Japanese cataract and refractive surgeons (2022; 144 men, 75 women) found significant gender disparities in job title, income, and family roles, with 65% of men vs 36% of women working as clinic directors and 64% of men vs 26% of women earning > ¥21 million annually (p<0.0001). Women bore substantially more domestic responsibilities (39% spent >3 hours/day on chores vs 5% of men; p<0.0001) and were more likely to change work schedules after childbirth (71% vs 32%), highlighting structural inequities in Japanese ophthalmology.

• Kalavar M, Watane A, Iyer P, Cavuoto KM, Haller JA, Sridhar J. Effect of the SARS-CoV-2 Pandemic on Authorship Gender Disparities in the Ophthalmology Literature. J Acad Ophthalmol (2017). 2023 Jan 17;15(1):e16-e23. DOI: 10.1055/s-0043-1760833. PMID: 38737151; PMCID: PMC10804738.

This bibliometric study of 577 articles in three high-impact ophthalmology journals (July–Sept 2019 vs 2020; 1,113 authors) found female first authorship increased from 32% pre-COVID-19 pandemic to 40% during the pandemic (p=0.01), and from 31% to 43% for research articles alone (p=0.02), while female last authorship remained unchanged at 26% (p=0.92). No significant association was observed between first and last author gender before or during the pandemic, indicating persistent senior authorship disparities despite gains in early-career representation.

• Huh DD, Yamazaki K, Holmboe E, Bartley GB, Schnabel SD, Levine RB, Srikumaran D. Gender Bias and Ophthalmology Accreditation Council for Graduate Medical Education Milestones Evaluations. JAMA Ophthalmol. 2023 Oct 1;141(10):982-988. DOI: 10.1001/jamaophthalmol.2023.4138. PMID: 37707837; PMCID: PMC10502694.

This retrospective study of 452 U.S. PGY-4 ophthalmology residents graduating in 2019 (39% women) found no significant gender differences in patient care Milestone ratings at midyear (P=.06) or year-end (P=.51), and no difference in year-end medical knowledge ratings (4.10 women vs 4.18 men; P=.20). These findings suggest no major gender bias in ACGME Milestone evaluations at the time of graduation.

• Hoyer A, Randolph A, Syed MF, Afkhamnejad E, Mirza RG. Enhancing Mentorship Networks through the Experiences of Women Professors of Ophthalmology. J Acad Ophthalmol (2017). 2023 Jan 13;15(1):e1-e7. DOI: 10.1055/s-0042-1760206. PMID: 38737166; PMCID: PMC10804760.

A survey of U.S. women full professors of ophthalmology (2021; n=62, 30% response rate) found most held MD/DO degrees (69.4%) and completed fellowship training (74.2%), with 46% taking 11–15 years to achieve full professorship and 37.7% reporting family or medical leave during their career. Mentorship was common—73.8% had mentors (mostly 1–3), and 72.1% currently participate in mentoring programs—supporting structured mentorship initiatives to improve promotion and retention of women in academic ophthalmology.

• Choudhry HS, Burton C, Garcia DJ, Kumarapuram S, Parikh A, Eraky F, Choudhury T, Shaikh A, Sadek HS, Dastjerdi MH. Female authorship trends and the effect of COVID-19 on cataract and refractive surgery literature. J Cataract Refract Surg. 2023 May 1;49(5):531-537. DOI: 10.1097/j.jcrs.0000000000001112. PMID: 37088936.

A retrospective bibliometric analysis of 3,153 cataract and refractive surgery articles (2015–2022) found women comprised 28.9% of first authors (910/3,153) and 20.6% of senior authors (648/3,153), with no significant overall increase from 2015 to 2022. Female senior authors were 1.4 times more likely to have female first authors (OR 1.396; 95% CI 1.160–1.681; p<0.001), and citation impact did not differ by gender, indicating persistent authorship gaps but similar scholarly influence.

• Bondok M, Selvakumar R, Khan M, Bondok MS, Nguyen AX, Ing E, Law C. Gender Representation on North American Ophthalmology Societies' Governance Boards. J Acad Ophthalmol (2017). 2023 Dec 13;15(2):e287-e294. DOI: 10.1055/s-0043-1777430. PMID: 38094219; PMCID: PMC10719047.

This retrospective analysis of 74 North American ophthalmology societies (2022; 949 board members) found women comprised 32.9% of board presidents (24/73) and 36.8% of other board members (322/876), proportions comparable to the 27.2% of practicing U.S. ophthalmologists who are women. Female board president representation increased sevenfold from 3.1% (2/65) in 1942–1961 to 23.7% (210/888) in 2002–2021 (p<0.001), and while men had higher median h-index and publications overall (p≤0.03), m-quotient did not differ (p=0.67), indicating similar productivity when career length is considered.

• Barequet IS, Rosenblatt A, Schaap Fogler M, Pedut-Kloizman T, Gaton D, Loewenstein A, Habot-Wilner Z. Gender related trends among Israeli ophthalmologists professional career and personal life performance. Eye (Lond). 2023 Nov;37(16):3496-3501. DOI: 10.1038/s41433-023-02543-7. Epub 2023 Apr 27. PMID: 37106146; PMCID: PMC10630451.

A national cross-sectional survey of Israeli ophthalmologists (2020; n=252, 46% women) found men had significantly more peer-reviewed publications (median 11–16 vs <10; P=0.004), more journal appointments (50.7% vs 39.7%; P=0.002), and worked more hours (P=0.027), while subspecialty distribution differed (cornea/cataract predominantly men P<0.001; pediatric/strabismus predominantly women P<0.01). Women reported higher rates of perceived inequity during residency (clinic 26.7% vs 14%; OR 25% vs 9.6% in OR; P≤0.011) and markedly more sexual harassment (59.5% vs 16.9%; P<0.001), highlighting persistent gender disparities despite similar managerial representation.

• Baharav-Shlezinger E, Mosleh R, Ben-David G, Mezer E, Wygnanski-Jaffe T. [ASPECTS AFFECTING PEDIATRIC OPHTHALMOLOGY AND STRABISMUS PUBLICATION TIMES]. Harefuah. 2023 Dec;162(10):677-680. Hebrew. PMID: 38126153.

A retrospective bibliometric analysis of 2,487 pediatric ophthalmology and strabismus articles (2002–2007 vs 2014–2018) found median times of 156 days (submission to acceptance), 79 days (acceptance to publication), and 244 days total, with overall publication times decreasing over time. Although female senior authors initially experienced longer submission-to-acceptance intervals in the first decade, this disparity resolved in the later period, indicating a narrowing gender gap in publication timelines. 

• Aljuhani GA, Abdulaziz M, Alharbi AS. The Influence of Gender on Choosing Ophthalmology as a Career Among Medical Students and Interns in Madinah, Saudi Arabia. Cureus. 2023 Sep 9;15(9):e44936. DOI: 10.7759/cureus.44936. PMID: 37818508; PMCID: PMC10561008.

A cross-sectional survey of 449 medical students and interns in Madinah, Saudi Arabia (2023; 51.4% women) found no significant gender difference in interest in pursuing ophthalmology (41% men vs 37% women; p=0.379). Although motivating factors differed slightly (e.g., fewer working hours for men, work-life balance/interest for women), gender overall did not significantly influence career choice, suggesting comparable interest between male and female students.

• Reeves MR, Pasricha MV, Ludwig CA, Chandramohan A, Azad AD, Li AS, Rosenblatt TR, Sears CM, Kossler AL, Do DV, Pan CK. Trends in Leadership and Award Recognition Among Women in the American Society of Retina Specialists. J Vitreoretin Dis. 2021 Jul 9;6(5):374-380. DOI: 10.1177/24741264211021019. PMID: 37006904; PMCID: PMC9954927.

This retrospective longitudinal analysis of American Society of Retina Specialists (ASRS) data (1983–2020) found female membership increased from 1.5% in 1984 to 19.7% in 2020, and female board representation rose from 0% (1983–1989) to 21.9% in 2020 (p=0.02 vs 1983–1989). However, only 1 of 23 ASRS presidents (4.3%) has been a woman, and women comprised 14.1% of all society award recipients overall (21.1% during 2010–2019), highlighting persistent leadership disparities despite progress.

• Rattan SA, Mutashar MK, AnNasseh MG, Al-Attar Z. Obstacles and Challenges Facing Iraqi Women Ophthalmologists. Middle East Afr J Ophthalmol. 2023 Feb 24;29(2):80-84. DOI: 10.4103/meajo.meajo_87_22. PMID: 37123428; PMCID: PMC10138133

A cross-sectional survey of 209 Iraqi ophthalmology specialists (2021; female-to-male ratio 1:1.6) found women worked fewer hours and operation days (P=0.002 and P=0.001), were less likely to practice privately (67.9% vs 94.7%; P<0.0001), and less likely to hold subspecialty degrees (11.5% vs 29.2%; P=0.003). Women reported lower career satisfaction (53.8% vs 71.8%; P=0.009) and more perceived challenges (83.3% vs 64.4%; P=0.007), with family responsibilities cited as the main barrier to advancement. 

• Paul M, Dweck M, Chadha N. Ophthalmology Education Leadership Attitudes Toward Mentorship of Female Medical Students. Am J Ophthalmol. 2022 Nov;243:149-157. DOI: 10.1016/j.ajo.2022.07.026. Epub 2022 Aug 3. PMID: 35932822.

A cross-sectional survey of 75 Association of University Professors of Ophthalmology-chairs, program directors, and medical student educators (2022) found female and male leaders mentored a similar proportion of female students (~47%; P=0.45), but women were significantly more likely to value same-gender mentorship (56.1% vs 21.2%; P<0.01) and to have had a significant female mentor themselves (32.5% vs 3%; P<0.01). Despite women comprising ~48% of U.S. medical graduates, they represent only 25% of full professors and 18.9% of department chairs, underscoring the need to expand female mentorship to address leadership disparities.

• Park J, Xue Y, Xue R, Felfeli T. Representation of women on editorial boards of ophthalmology journals: protocol for a cross-sectional study. BMJ Open. 2022 Apr 26;12(4):e060665. DOI: 10.1136/bmjopen-2021-060665. PMID: 35473728; PMCID: PMC9045046

The protocol for a global cross-sectional study of ophthalmology journal editorial boards (data to October 2021) aims to quantify the proportion of women serving as editors-in-chief, editors, and advisory board members across journals by region, subspecialty, and impact factor. The study also plans to compare research productivity metrics (publications, citations, h-index, m-quotient) between male and female board members to better characterize leadership inequities in academic ophthalmology. 

• Park J, Xue Y, Lim M, Tretiakov N, Felfeli T. Representation of women in ophthalmology journal editorial boards. BMJ Open Ophthalmol. 2022 Oct;7(1):e001127. DOI: 10.1136/bmjophth-2022-001127. Epub 2022 Oct 3. PMID: 36318698; PMCID: PMC9535156.

A cross-sectional global analysis of 193 ophthalmology journals (2021; 222 editors-in-chief, 2,658 editors, 206 advisory board members) found women comprised 16.7% of editors-in-chief, 25.3% of editors, and 22.3% of advisory board members. Women editors were less likely to hold MD degrees (69% vs 78%; p<0.001) but more likely to hold PhDs (56% vs 49%; p=0.002), and female representation was lowest in retina (10%) and basic science (0%) subspecialty journals, highlighting persistent leadership disparities in academic ophthalmology.

• Halawa OA, Sekimitsu S, Boland MV, Zebardast N. Sex-Based Differences in Medicare Reimbursements among Ophthalmologists Persist across Time. Ophthalmology. 2022 Sep;129(9):1056-1063. DOI: 10.1016/j.ophtha.2022.05.006. Epub 2022 May 17. PMID: 35588946; PMCID: PMC9730864.

A retrospective cohort study of U.S. ophthalmologists (2013–2019; n=20,281, 76% men) found women received lower median annual Medicare reimbursements than men ($94,734 vs $194,177; p<0.001) and billed fewer services (1,228 vs 2,259; p<0.001), with disparities persisting after adjustment (−$20,209/year; 95% CI −21,717 to −18,701; p<0.001). Women also accounted for only 4% of the top 1% of earners despite comprising 24% of the workforce, highlighting persistent reimbursement inequities in ophthalmology.

• Gervasio KA, Sklar BA, Nguyen AX, Wu AY. Gender Authorship Trends in the Ophthalmic Plastic and Reconstructive Surgery Literature. Ophthalmic Plast Reconstr Surg. 2022 Mar-Apr 01;38(2):160-165. DOI: 10.1097/IOP.0000000000002013. PMID: 34293783; PMCID: PMC8776886.

A retrospective bibliometric analysis of 999 oculoplastics articles in OPRS and Orbit (1985–2020) found women comprised 31% of all authors (1,151/3,716), 29.7% of first authors, and 21.5% of senior authors, with first authorship increasing from 2.4% in 1985 to 44.2% in 2020 and senior authorship from 3.8% to 29.8% (both p<0.001). Despite significant gains—particularly in original investigations—women remain underrepresented in senior authorship positions within ophthalmic plastic and reconstructive surgery literature.

• Einav B, Rachel S, Ofir M, Eedy M, Tamara WJ. Gender authorship of articles in pediatric ophthalmology and strabismus between 2002 and 2018. Eye (Lond). 2022 Mar;36(3):661-662. DOI: 10.1038/s41433-021-01397-1. Epub 2021 Feb 19. PMID: 33608637; PMCID: PMC8873450.

This retrospective bibliometric analysis of 6,617 pediatric ophthalmology and strabismus articles (2002–2018; 20,755 authors analyzed) found women comprised 43.3% of authors overall, including 45.7% of first authors and 35.2% of senior authors (p<0.001 for position differences), with female authorship increasing from 37.7% to 47.1% over time (p<0.001). Despite progress—particularly in American journals—women remained underrepresented in senior authorship and in higher-ranking journals.

• Cao S, Xiong Y, Zhang W, Zhou J, He Z. The Extent of Gender Gap in Citations in Ophthalmology Literature. Front Med (Lausanne). 2022 May 18;9:855385. DOI: 10.3389/fmed.2022.855385. PMID: 35665332; PMCID: PMC9159794.

This study analyzed gender differences in citation patterns across four leading ophthalmology journals (2015–2020). Female-led papers (last author female) increased slightly (27% to 30%) but remained underrepresented overall. Contrary to concerns of under-citation, female-led papers were cited more often than expected, while male-led papers were cited less than expected. However, male-led (MM) teams were less likely to cite female-led work, whereas female-led teams cited female-led papers more frequently. These patterns persisted even after accounting for co-authorship networks. Overall, although citation rates for female-led papers were relatively strong, structural underrepresentation remains.

• Cai CX, Klawe J, Ahmad S, Zeger SL, Wang J, Sun G, Ramulu P, Srikumaran D. Geographic variations in gender differences in cataract surgery volume among a national cohort of ophthalmologists. J Cataract Refract Surg. 2022 Sep 1;48(9):1023-1030. DOI: 10.1097/j.jcrs.0000000000000938. Epub 2022 Mar 18. PMID: 35318293; PMCID: PMC9415203.

This retrospective national Medicare cohort study of 8,480 U.S. cataract surgeons (2012–2018; 78% men) found male surgeons performed nearly twice as many cataract surgeries per year as women (276 vs 140; P<0.001) and had higher surgery-to-office-visit ratios (0.25 vs 0.15; P<0.001), with adjusted incidence rate ratios up to 1.80 in the South. These gender disparities remained unchanged over time and persisted after adjusting for practice location, although geographic factors (rurality and social deprivation) partially explained differences in certain regions.

• Bansal R, Spivey BE, Honavar SG. Women in ophthalmology - An upsurge! Indian J Ophthalmol. 2022 Mar;70(3):723-726. DOI: 10.4103/ijo.IJO_387_22. PMID: 35225504; PMCID: PMC9114601.

A historical editorial review of pioneering women in ophthalmology (19th–early 20th century) highlights early female trailblazers such as Amy Stokes Barton (first female physician in Pennsylvania, 1874 graduate) and Trinidad Arroyo (Spain’s first female ophthalmologist, 1896), emphasizing how individual women overcame formal bans on female medical admission (e.g., University of Valladolid, 1882) and established ophthalmic departments and institutions. The article underscores that these early leaders laid the groundwork for modern gender equity efforts in ophthalmology by breaking structural and institutional barriers.

• Azad AD, Chandramohan A, Li AS, Rosenblatt TR, Reeves MR, Veerappan-Pasricha M, Ludwig CA, Nguyen A, Winges KM, Wang SY, Pan CK, Moss HE, Do DV, Fountain TR, Kossler AL. Representation of Women in Ophthalmology Subspecialty Societies over 20 Years. Ophthalmology. 2022 May;129(5):587-590. DOI: 10.1016/j.ophtha.2021.12.011. Epub 2021 Dec 24. PMID: 34958831; PMCID: PMC9176792.

This retrospective 20-year analysis of 6 U.S. ophthalmology subspecialty societies (2000–2019) found women as new members increased from 42.2% to 53.6% (p<0.001), award recipients from 20.1% to 27.8% (p=0.008), and executive committee members from 15.1% to 21.5% (p=0.008), yet women comprised only ~20% of society presidents with no significant change over time (19.6% vs 20.0%; p=0.961). Although progress toward parity was observed—particularly in AAPOS—women remained underrepresented in awards and top leadership relative to membership proportions.

• Andoh JE, Feng PW, Mir TA, Yoon J, Chadha N, Teng CC. Gender Differences in Ophthalmic Procedural Volume: A Study of Male vs. Female Glaucoma Specialists. Ophthalmol Glaucoma. 2022 Nov-Dec;5(6):594-601. DOI: 10.1016/j.ogla.2022.03.010. Epub 2022 Apr 9. PMID: 35405381.

A cross-sectional Medicare analysis of 879 U.S. glaucoma specialists (2014–2018; 213 women, 666 men) found men performed more MIGS (+6.1 procedures; 95% CI 0.5–11.8; P=0.03) and cataract surgeries (+110.2; 95% CI 16.9–203.5; P=0.02) than women after multivariable adjustment. No significant gender differences were observed for trabeculectomy, glaucoma drainage implants, or glaucoma laser procedures after adjustment, indicating disparities primarily in MIGS and cataract volume.

• Nguyen AX, Trinh XV, Kurian J, Wu AY. Impact of COVID-19 on longitudinal ophthalmology authorship gender trends. Graefes Arch Clin Exp Ophthalmol. 2021 Mar;259(3):733-744. DOI: 10.1007/s00417-021-05085-4. Epub 2021 Feb 3. PMID: 33537883; PMCID: PMC7857347.

This retrospective longitudinal bibliometric analysis of ophthalmology publications (2002–2020) found that during January–July 2020, women comprised 31.2% of authors overall, including 31.2% of first authors and 24.6% of senior authors, representing declines of 6.1% overall, 7.8% for first authors, and 5.5% for senior authors compared with predicted trends (all p<0.05). These findings indicate that COVID-19 reversed previously increasing female authorship gains, particularly in senior positions.

• Gupta S, Haripriya A, Ravindran RD, Ravilla T. Differences Between Male and Female Residents in Case Volumes and Learning in Cataract Surgery. J Surg Educ. 2021 Jul-Aug;78(4):1366-1375. DOI: 10.1016/j.jsurg.2020.12.017. Epub 2021 Jan 8. PMID: 33431298.

A hospital-based retrospective cohort study of 95 Indian ophthalmology residents (2012–2015 cohorts; 64 women, 31 men) found male residents performed 26.9% more cataract surgeries than female residents (662.2 vs 521.8; p<0.05), driven by 21% more surgeries per surgical turn (5.7 vs 4.7; p=0.04), despite similar numbers of surgical turns. Intraoperative complication rates were comparable (2.40% men vs 2.30% women; p=0.27), and learning curves did not differ by gender, with complication rates flattening after ~300 surgeries.

• Gertig D, Keane MC, Matthews JM, Williams KA, Smith JR. Women's Authorship of Reviews in Ophthalmic Journals Over Time. Asia Pac J Ophthalmol (Phila). 2021 Nov 16;10(6):590-594. DOI: 10.1097/APO.0000000000000444. PMID: 34789673; PMCID: PMC8673851.

Literature survey of 471 review articles in three ophthalmic review journals (1999, 2009, 2019; 841 first/senior authors analyzed) found female first authorship increased from 19% to 44% (P<0.001) and senior authorship from 16% to 29% (P=0.018) over 20 years. Despite improvement, in 2019 more than 55% of first authors and over 70% of senior authors were men, indicating persistent senior authorship disparity.

• Fathy CA, Cherkas E, Shields CN, Syed ZA, Haller JA, Zhang QE, Sharpe J, Garg Shukla A. Female Editorial Authorship Trends in High-Impact Ophthalmology Journals. JAMA Ophthalmol. 2021 Oct 1;139(10):1071-1078. DOI: 10.1001/jamaophthalmol.2021.3027. PMID: 34383002; PMCID: PMC8529415.

This cross-sectional analysis of 814 editorials in three high-impact ophthalmology journals (2005–2009 vs 2015–2019; 1,179 first/senior authors) found women comprised 25.5% of editorial authorships, including 32.9% of first and 23.9% of senior authors. Female authorship increased by 68.0% over time (18.1% to 30.4%; P<.001), yet women remained underrepresented—particularly as senior authors—despite exceeding the proportion of board-certified female ophthalmologists among first authors (28.9% vs 18.3%; P<.001).

• Camacci ML, Ikpoh B, Lehman EB, Bowie E, Scott IU, Pantanelli SM, Ely A. Gender disparities among United States academic pediatric ophthalmologists: an analysis of publication productivity, academic rank, and NIH funding. J AAPOS. 2020 Dec;24(6):337.e1-337.e6. DOI: 10.1016/j.jaapos.2020.06.013. Epub 2020 Oct 10. PMID: 33049372; PMCID: PMC10956642.

This cross-sectional analysis of 389 U.S. academic pediatric ophthalmologists across 113 programs (2019; 49.9% women) found similar representation across academic ranks after adjusting for career length (full professor: 13.9% women vs 34.9% men; P=0.119). Women had lower median h-index (5.0 vs 8.0; P=0.008) but similar m-quotient (0.5 vs 0.5; P=0.525), and comparable NIH funding rates (20 women vs 27 men; P=0.826), suggesting productivity differences largely reflect shorter career duration rather than inequity.

• Pershing S, Stell L, Fisher AC, Goldberg JL. Implicit bias and the association of redaction of identifiers with residency application screening scores. JAMA Ophthalmol. 2021. DOI:10.1001/jamaophthalmol.2021.4323 

A quality improvement study (2019–2020 ophthalmology residency application cycle) evaluated 462 applications reviewed by 46 faculty to assess whether redacting identifiers (name, sex/gender, race/ethnicity) affected scoring. Among applicants (60.0% male; 15.4% URiM), redaction was not associated with score differences (β = –0.06 on a 1–9 scale; 95% CI, –0.22 to 0.10; P = .48), and sex (β = –0.08; P = .26), URiM status (β = –0.03; P = .94), and IMG status (β = 0.39; P = .35) were not associated with scores, suggesting redaction alone did not reduce disparities in application review.

• Woreta F., Gordon L.K., Knight O.J., Randolph J., et al: Enhancing diversity in the ophthalmology workforce. Ophthalmology 2022; 129: pp. e127-e136. 

  This narrative review and workforce analysis (published 2022; using 2021 AAO and national data) reports that women comprise 26.2% of practicing U.S. ophthalmologists and 38.6% of trainees, while underrepresented minorities (URM) represent only ~6% of the workforce despite constituting 32% of the U.S. population. Black and Hispanic ophthalmologists account for 2.7% and 4.1% of practicing members, respectively, compared with 12.1% and 18.7% in the general population, highlighting persistent racial and ethnic underrepresentation in ophthalmology.

• Randolph JD, Zebardast N, Pérez-González CE. Improving ophthalmic workforce diversity: a call to action. Ophthalmology 2022; 129:10811082. 

  This commentary (published 2022) highlights persistent workforce disparities in ophthalmology, noting that underrepresented minorities (URM) comprise 32% of the U.S. population and 22% of U.S. medical students, yet only 6% of the ophthalmology workforce. Women and URM physicians remain underrepresented in leadership and academic roles, and only 7.7% of practicing optometrists are URM and 46.1% women, emphasizing the need for pipeline programs, holistic review, and bias mitigation to improve workforce diversity.

• Fairless EA, Nwanyanwu KH, Forster SH, Teng CC. Ophthalmology departments remain among the least diverse clinical departments at united states medical schools. Ophthalmology 2021; 128:11291134. 

  A secondary data analysis (2019 AAMC Faculty Roster data) evaluated 3,060 ophthalmology faculty across U.S. medical schools and found that only 6.8% (208 faculty) were underrepresented minorities (URM), compared with 9.8% across all clinical faculty and 16.5% of graduating U.S. medical students. Black and Hispanic physicians each comprised only 2.3% of ophthalmology faculty (vs 12.7% and 18.3% of the U.S. population, respectively), and ophthalmology ranked third lowest in URM representation among 18 clinical departments, highlighting persistent academic workforce disparities.

• Atkuru A, Lieng MK, Emami-Naeini P. Trends in racial diversity among united states ophthalmology residents. Ophthalmology 2022; 129:957959. 

  A retrospective ACGME database analysis (2011–2012 to 2019–2020) evaluating 144,988 residents in 2019–2020 found that although 11.7% of all U.S. residents were underrepresented minorities (URM), only 6.3% of ophthalmology residents (96 of 1,515) identified as URM—the lowest proportion among 18 specialties. Over 8 years, ophthalmology had a modest annual URM increase of 0.24% (95% CI, 0.12%–0.38%), yet representation remained far below U.S. medical school enrollment (19.1% URM) and the U.S. population (33.4% URM), indicating persistent underrepresentation in residency training.

• Aguwa UT, Srikumaran D, Canner J, et al. Trends in racial and ethnic diversity of ophthalmology residents and residency applicants. Am J Ophthalmol 2022; 240:260264. 

  This trend study (ACGME 2011–2019; SF Match 2016–2019) found that URiM ophthalmology residents increased from 4.7% (66/1,419) to 5.8% (85/1,473) (P < .001), while URiM match applicants rose from 5.9% (43/726) to 11.8% (87/741) and URiMs matching increased from 4.9% (23/467) to 10.8% (52/484) (P = .002). Despite these gains—largely driven by Hispanic/Latinx growth (3.9% to 8.2%, P < .001)**—overall URiM representation remained substantially below the 33% URiM proportion of the U.S. population, underscoring persistent underrepresentation in ophthalmology.

• Pineles S. Racial diversity among united states ophthalmology residents: a call to action. Ophthalmology 2022; 129:960961. 

  This commentary (2011–2012 to 2019–2020 ACGME data) reports that in 2019–2020, 11.7% of all U.S. residents identified as underrepresented in medicine (URiM), compared with only 6.3% of ophthalmology residents, representing the lowest URiM proportion among major specialties and reflecting only a 0.24% increase over 8 years. The article highlights pipeline initiatives, including >245 participants in the Raab-Venable program and 189 active students in the Minority Ophthalmology Mentoring program (89% maintained or increased interest), advocating for holistic review to improve racial diversity in residency training.

• Aguwa UT, Wang J, Woreta F, et al. Residency program diversity recruitment and education: survey of efforts and barriers to implementation. J Surg Educ 2022; 79:595605. 

  A cross-sectional multi-center survey study (August 2020–January 2021) of 63 residency program leaders (34% response rate; 56% ophthalmology) found that 22% of programs had 0 URM residents, and 47.6% matched 0 URM applicants in the most recent cycle. Although 81% used URM recruitment strategies and 92% believed diversity training was important, only 54% had a formal curriculum for both trainees and faculty, with major barriers including lack of curricular time (30%) and faculty expertise (30%), underscoring gaps between diversity intentions and implementation.

• Ledesma Vicioso N, Woreta F, Sun G. Presence of diversity or inclusion information on US ophthalmology residency program websites. JAMA Ophthalmol 2022; 140:606609. 

  A quality improvement cross-sectional website review (May 1–June 2, 2021) evaluated 121 U.S. ophthalmology residency program websites and found that only 29 programs (24%) met at least 1 of 6 predetermined diversity or inclusion criteria. Programs with >12 residents (OR 3.58; 95% CI, 1.39–9.55; P = .004) and those ranked in the top 20 (OR 3.28; 95% CI, 1.05–10.1; P = .02) were more likely to include such information, indicating that most programs lacked visible diversity content for prospective applicants.

• Harrell MJ, Barnett KG, Rowe S. Strategies potentially associated with increasing racial and ethnic groups underrepresented in medicine: application to ophthalmology. JAMA Ophthalmol 2021; 139:825826. 

  This viewpoint (2021) reports that although individuals underrepresented in medicine (URiM) comprised 30.7% of the U.S. population, only 6% of practicing ophthalmologists and 7.7% of ophthalmology residents identified as URiM, compared with 12.6% of physicians overall. Drawing on interventions from other specialties that increased URiM representation from 0% to 25% and from 12.1% to 23.5%, the authors recommend holistic review, bias mitigation, and targeted recruitment to improve diversity in ophthalmology.

• Olivier M.M.G., Forster S., Carter K.D., et al: Lighting a pathway: the minority ophthalmology mentoring program. Ophthalmology 2020; 127: pp. 848-851. 

  An editorial (2020) introducing the Minority Ophthalmology Mentoring (MOM) program reports that although underrepresented-in-medicine groups comprised approximately 33% of the U.S. population, they represented only 6% of practicing ophthalmologists, a figure unchanged over a decade. Residency data show Black applicants accounted for 3.6% and Hispanic applicants 8.2% of ophthalmology applicants versus 13.4% and 18.3% of the U.S. population, respectively, leading to the creation of a pipeline program supporting 35 students annually to improve workforce diversity and advance equity in eye care.

• Mehta SP, Ali M, Sabit A, Green LK, Pettey JH, Siatkowski RM, Sun G, Knight OJ, Woreta FA. Ophthalmology Residency Match Rates by Applicant Demographics. JAMA Ophthalmol. 2026 Jan 8:e255581. DOI: 10.1001/jamaophthalmol.2025.5581. Epub ahead of print. PMID: 41505123; PMCID: PMC12784255.

A research letter (2021–2023 San Francisco Match cycles) analyzing ophthalmology residency match rates by sex, race, and ethnicity included 2,367 applicants, of whom 57.3% were male and 5.1% Black, 8.3% Hispanic, 29.3% Asian, and 42.8% White. Female applicants had higher match rates than males (71.9% vs 64.2%, P < .001), Black applicants had the highest overall match rate (80.7%) compared with White (68.4%), Asian (66.6%), and Hispanic applicants (54.5%), and Black male applicants had the highest subgroup match rate (87.1%), highlighting intersectional differences in match outcomes.

• Josef JD, Bradfield YS, Greninger DA, Chang TC; Diversity, Equity Inclusion Task Force members; Annual Program Committee members of the American Association of Pediatric Ophthalmology and Strabismus. Minority representation in the 2024 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) annual meeting program. J AAPOS. 2026 Feb 12:104742. DOI: 10.1016/j.jaapos.2026.104742. Epub ahead of print. PMID: 41628761.

This cross-sectional study of the 2024 AAPOS Annual Meeting submissions (2024 cycle), evaluating 443 abstracts, found that 17% of research submissions and 13.7% of presenting authors self-identified as URiM, with no significant differences in acceptance rates between URiM and non-URiM authors (77.8% vs 74.9%, P=0.86), and similar findings for workshop abstracts (P=0.20), suggesting an equitable review process despite 16–18% declining URiM disclosure.

• Gao A, Miller T, Ortin-Martinez A, Kohly RP. Racial Disparities in Ophthalmology in Training and Practice: A Systematic Review. Am J Ophthalmol. 2026 Jan 14;284:196-207. DOI: 10.1016/j.ajo.2026.01.008. Epub ahead of print. PMID: 41544736.

A systematic review of 41 studies published between 2000 and 2025 (databases searched from inception to November 2024) including 500,823 responses found persistent racial disparities, with URiM comprising 6.3% of ophthalmology residents (2011–2020) versus 11.7% across specialties (P<.01) and Black residents representing 2.5% of matched trainees despite 6.6% of medical school graduates (P<.01); URiM faculty remained low at 6.8%–7.0% by 2019, indicating limited progress in workforce equity.

• Thompson C, Challa P, Stinnett SS, Fekrat S. Contemporary diversity trends among matched ophthalmology residents in the USA. BMJ Lead. 2025 Jul 2:leader-2024-001204. DOI: 10.1136/leader-2024-001204. Epub ahead of print. PMID: 40603004.

This retrospective analysis of ACGME data on U.S. ophthalmology residents (sex: 2008–2022; race/ethnicity: 2012–2022) showed that female representation remained stagnant at 41% in 2008 vs 41.8% in 2022, compared with 54.6% of U.S. medical students. URiM representation increased from 5.4% before 2020 to 10% after 2020 (p<0.001), peaking at 10.5% in 2021–2022 (0% American Indian/Alaskan Native, 3.01% Black, 7.50% Hispanic), yet overall levels remain markedly below population benchmarks, underscoring persistent diversity gaps in ophthalmology residency.

• Sirivolu S, Pike S, Reid MW, Berry JL, Chang MY, Nguyen AM. Discrimination Within the US Ophthalmology Workforce. JAMA Ophthalmol. 2025 Jan 1;143(1):73-77. DOI: 10.1001/jamaophthalmol.2024.5139. PMID: 39636619; PMCID: PMC11622101. 

A cross-sectional survey of US ophthalmologists and trainees (May–July 2022) including 463 respondents found that 41.9% reported workplace discrimination, with women more likely to report gender-based discrimination than men (67.6% vs 9.5%, P<.001) and men more likely to report race/ethnicity-based discrimination (61.9% vs 17.6%, P<.001). Experiencing discrimination was associated with lower job satisfaction (3.9 vs 4.3/5, P<.001) and reduced career goal achievement (3.9 vs 4.3/5, P<.001), underscoring ongoing equity gaps in ophthalmology.

• Rajeswaren V, Croniger B, Dirani K, Wilson MR. Adherence to Updated Race and Ethnicity Reporting Guidance in Ophthalmology Journals. JAMA Netw Open. 2025 Sep 2;8(9):e2529778. DOI: 10.1001/jamanetworkopen.2025.29778. PMID: 40892410; PMCID: PMC12406061.

Systematic review of 525 articles published August 2023 - August 2024 in 3 high-impact ophthalmology journals found that only 54.3% reported race/ethnicity and 18.3% socioeconomic measures, while 19.0% misclassified race vs ethnicity and 68.1% did not report who determined race/ethnicity. These findings indicate substantial nonadherence to updated AMA reporting guidelines and persistent gaps in equity-focused demographic reporting.

• Paracha SS, Williams SA, Shamshad A, Persad-Paisley EM, Migliori ME. Representation Quotients to Examine Diversity in Ophthalmology Residency Applicants and Matriculants. JAMA Ophthalmol. 2025 Feb 1;143(2):145-152. DOI: 10.1001/jamaophthalmol.2024.5863. PMID: 39821053; PMCID: PMC11843372.

A retrospective cross-sectional study using AAMC and SF Match data from 2008–2021 (applicants 2015–2021; matriculants 2008–2021) found persistent underrepresentation of Black and female individuals in ophthalmology residency, with Black applicants having the lowest median representation quotients (RQapp 0.604; RQmat 0.469) and declining from applicant to matriculant status (P = .047). Although Hispanic applicants were overrepresented at application (RQapp 1.46), this decreased at matriculation (RQmat 1.04; P = .03), and female representation declined over time (applicants slope –0.031, P = .01), indicating structural barriers in the residency pathway.

• Israeli A, Blumenthal EZ, Nemet A, Zayit-Soudry S, Pizem H, Mezer E. Have gender and ethnic disparities in ophthalmology disappeared? Insights from a workforce-based study in Israel (2006-2021). Isr J Health Policy Res. 2025 Jan 10;14(1):2. DOI: 10.1186/s13584-024-00664-2. PMID: 39794800; PMCID: PMC11720563.

Nationwide cross-sectional workforce-based study in Israel (2006–2021) found persistent gender and ethnic disparities among board-certified ophthalmologists (BCOs), with women comprising 37.9% and Arabs 10.5% of BCOs in 2021 despite representing 50.4% and 20.7% of the population, respectively (both p<0.001). Although Arab BCO density increased 288% (0.25–0.98 per 100K; AYI 12%) and female BCO density rose 21.3% (2.8–3.4; AYI 1.38%), Jewish and male dominance remained significant after population adjustment, while gender disparities among new residents resolved after 2015.

• Uner OE, Choi D, Hwang TS, Faridi A. Bias Reduction Practices in Underrepresented Groups in Ophthalmology Resident Recruitment. JAMA Ophthalmol. 2024 May 1;142(5):429-435. DOI: 10.1001/jamaophthalmol.2024.0394. PMID: 38546576; PMCID: PMC10979357.

This cross-sectional survey study of AUPO residency program directors (July–December 2022) including 65 of 106 PDs (61.3% response rate) found that 86.2% used at least 1 bias reduction tool and 60.0% used interview rubrics, but only use of multiple bias reduction tools (OR 1.47; 95% CI 1.13–1.92; P=.01) and larger class size (OR 1.34; P=.01) were associated with increased URiO representation in the past 5 classes. In contrast, use of interview rubrics (OR 0.72; P=.001) and higher weighting of applicant interest (OR 0.83; P=.02) were negatively associated with URiO diversity, highlighting mixed impacts of recruitment practices on equity.

• Udeh A, Huh D, Young T, Knight O, Woreta F. Disparities in Promotion and Retention Rates Among Underrepresented in Medicine Faculty in U.S. Ophthalmology Departments. Am J Ophthalmol. 2024 Feb;258:1-7. DOI: 10.1016/j.ajo.2023.09.013. Epub 2023 Sep 25. PMID: 37757997.

A retrospective panel study of U.S. ophthalmology faculty using AAMC Faculty Roster data (faculty appointed 2000–2010, followed through November 2021) found that Black assistant professors had significantly lower promotion rates than White faculty (20% vs 37%, P<.001) and higher attrition from academia (46% vs 33%, P<.001). Overall, URiM faculty were more likely to leave academic medicine (42% vs 33%, P<.001), highlighting persistent racial disparities in promotion and retention within academic ophthalmology.

• Tao BK, Ding J, Ing EB, Kohly RP, Langan R, Nathoo N, Rocha G, Sogbesan E, Teja S, Siddiqi J, Khosa F. Gender, Race, and Ethnicity of US Academic Ophthalmology Faculty and Department Chairs From 1966 to 2021. JAMA Ophthalmol. 2024 Aug 1;142(8):742-748. DOI: 10.1001/jamaophthalmol.2024.2375. PMID: 38990520; PMCID: PMC11240232.

This cohort study of full-time U.S. academic ophthalmology faculty and department chairs (1966–2021) demonstrated that although women increased from 12.2% (27/221) in 1966 to 41.8% (1320/3158) in 2021 and minoritized race faculty from 17.2% to 41.1%, gains were concentrated in lower ranks, with persistent underrepresentation at professor level (PA-MD 81.33%). URiM groups grew the least overall, and department chair diversity remained limited (16.35% women; 21.15% minoritized race in 2021), indicating slow progress in leadership equity over five decades.

• Sun E, Tian J, Eltemsah L, Srikumaran D, Sun G, Chow J, Woreta F. Impact of Gender and Underrepresented in Medicine Status on Research Productivity Among Ophthalmology Residency Applicants. Am J Ophthalmol. 2024 Jan;257:1-11. DOI: 10.1016/j.ajo.2023.07.018. Epub 2023 Jul 20. PMID: 37478961; PMCID: PMC10799179.

A retrospective cohort study of 1,376 ophthalmology residency applicants (2019–2021 cycles) demonstrated that self-identified URiM applicants (12.9%) were less likely to have at least one ophthalmology publication (OR 0.650; P=0.047) or first-author ophthalmology publication (OR 0.570; P=0.024), while women (39.1%) had equal or greater research output than men, including more ophthalmology publications (2.08 vs 1.73; P=0.05). These findings indicate that reliance on research productivity metrics may disproportionately disadvantage URiM applicants.

• Rehman M, Nanni A, Suresh S, Saleh I, Dalal S, Firoz M, Patel M, Georges B, Rehman AS, Kooner KS. Exploring Underrepresentation: The Role of Diversity Statements in Ophthalmology Residency Programs. Cureus. 2024 Mar 20;16(3):e56569. DOI: 10.7759/cureus.56569. PMID: 38646330; PMCID: PMC11031127.

This cross-sectional website analysis of 126 U.S. ophthalmology residency programs (data collected April–May 2023; published 2024) showed that only 16.7% had program-specific diversity statements, despite 91.3% having institutional-level statements, and disability was the least frequently mentioned category (53.2%). Given that URMs comprise 19% of medical students but only 6.3% of ophthalmology residents, the limited presence of program-level diversity messaging may contribute to persistent underrepresentation in the field.

• Lee EY, Farrokhyar F, Bakshi N, Levin LA, Ahuja N. Equity, diversity, and inclusion landscape in Canadian postgraduate medical education for ophthalmology. Can J Ophthalmol. 2024 Feb;59(1):31-39. DOI: 10.1016/j.jcjo.2022.08.015. Epub 2022 Sep 24. PMID: 36162441.

A cross-sectional national survey of 15 Canadian ophthalmology programs and 57 residents (2021) showed that 73% of programs were in the early stages of equity, diversity, and inclusion (EDI) framework development, while 44% of residents identified as women and 51% as visible minorities, with no respondents identifying as Indigenous. Despite 80% perceiving their program as an equal opportunity provider, 59% of reported EDI-related experiences were negative, highlighting persistent inclusion gaps.

• Duarte Bojikian K, Mekonnen ZK, Adan NM, Rivera-Morales P, Kombo N, Feng S. Primary Practice Emphasis Area and Diversity Among Board-Certified Ophthalmologists. Am J Ophthalmol. 2024 Apr;260:84-90. DOI: 10.1016/j.ajo.2023.11.026. Epub 2023 Dec 14. PMID: 38103875.

Retrospective cohort study of American Board of Ophthalmology diplomates (1992–2020) showed that only 10.1% (575/5707) self-identified as underrepresented in medicine (URiM), with representation declining from 12.0% (1990–1999 graduates) to 7.4% (2010–2019 graduates; P<.001). URiM ophthalmologists were more likely to report glaucoma as their primary emphasis area (12.7% vs 8.8%; P=.039), yet remained markedly underrepresented across all U.S. regions, including the South (12.0% vs 32.0% URiM in the general population), underscoring persistent workforce inequities.

• Atchison EA. Diversity in Academic Ophthalmology-50 Years of Slow Growth. JAMA Ophthalmol. 2024 Aug 1;142(8):749. DOI: 10.1001/jamaophthalmol.2024.2593. PMID: 38990577.

An invited commentary reviewing a 50-year AAMC analysis of U.S. academic ophthalmology (1966–2021) reported faculty growth from 221 to 3,158, with women increasing from 12% to 42% and URiM individuals from 17% to 40%; however, women held only 16% of department chair positions, and Hispanic/Latino representation declined from 4% to 2%. Diversity gains were concentrated in lower academic ranks, highlighting that leadership representation has not kept pace with overall workforce diversification.

• Aldebasi T, Alhejji AM, Bukhari BH, Alawad NK, Alghaihab SM, Alakel RM, Alhamzah A, Almudhaiyan T, Alfreihi S, Alrobaian M, Gangadharan S. Ophthalmology workforce over a decade in the Kingdom of Saudi Arabia: demographics, distribution, and future challenges. Hum Resour Health. 2024 Mar 4;22(1):19. DOI: 10.1186/s12960-024-00902-3. PMID: 38439073; PMCID: PMC10913636.

A national workforce analysis of ophthalmologists in the Kingdom of Saudi Arabia (2010–2023) reported 2,608 registered ophthalmologists in 2023 (81.06 per 1,000,000 population), yet only 38% were Saudi nationals and 69.7% were male, highlighting reliance on non-Saudi physicians. Although Saudi female graduates increased from 13.3% to 37.2% between 2010 and 2022 (P<0.001), geographic maldistribution persisted (42.8–91.5 per 1,000,000 across regions; P<0.0001), indicating ongoing equity and access gaps.

• Maru JA, Wang J, Knight OJ, Tsou BC, Oatts JT, Ross DA, Moore EZ, Zhang AY, Ramanathan S, Woreta FA. Barriers in Ophthalmology Residency Applications for Students Identifying as Underrepresented in Medicine: A San Francisco Match Analysis. J Surg Educ. 2023 Jul;80(7):971-980. DOI: 10.1016/j.jsurg.2023.04.009. Epub 2023 May 20. PMID: 37217381; PMCID: PMC10330680.

Retrospective multicenter cohort study of 1,529 ophthalmology residency applicants (2018–2020 SF Match cycles) demonstrated that 11.9% self-identified as URiM and had lower median USMLE Step 1 (239 vs 246, p<0.001) and Step 2 scores (246 vs 251, p<0.001) compared to non-URiM applicants. Letters for URiM applicants more frequently used “warm” (26.9% vs 19.5%, p=0.020) and “caring” (44.5% vs 35.6%, p=0.020), while non-URiM letters emphasized “dependable” (15.5% vs 8.2%, p=0.009) and “research” (93.1% vs 89.6%, p=0.046), highlighting potential bias in evaluative language that may disadvantage URiM applicants.

• Choudhry HS, Toor U, Sanchez AJ, Mian SI. Perception of Race and Sex Diversity in Ophthalmology by Artificial Intelligence: A DALL E-2 Study. Clin Ophthalmol. 2023 Oct 3;17:2889-2899. DOI: 10.2147/OPTH.S427296. PMID: 37808001; PMCID: PMC10559891.

A cross-sectional AI image analysis using DALL·E-2 (November 2022) evaluated 1,560 generated images and showed that the query “American ophthalmologist” depicted ophthalmologists as 75% White and 77.5% male, closely mirroring historical workforce demographics. Senior roles such as department chairs were portrayed as 85% male and 75% White, while residents were 70% male and 77.5% White, suggesting that AI-trained internet data may reflect and potentially reinforce existing racial and gender disparities in ophthalmology.

• Ali M, Menard M, Zafar S, Williams BK Jr, Knight OJ, Woreta FA. Sex and Racial and Ethnic Diversity Among Ophthalmology Subspecialty Fellowship Applicants. JAMA Ophthalmol. 2023 Oct 1;141(10):948-954. DOI: 10.1001/jamaophthalmol.2023.3853. PMID: 37651110; PMCID: PMC10472264.

This cohort study of 537 ophthalmology subspecialty fellowship applicants in the 2021 San Francisco Match showed that 42.6% were female and 12.9% were URiM, with similar match rates by sex (70.5% female vs 69.2% male; P=.74) but significantly lower match rates for URiM applicants compared to non-URiM applicants (55.0% vs 72.2%; P=.007). URiM applicants had lower median USMLE Step 1 scores (238 vs 246 Asian and 243 White; P=.04), submitted fewer applications (10 vs 21 Asian and 17 White; P=.001), and completed fewer interviews (2 vs 12 Asian and 8 White; P=.001), underscoring persistent racial disparities across ophthalmology fellowships.

• Ali AA, Chauhan MZ, Doty M, Bui T, Phillips PH, Sallam AB. Ophthalmology Faculty Diversity Trends in the US. JAMA Ophthalmol. 2023 Nov 1;141(11):1021-1028. DOI: 10.1001/jamaophthalmol.2023.4476. PMID: 37824107; PMCID: PMC10570920.

A cross-sectional analysis of 56,438 U.S. ophthalmology faculty using AAMC data (2000–2021) showed that URiM representation remained largely stagnant, with URiM women comprising 3.1% and URiM men 3.5% overall, and minimal change from 2000 to 2021 (URiM men 3.5% to 3.3%). Although non-URiM women increased from 23.2% to 37.3% and women’s representation rose across academic ranks, ophthalmology had among the lowest gains in URiM faculty compared with other specialties, with growth less than one-third that of the diversifying U.S. population, underscoring persistent racial inequities in academic leadership.

• Aguwa UT, Williams BK Jr, Woreta FA. Diversity, equity and inclusion in ophthalmology. Curr Opin Ophthalmol. 2023 Sep 1;34(5):378-381. DOI: 10.1097/ICU.0000000000000970. Epub 2023 May 3. PMID: 37326224.

This narrative review of diversity, equity, and inclusion (DEI) in ophthalmology (published 2023) summarizes persistent disparities in vision health and workforce diversity, noting that URiM individuals comprise 32% of the U.S. population and 22% of U.S. medical students but only 6% of the ophthalmology workforce and 6.3% of residents. The review highlights that URiM residency matches increased from 4.9% (23/467) in 2016 to 10.8% (52/484) in 2019 (P=0.001), yet representation remains low, and emphasizes structural drivers such as social determinants of health and underrepresentation in clinical trials.

• Afzali K, Fujimoto DK, Mohammadi SO, Lin KY. Race and Gender Shift among Academic Glaucoma Specialists in the Last 5 Decades. J Curr Glaucoma Pract. 2023 Apr-Jun;17(2):98-103. DOI: 10.5005/jp-journals-10078-1407. PMID: 37485463; PMCID: PMC10357023.

A retrospective observational study of 457 U.S. academic glaucoma specialists certified between 1964–2019 (published 2023) showed that women comprised 40.5% of faculty and increased significantly over time (OR 1.049 per year; p<0.001), with 55.9% of those certified after 2010 being women, whereas URM representation remained stagnant at 9.2% overall with no significant temporal change (p=0.445). URMs were underrepresented across academic ranks (4.8% of full professors), highlighting persistent racial inequities despite gender gains.

• Ledesma Vicioso N, Woreta F, Sun G. Presence of Diversity or Inclusion Information on US Ophthalmology Residency Program Websites. JAMA Ophthalmol. 2022 Jun 1;140(6):606-609. DOI: 10.1001/jamaophthalmol.2022.1326. PMID: 35550655; PMCID: PMC9100445

A quality improvement cross-sectional review of 121 U.S. ophthalmology residency program websites (May–June 2021) demonstrated that only 24% (29/121) included at least one diversity or inclusion criterion, indicating limited public-facing commitment to equity. Larger programs (>12 residents; OR 3.58; P=.004) and top-20 ranked programs (OR 3.28; P=.02) were more likely to display such information, highlighting variability in transparency that may influence underrepresented applicants’ decisions.

• Chiang MF. The 2021 National Eye Institute Strategic Plan: Recruiting and Training a Diverse New Generation. Am J Ophthalmol. 2022 Jan;233:A1-A4. DOI: 10.1016/j.ajo.2021.10.022. Epub 2021 Nov 1. PMID: 34736950; PMCID: PMC12038911.

A strategic policy editorial outlining the 2021 National Eye Institute (NEI) Strategic Plan (published 2022) highlights persistent inequities in the vision research workforce, noting that Black applicants were 13 percentage points and Asian applicants 4 percentage points less likely than White applicants to receive NIH investigator-initiated awards, and that NEI’s targeted diversity funding has more than tripled since 2016. The plan prioritizes recruitment and training of a diverse workforce and integration of health disparities research to address structural inequities in vision science.

• Aguwa UT, Srikumaran D, Canner J, Knight OJ, Scott AW, Green L, Woreta F. Trends in Racial and Ethnic Diversity of Ophthalmology Residents and Residency Applicants. Am J Ophthalmol. 2022 Aug;240:260-264. DOI: 10.1016/j.ajo.2022.03.006. Epub 2022 Mar 12. PMID: 35288067.

This trend study of ACGME and SF Match data (2011–2019 for residents; 2016–2019 for applicants) demonstrated that URiM ophthalmology residents increased from 4.7% (66/1419) to 5.8% (85/1473; P<.001), while URiM applicants rose from 5.9% (43/726) to 11.8% (87/741; P<.001) and matched URiM participants from 4.9% (23/467) to 10.8% (52/484; P=.002). Despite these improvements, URiM representation remained substantially below the 33% URiM proportion in the U.S. population, highlighting ongoing racial disparities in residency recruitment and representation.

• Yashadhana A, Clarke NA, Zhang JH, Ahmad J, Mdala S, Morjaria P, Yoshizaki M, Kyari F, Burton MJ, Ramke J. Gender and ethnic diversity in global ophthalmology and optometry association leadership: a time for change. Ophthalmic Physiol Opt. 2021 May;41(3):623-629. DOI: 10.1111/opo.12793. Epub 2021 Mar 2. PMID: 33650712; PMCID: PMC7618277.

This cross-sectional desk-based study of 177 ICO and 53 WCO member organizations (February–March 2020) showed that women held approximately one-third of board positions (ICO 33.7%; WCO 34.8%) and 32.3% (ICO) and 21.7% (WCO) of chair roles globally, with only 12% of leadership bodies achieving ≥50% female representation. In high-income Eurocentric regions, white men occupied 56% of board and 58% of chair positions, while ethnic minority women held just 6% of board and 6.7% of chair roles, highlighting marked intersectional inequities in global ophthalmology leadership.

• Duong AT, Law JC, Ramirez DA, et al. Advancing lesbian, gay, bisexual, transgender, and queer (LGBTQ+) diversity, equity, and inclusion in ophthalmology. Ophthalmology 2022; 129:12321234. 

  An editorial (2022) focused on LGBTQ+ diversity, equity, and inclusion in ophthalmology identifies measurable gaps in representation, reporting that although 6.3% of graduating U.S. medical students identified as lesbian, gay, or bisexual, only 3.3% selected ophthalmology, reflecting nearly a 50% lower specialty entry rate compared with overall LGB representation. The authors additionally cite nondisclosure rates of 30% among general surgery residency applicants and 41% among practicing LGBTQ+ physicians, and highlight that 14% of U.S. matriculating medical students in 2021 identified as LGBTQ+, emphasizing the need for systematic data collection, mentorship initiatives, and structured institutional strategies to improve workforce inclusion and equity within ophthalmology.

• Ramirez D.: Support for LGBTQ Members in Ophthalmology – American Academy of Ophthalmology. YO Info. https://www.aao.org/young-ophthalmologists/yo-info/article/support-for-lgbtq-members-in-ophthalmology 

  This commentary (published 2022) reflects on LGBTQ+ visibility and mentorship in ophthalmology, describing the experience of encountering only 1 other openly LGBTQ+ applicant during an interview season and difficulty identifying LGBTQ+ role models within the field. The article highlights the creation of an LGBTQ+ ophthalmology community and dedicated contact platform through the Academy to foster mentorship, safe networking, and visibility, underscoring the need for structured support systems to reduce professional isolation and promote inclusion.

• LGBTQ+ Community and the Academy. American Academy of Ophthalmology. Published 2021. https://www.aao.org/lgbtq-community

  A useful webpage (2023 archive content) that outlines the American Academy of Ophthalmology’s LGBTQ+ Community efforts to advance equity and professional inclusion through structured visibility, mentorship, partnership, and advocacy initiatives, including an online member network open to medical students, residents, and practicing physicians. The page highlights formal mentorship matching, collaboration with the VISION Mentoring Program (AAO/AUPO), educational programming (e.g., AAO 2022 inclusive learning symposium), and dedicated task forces on diversity and disparities, reflecting an institutional framework to support LGBTQ+ ophthalmologists and promote inclusive practice.

• Chang TC, Candelario C, A R, et al. LGBTQ+ identity and ophthalmologist burnout. Am J Ophthalmol 2023; 246:6685. 

  This cross-sectional international survey study (October–December 2021) of 403 ophthalmologists found that 13.2% identified as LGBTQ+, and LGBTQ+ participants had significantly higher mean personal burnout scores (55.7 vs 43.1) and work-related burnout scores (49.8 vs 37.7) compared to non-LGBTQ+ peers, with nonoverlapping 95% confidence intervals. In multivariable analysis, LGBTQ+ identity independently increased personal and work-related burnout by 11.8 and 11.1 points, respectively (P = .0005 and .0023), and 11.7% reported witnessing or experiencing LGBTQ+-related workplace discrimination, identifying LGBTQ+ status as an independent burnout risk factor in ophthalmology.

• Tao BK, Xie JS, Leong R, Xia M, Nguyen AX, Ling J, Nathoo N, Ing EB, Kohly RP, Khosa F. Gender inclusivity of ophthalmology journal submission guidelines and associated research metrics. Eur J Ophthalmol. 2025 Jan;35(1):126-132. DOI: 10.1177/11206721241259806. Epub 2024 Jun 5. PMID: 38840477; PMCID: PMC11697490.
  
  A cross-sectional analysis of 94 ophthalmology journals indexed in the 2021 Journal Citation Reports (data collected April 2023; published 2025) found that only 29.8% (28/94) had gender-inclusive author submission guidelines, with 71.4% of inclusive journals including an inclusivity statement and 25.0% outlining a name-change policy. Inclusive journals demonstrated significantly higher impact metrics, including greater 2021 JIF (median difference 1.84; 95% CI 0.71–3.49) and article influence scores (MD 0.42; 95% CI 0.09–0.73), highlighting limited but academically influential adoption of LGBTQ+-affirming and gender-inclusive policies.

• Smith M, Fuller D, Uner OE, Torres Quinones C, Thomas M. LGBTQIA+ inclusion and care in ophthalmology. Retina Today. March 2025. Accessed February 15, 2026.

A single-center cross-sectional survey of ophthalmology patients and providers (March–June 2023; published 2025) found that 12.1% of 116 patients and 13.9% of 36 providers identified as LGBTQIA+, yet 87.6% of patients reported their eye care provider had not asked about sexual orientation or gender identity and only 15.4% of LGBTQIA+ patients had disclosed identity to an eye provider. Additionally, 84.8% of providers endorsed the need for LGBTQIA+ training, highlighting gaps in SOGI documentation and inclusive care within ophthalmology.

• Iyengar NS, Bellis RM, Tran AQ. The Role of Oculofacial Surgeons in Facial Gender-affirming Surgery. Ophthalmic Plast Reconstr Surg. 2023 Mar-Apr 01;39(2):196-197. DOI: 10.1097/IOP.0000000000002358. Epub 2023 Mar 2. PMID: 36867768.

Letter to the Editor advocating for oculofacial surgeon involvement in gender-affirming surgery (accepted January 3, 2023; published 2023) highlights persistent unmet need for gender-affirming care (GAC) and facial gender-affirming surgery in the United States, noting limited transgender representation in ophthalmology and few peer-reviewed facial GAS publications by oculofacial surgeons. The authors argue that strengthening LGBTQ+ diversity, equity, and inclusion within ophthalmology and incorporating GAS into training could expand access and better serve marginalized transgender patients.

• Hemmerich C, Jones G, Staggs J, Anderson RM, Bacani R, Vassar M. Inequities and Research Gaps in Ophthalmology: A Scoping Review. JAMA Ophthalmol. 2023 Jan 1;141(1):63-70. DOI: 10.1001/jamaophthalmol.2022.5237. PMID: 36480183; PMCID: PMC9857159.

A scoping review of English-language ophthalmology studies (2016–2021; databases searched July 2022) screened 8,170 abstracts and included 75 studies evaluating health inequities, identifying consistent disparities among Black and Hispanic patients and lower-income individuals, who were more likely to experience vision impairment and reduced eye care utilization. Notably, none of the included studies examined LGBTQ inequities in ophthalmology patients following the 2016 NIH designation of sexual and gender minority populations, underscoring a complete absence of LGBTQ-focused research in recent ophthalmic literature.

• Chang TC, A R, Candelario C, Berrocal AM, Briceño CA, Chen J, Shoham-Hazon N, Berco E, Valle DS, Vanner EA. LGBTQ+ Identity and Ophthalmologist Burnout. Am J Ophthalmol. 2023 Feb;246:66-85. DOI: 10.1016/j.ajo.2022.10.002. Epub 2022 Oct 14. PMID: 36252675.

This international cross-sectional survey of 403 ophthalmologists (October–December 2021; published 2023) found that 13.2% identified as LGBTQ+ and had significantly higher personal (55.7 vs 43.1) and work-related burnout scores (49.8 vs 37.7) compared to non-LGBTQ+ peers, with LGBTQ+ status independently associated with increased burnout in multivariable analysis (β=11.8 and 11.1; P=.0005 and .0023). Additionally, 11.7% reported witnessing or experiencing LGBTQ+-related workplace discrimination, underscoring the link between minority stress and professional well-being.

• Iyengar NS, Law JC, Chang TC. Increasing LGBTQ+ Visibility and Representation in Ophthalmology: A Professional Imperative. Am J Ophthalmol. 2022 Oct;242:A4-A6. DOI: 10.1016/j.ajo.2022.05.006. Epub 2022 May 18. PMID: 35594915.

An editorial on LGBTQ+ visibility in ophthalmology (published 2022) reported that only 3.3% (46/1379) of graduating U.S. medical students intending to pursue ophthalmology identified as a sexual minority, compared with an estimated 5.3% of graduating medical students overall, with just 2.0% (11/558) of female ophthalmology-bound graduates identifying as sexual minorities. The authors argue that this underrepresentation reflects limited visibility and cultural inclusivity within the field and call for targeted efforts to improve LGBTQ+ representation and professional inclusion.

• Duong AT, Law JC, Ramirez DA, Woreta F, Sun G. Advancing Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Diversity, Equity, and Inclusion in Ophthalmology. Ophthalmology. 2022 Nov;129(11):1232-1234. DOI: 10.1016/j.ophtha.2022.07.021. Epub 2022 Aug 18. PMID: 35987664.

This editorial (2022) discussing contemporary data on LGBTQ+ diversity, equity, and inclusion (DEI) in ophthalmology highlights underrepresentation and workplace barriers affecting recruitment and retention. The article reports that although 6.3% of graduating U.S. medical students identified as lesbian, gay, or bisexual, only 3.3% intended to pursue ophthalmology, and nationally 14% of matriculating medical students in 2021 identified as LGBTQ+; additionally, 30% of general surgery residency applicants and 41% of practicing LGBTQ+ physicians reported not disclosing their sexual orientation due to fear of discrimination, underscoring marked LGBTQ+ underrepresentation.

• Bennett CL, Baker O, Rangel EL, Marsh RH. The gender gap in surgical residencies. JAMA Surg. 2020;155(9):893-894. DOI:10.1001/jamasurg.2020.2171. 

  This cross-sectional study (AY 2007–2018 ACGME National GME Census data) evaluated the 20 largest U.S. residency specialties and found that 13 of 20 (65%) had female representation below the 45.4% overall trainee benchmark, with surgical fields comprising the lowest quartile (otolaryngology, plastic surgery, urology, orthopedic surgery, neurosurgery). Projected annual increases in female representation were modest (e.g., orthopedic surgery 0.26% per year, 99% CI 0.19%–0.32%), with time to parity with the U.S. population (50.8%) estimated at 7 years for plastic surgery, 19 years for otolaryngology, 47 years for neurosurgery, 71 years for urology, and up to 138 years for orthopedic surgery, indicating that gender parity in surgical specialties remains decades away.

  
  
• Singh C, Loseth C, Shoqirat N. Women in surgery: a systematic review of 25 years. BMJ Leader. 2021; 5:283-290. DOI:10.1136/leader-2019-000199. 

  A systematic review (1998–2018) of 48 studies on women in surgery identified persistent gender inequities in recruitment, leadership, and work–life integration despite women comprising >50% of medical students but <50% of surgical residents. Women held only 3% of department chair roles, 10% of program director positions, and 6.3% of American Board of Medical Specialties board seats, while in orthopaedics women represented 14% of trainees, 8.7% of professors, and 6.5% of AAOS members, underscoring ongoing structural barriers and the need for mentorship and policy reform.

  
  
• Koichopolos J, Ott MC, Maciver AH, Van Koughnett JAM. Gender-based differences in letters of recommendation in applications for general surgery residency programs in Canada. Can J Surg. 2022;65(2):E236-E241. DOI:10.1503/cjs.025120
  
  In general surgery, a study found that female medical students applying to residency had more letters written by female staff, corroborating female sex preferences in mentors.
  
  
• Lulla T, Behmer Hansen RT, Smith CA, Silva NA, Patel NV, Nanda A. Women neurosurgeons around the world: a systematic review. Neurosurg Focus. 2021;50(3):E12. DOI:10.3171/2020.12.FOCUS20902

A systematic review in neurosurgery identified that female mentorship was the most cited factor contributing to sex differences in its field.

• Turrentine FE, Dreisbach CN, St Ivany AR, Hanks JB, Schroen AT. Influence of gender on surgical residency applicants’ recommendation letters. J Am Coll Surg. 2019;228(4):356-365.e3. DOI:10.1016/j.jamcollsurg.2018.12.020.
  
  In general surgery, reference letters for males were found to emphasize leadership abilities, achievements, and ability; letters for females more often referenced physical appearance, compassion, communication skills, and adaptability.

• Stephens EH, Heisler CA, Temkin SM, Miller P. The current status of women in surgery: how to affect the future. JAMA Surg. 2020;155(9):876-885. DOI:10.1001/jamasurg.2020.0312.

Behaviors celebrated in male colleagues, such as decisiveness and assertiveness, which typically fall within the gender schema for males, were often perceived as aggressive in females.

• Barnes KL, McGuire L, Dunivan G, Sussman AL, McKee R. Gender bias experiences of female surgical trainees. J Surg Educ. 2019;76(6):e1-e14. DOI:10.1016/j.jsurg.2019.07.024
  
  There are multiple studies reporting female surgical residents altering their appearance, interests, or habits, downplaying stereotypically female characteristics, as well as feeling the need to increase their efforts to prove their ability and intellect.
  
  
• Dossa F, Simpson AN, Sutradhar R, et al. Sex-based disparities in the hourly earnings of surgeons in the fee-for-service system in Ontario, Canada. JAMA Surg. 2019;154(12):1134-1142. DOI:10.1001/jamasurg.2019.3769

A population analysis not captured in this review found that ophthalmology had the third greatest mean difference in hourly earnings in a single-payer system, with females earning $54.06 less per hour, just behind orthopedic and cardiothoracic surgery.111 In comparison, the mean difference in hourly earnings in plastic surgery was only $2.68.

• Dossa F, Zeltzer D, Sutradhar R, Simpson AN, Baxter NN. Sex differences in the pattern of patient referrals to male and female surgeons. JAMA Surg. 2022;157(2):95-103. DOI:10.1001/jamasurg.2021.5784

* Male physicians had higher odds of same-sex referrals compared with female physicians, even after accounting for patient characteristics and physician experience and availability.112 Females were also less likely to receive procedural referrals.112 Referral preferences result in lower volumes and fewer operative referrals to female surgeons and correlate with sex-based income disparities.

• Sexton KW, Hocking KM, Wise E, et al. Women in academic surgery: the pipeline is busted. J Surg Educ. 2012;69(1):84-90. DOI:10.1016/j.jsurg.2011.07.008.

Although it has been proposed that the paucity of females in leadership positions may be attributed to a lack of available candidates, Sexton et al demonstrated that stable growth curves among female surgical residents did not improve the representation of female professors of surgery over 25 years. This suggests that increasing the number of females in surgery was insufficient to improve leadership representation.

• Abelson JS, Chartrand G, Moo TA, Moore M, Yeo H. The climb to break the glass ceiling in surgery: trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015. Am J Surg. 2016;212(4):566-572.e1. DOI:10.1016/j.amjsurg.2016.06.012

A 2016 study found the rate of female full professors of surgery increased by on average 0.3% per year from 1994 to 2015; with this rate of increase, female full professors are not expected to achieve sex parity until 213.

• Lim WH, Wong C, Jain SR, et al. The unspoken reality of gender bias in surgery: a qualitative systematic review. PLoS One. 2021;16(2):e0246420. DOI:10.1371/journal.pone.0246420

Although scholarly productivity, including authorship, impacts career promotion, a study exploring authorship trends from 2008 to 2018 among the 25-highest impact journals in general surgery and other subspecialties found that although female authorship was improving overall, the rise in female last authorship had been slower than first authorship. Yet, the data were clear: where there was greater female representation in positions of leadership, other females benefit. Having a female department chair was associated with a greater proportion of female faculty and residents, and female last authorship was associated with increased female first authorship.

• Tanya SM, Nguyen AX, Joly-Chevrier M, Pur DR, Sharma S, Costello F, Kherani F, Trinh VQ, Hardy I, Lando L. Gender representation in professorship and research productivity across all surgical specialties in Canadian academic institutions. Can J Surg. 2025 Jun 18;68(3):E253-E264. DOI: 10.1503/cjs.015723. PMID: 40533252; PMCID: PMC12180920.

This retrospective cross-sectional study of 5,250 academic surgeons across 10 specialties and 17 Canadian institutions (data collected May–November 2021; published 2025) demonstrated that women comprised 32% of surgeons and were underrepresented at all academic ranks (assistant 37%, associate 27%, full professor 18%; all p<0.001), with lower mean h-index (6.4 vs 11.6), fewer publications (18.2 vs 44.1), and shorter research duration (11.5 vs 16.6 years). Multivariable analysis showed men were significantly more likely to hold senior professorship independent of productivity (OR 1.30–1.33), highlighting persistent structural barriers to advancement in surgical academia.

• Smith BT, Villela-Castrejon J, Rodriguez L, Kalva P, Beal T, Lee T, George JT, Weaver ML, Cheng LS. Authorship Trends and Gender Concordance in Surgical Research. J Surg Res. 2025 Aug;312:148-154. DOI: 10.1016/j.jss.2025.06.001. Epub 2025 Jun 27. PMID: 40580574; PMCID: PMC12221200.

A bibliometric analysis of 741 articles in JAMA Surgery, Annals of Surgery, Nature, and Science (1991, 2001, 2011, 2021; published 2025) showed that women authors increased from 13% in 1991 to 26% in 2021, and women senior authors rose from 12% to 25%, yet women remain underrepresented overall. Articles with a woman senior author had significantly higher proportions of women coauthors than those with a man senior author (55% ± 4% vs 12% ± 6%; P<0.05), demonstrating persistent gender disparity and strong gender concordance patterns in academic surgical research.

• Rahman R, McColgan R, Lu S, Fufa D. Evaluating Differences in Case Volume During Orthopedic Surgery Residency by Gender and Race: A Single-Institution Study. HSS J. 2025 Oct 22:15563316251383758. DOI: 10.1177/15563316251383758. Epub ahead of print. PMID: 41140889; PMCID: PMC12549597.

A retrospective single-institution study of 111 orthopedic surgery residents (2010–2023) found no overall differences in operative case volume by gender (women 1865.6 vs men 1861.0 cases; P=.95) or race/ethnicity (White 1885.5 vs other 1803.2; P=.18), although women logged more PGY-4 cases (430.3 vs 370.0; P=.015). These findings suggest that institutional diversity and inclusion efforts may mitigate gender and racial disparities in surgical training volume.

• Ikesu R, Gotanda H, Russell TA, Maggard-Gibbons M, Russell MM, Yoshida R, Li R, Klomhaus A, de Virgilio C, Tsugawa Y. Long-Term Postoperative Outcomes by Surgeon Gender and Patient-Surgeon Gender Concordance in the US. JAMA Surg. 2025 Jun 1;160(6):624-632. DOI: 10.1001/jamasurg.2025.0866. PMID: 40266610; PMCID: PMC12019671.

This population-based cross-sectional study of 2,288,279 Medicare beneficiaries undergoing 14 surgeries (2016–2019) found that patients treated by female surgeons (5.7% of cases) had lower adjusted 90-day mortality than those treated by male surgeons (2.6% vs 3.0%; aRD −0.3 percentage points; P<.001), with similar patterns at 1 year. Among female patients, patient-surgeon gender concordance was associated with lower 90-day readmission (7.3% vs 7.7%; aRD −0.4 pp; P=.001) and complication rates (12.2% vs 12.8%; aRD −0.5 pp; P=.005), underscoring outcome-relevant implications of gender equity and representation in surgery.

• Agharia S, de Wet H, Di Bella C. Women in Surgery: An Analysis of Mental Health, Stress Perception and Resilience. Indian J Orthop. 2025 Jun 19;59(10):1627-1635. DOI: 10.1007/s43465-025-01448-9. PMID: 41116883; PMCID: PMC12535571.

A narrative literature review of 59 studies on women in surgery (no time restriction; search conducted 2025) identified persistent gender-based stressors including harassment (19.9% of female general surgery residents vs 0.9% of men), high burnout rates (50% among Canadian female orthopaedic surgeons), and elevated infertility (32% vs 10.9% general population). Alcohol use disorder was reported in 25.6% of female surgeons versus 13.9% of men, underscoring disproportionate mental health burden and the need for structural reforms to promote gender equity and well-being in surgical fields.

• Winer LK, Panzica N, Lynch K, Parker C, Lancaster R, Gillis A, Lindeman B, Chen H, Fazendin J, Cortez AR, Zmijewski P. Resident perspectives on the role of gender in operative experience during general surgery residency training: A mixed-methods study. Am J Surg. 2024 Nov;237:115755. DOI: 10.1016/j.amjsurg.2024.04.026. Epub 2024 Apr 27. PMID: 38719681.

This cross-sectional survey of 96 general surgery residents from 16 U.S. programs (surveyed July–September 2022; published 2024) found that 53.0% of female residents vs 20.0% of male residents believed the quality of operative training was affected by gender (p<0.01), despite similar perceptions of case log accuracy. Female residents more frequently reported sexism/gender bias, misidentification, and reduced autonomy as barriers, and 22.7% reported personally experiencing operative barriers (vs 13.3% of males), highlighting perceived inequities in surgical training experience.

• Stevens N, Alfred A, Gao R, Khalil S, Miller L, Sawyer R, Shebrain S. Scholarly Activity and Gender of an Applicant for a General Surgery Residency. J Surg Res. 2024 Mar;295:95-101. DOI: 10.1016/j.jss.2023.10.008. Epub 2023 Nov 23. PMID: 38000260.

A retrospective single-institution study of 335 general surgery residency applicants (2016–2021 interview cycles) showed no association between gender and scholarly activity (SCA), with 84.8% of male vs 88.0% of female applicants reporting ≥1 SCA (P=0.409) and similar median total SCAs (4 vs 5; P=0.272). Although overall productivity did not differ, women trended toward more poster presentations while men reported slightly more oral presentations, highlighting comparable academic engagement but subtle differences in scholarly exposure.

• Saka N, Yamamoto N, Watanabe J, Wallis C, Jerath A, Someko H, Hayashi M, Kamijo K, Ariie T, Kuno T, Kato H, Mohamud H, Chang A, Satkunasivam R, Tsugawa Y. Comparison of Postoperative Outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis. Ann Surg. 2024 Dec 1;280(6):945-953. DOI: 10.1097/SLA.0000000000006339. Epub 2024 May 10. PMID: 38726676; PMCID: PMC11542977.

A systematic review and meta-analysis of 15 observational studies including 5,448,121 patients (search from database inception to September 2022; updated July 2023; published 2024) demonstrated that patients treated by female surgeons had lower postoperative mortality compared with male surgeons (aOR 0.93; 95% CI 0.88–0.97; I²=27%), with similar findings in elective and nonelective surgeries. There were no significant differences in readmission (aOR 1.20; 95% CI 0.83–1.74) or complication rates (aOR 0.94; 95% CI 0.88–1.01), supporting equivalent or superior outcomes despite persistent underrepresentation of women in surgery.

• Ogunnowo S, Zakrison TL, Baird B, Erben Y, Tung EL, Yang JP, Dorsey C. Exploring Experiences of Traumatic Microaggressions Toward Surgeons and Surgical Residents. J Surg Res. 2024 Mar;295:191-202. DOI: 10.1016/j.jss.2023.10.018. Epub 2023 Nov 29. PMID: 38035870; PMCID: PMC10922079.

A cross-sectional survey of 130 surgeons and trainees from academic surgical societies (data collected 2022; published 2024) reported that 81% experienced workplace microaggressions in the prior 12 months, with women more likely than men to experience frequent microaggressions (87.7% vs 44.8%; p=0.029). Female surgeons were significantly more likely to report working harder to gain patient confidence (p=0.006), experiencing burnout (p=0.037), and modifying communication and behavior (e.g., 61% vs 24% changed non-verbal style; p<0.001), highlighting gender-based psychological and professional impacts in surgical culture.

• Miao X, Sarsour R, Givant M, Spartz H. Exploring the gender gap: A nationwide comparative analysis of general surgery residency program leadership. Surg Open Sci. 2024 May 31;20:57-61. DOI: 10.1016/j.sopen.2024.05.020. PMID: 38911054; PMCID: PMC11190743.

This cross-sectional nationwide analysis of 345 U.S. general surgery residency programs using AMA FREIDA data (leadership data collected 2024; published 2024) showed that women held only 28.3% of program director (PD), 39.7% of associate program director (APD), and 13.3% of department/division chief (DC) roles, despite women comprising 46.1% of general surgery trainees in 2021. University-based programs had significantly higher mean numbers of women leaders than community-based programs (e.g., PD p=0.02; APD and DC p<0.01), highlighting persistent gender disparities in surgical leadership, particularly in community settings.

• McCall J, Pudwell J, Pyper JS, Nitsch R. Impostor Phenomenon and Impact on Women Surgeons: A Canadian Cross-Sectional Survey. J Am Coll Surg. 2024 Sep 1;239(3):298-308. DOI: 10.1097/XCS.0000000000001111. Epub 2024 May 7. PMID: 38712839.

A cross-sectional national survey of 387 self-identified women surgeons in Canada (data collected September 2020–February 2021; published 2024) demonstrated that 98.7% experienced impostor phenomenon (IP), with 63.0% meeting criteria for high impostorism (CIPS >62) and a median score of 68, indicating frequent impostor feelings. IP was most intense in the first 5 years of practice and influenced clinical behavior, with 16.5% taking fewer complex cases, 7.5% reducing OR time, and 2.8% stopping operating altogether due to self-doubt, underscoring substantial career-level implications for women surgeons.

• Malacon K, Touponse G, Yoseph E, Li G, Wei PJ, Kicielinski K, Massie L, Williamson T, Han S, Zygourakis C. Gender Differences in Electronic Health Record Usage Among Surgeons. JAMA Netw Open. 2024 Jul 1;7(7):e2421717. DOI: 10.1001/jamanetworkopen.2024.21717. PMID: 39042410; PMCID: PMC11267410.

This cross-sectional EHR analysis of 224 attending surgeons at a single academic hospital (January–December 2022) found that female surgeons (30%) spent more time per note (4.8 vs 2.5 minutes; P<.001), wrote longer inpatient notes (6025 vs 4308 characters; P=.001) and outpatient notes (6321 vs 4445 characters; P<.001), and logged more after-hours EHR time (36.4 vs 14.1 min/month outside 7am–7pm; P=.05). Although overall monthly EHR time was similar, these documentation differences suggest disproportionate administrative burden for women surgeons with implications for burnout and compensation equity.

• Kim A, Dornelas LB, Telles L, Gerk A, Motter SB, Salomão SL, Mooney D, Camargo C, Ferreira R. Brazilian authorship gender trends on academic surgery: a bigdata analysis. Acta Cir Bras. 2024 Nov 29;39:e397724. DOI: 10.1590/acb397724. PMID: 39630701; PMCID: PMC11606619.

A cross-sectional bibliometric analysis of 1,881 manuscripts from 340 PubMed-indexed surgical journals with Brazilian affiliations (2018–2022) showed that women comprised only 16.7% of first authors (314/1,881) and 12.4% of last authors (234/1,881), with no meaningful improvement over time. Women were underrepresented in high-impact journals (14.3% of top-10 authors) and international collaborations (7% vs 12.6% of male first authors; OR 1.9), highlighting persistent gender disparities in academic surgical authorship and global visibility.

• Garcia E, Mandaleson A, Stannage K, Williams N. Occupational hazards and pregnancy in orthopaedics: female surgeons are at increased risk of infertility and pregnancy complications. ANZ J Surg. 2024 Nov;94(11):1910-1918. DOI: 10.1111/ans.18992. Epub 2024 Apr 8. PMID: 38590139.

This narrative review of occupational hazards and pregnancy in orthopaedics (published 2024) reports that infertility rates among surgeons reach 32% compared to 10.9% in the general population, and pregnancy complication rates range from 25%–35%, with 35.6% occurring in first pregnancies. Female surgeons are older at first birth (33.1 vs 24.6 years), more likely to delay childbearing (65%), and experience higher rates of major pregnancy complications (48.3% vs 27.2%; OR 1.72), highlighting structural workplace exposures and demands that disproportionately affect women in surgical careers.

• Finn CB, Syvyk S, Bakillah E, Brown DE, Mesiti AM, Highet A, Bergmark RW, Yeo HL, Waljee JF, Wick EC, Shea JA, Kelz RR. Barriers and Facilitators to Clinical Practice Development in Men and Women Surgeons. JAMA Surg. 2024 Jan 1;159(1):43-50. DOI: 10.1001/jamasurg.2023.5125. PMID: 37851422; PMCID: PMC10585584.

A multi-institutional qualitative study of 45 academic surgeons across 5 U.S. centers (July 2022–January 2023) found that women (51%) reported additional barriers to clinical practice growth beyond shared structural challenges, including gender-based discrimination, salary disparities, exclusion, and unequal resource allocation. Women also described receiving fewer and less complex referrals and facing greater nonoperative care demands, while gender concordance with patients and referring physicians facilitated practice development, underscoring structural inequities affecting early-career women surgeons.

• Ajay PS, Sharperson CM, Shah SK, Kooby DA, Shah MM. The Gender Gap in Surgical Literature: Are We Making Progress? J Surg Res. 2024 Mar;295:357-363. DOI: 10.1016/j.jss.2023.11.033. Epub 2023 Dec 7. PMID: 38064976; PMCID: PMC10922090.

This bibliometric analysis of 3,575 original research articles in four high-impact U.S. surgical journals (2008–2010 vs 2018–2020) showed that women primary authors increased from 22.8% to 31.7% and women senior authors from 13.9% to 21% (both p<0.001), yet overall only 26.9% of primary and 17.2% of senior authors were women. In 2008–2010, articles with women primary authors had fewer median citations than men (39 vs 42; p=0.005), although citation parity was achieved by 2018–2020, indicating progress but persistent underrepresentation in high-impact surgical scholarship.

• Xun H, Stonko DP, Goldsborough E, Keegan A, Srinivas T, Bose S, McDermott KM, Weaver ML, Hicks CW. A 10-Year Analysis of Representation of Women in Patent Applications and NIH Funding in Vascular Surgery. Ann Vasc Surg. 2023 Sep;95:244-250. DOI: 10.1016/j.avsg.2023.03.006. Epub 2023 Apr 8. PMID: 37037416; PMCID: PMC10523912.

A retrospective analysis of 2,992 vascular surgery–related patents and 1,736 NIH grants (2012–2021) demonstrated that women comprised only 11.5% of patent inventors and were least likely to be first inventors (8.9%), with no significant improvement over time (−0.2% per year; P=0.16). Although women represented 23.8% of NIH principal investigators and increased by +1.31% per year (P<0.001), they received lower median funding per award ($333,417 vs $377,993; P<0.001), indicating persistent gender disparities in surgical innovation and research funding.

• Winer LK, Kader S, Abelson JS, Hammaker AC, Eruchalu CN, Etheridge JC, Cho NL, Foote DC, Ivascu FA, Smith S, Postlewait LM, Greenwell K, Meister KM, Montgomery KB, Zmijewski P, Byrd SE, Kimbrough MK, Stopenski SJ, Nahmias JT, Harvey J, Farr D, Callahan ZM, Marks JA, Stahl CC, Al Yafi M, Sutton JM, Elsaadi A, Campbell SJ, Dodwad SM, Adams SD, Woeste MR, Martin RCG, Patel P, Anstadt MJ, Nasim BW, Willis RE, Patel JA, Newcomb MR, George BC, Quillin RC 3rd, Cortez AR. Disparities in the Operative Experience Between Female and Male General Surgery Residents: A Multi-institutional Study From the US ROPE Consortium. Ann Surg. 2023 Jul 1;278(1):1-7. DOI: 10.1097/SLA.0000000000005847. Epub 2023 Mar 30. PMID: 36994704; PMCID: PMC10896185.

This multi-institutional retrospective cohort study of 1,343 general surgery graduates from 20 U.S. programs (2010–2020) showed that women (35%) logged fewer median total cases than men (1140 vs 1177; P<0.01), largely due to fewer surgeon junior cases (829 vs 863; P<0.01), and were less likely to be high-volume residents (OR 0.74; 95% CI 0.56–0.98; P=0.03). Although disparities were significant in 2010–2015 (1135 vs 1077; P<0.01), they were no longer observed in 2016–2020 (1218 vs 1193; P=0.18), suggesting a narrowing operative gap over time.

• Rei KM, Reddy V, Mohammed S, Kashyap S, Cathel A, Siddiqi J. Gender Differences in Surgical Case Volume Among Neurosurgery Residents. Cureus. 2023 Mar 5;15(3):e35798. DOI: 10.7759/cureus.35798. PMID: 37033513; PMCID: PMC10075184.

A retrospective case log analysis of 47 neurosurgery residents at two U.S. programs (2015–2021; published 2023) found no significant gender differences in median surgical case volume at any PGY level, with women comprising 19.1% of residents and performing comparable cases to men across training years (all p>0.05). These findings contrast prior disparities reported in otolaryngology and ophthalmology and suggest potential training parity within the studied neurosurgery programs. 

• Nguyen M, Gonzalez L, Chaudhry SI, Ahuja N, Pomahac B, Newman A, Cannon A, Zarebski SA, Dardik A, Boatright D. Gender Disparity in National Institutes of Health Funding Among Surgeon-Scientists From 1995 to 2020. JAMA Netw Open. 2023 Mar 1;6(3):e233630. DOI: 10.1001/jamanetworkopen.2023.3630. PMID: 36939702; PMCID: PMC10028489.

This cross-sectional analysis of NIH-funded surgeon-scientists using NIH RePORTER data (1995–2020) showed that women comprised only 2.4% of academic surgeons serving as NIH-funded PIs in 2020 (92/3834) compared with 1.8% in 1995 (14/792; P=.10), indicating minimal proportional growth over 25 years. Although women obtained first NIH grants earlier (8.8 vs 10.8 years; P<.001) and were equally likely to secure R01-equivalent awards (aRR 0.99), they were 25% less likely to be super principal investigators with ≥$750,000 annual funding (aRR 0.75), highlighting persistent disparities in high-level research funding.

• Iwai Y, Yu AYL, Daniels NC, Manik R, Thomas SM, Sudan R, Beasley GM, Fayanju OM. Racial, Ethnic, and Gender Diversity Among Academic Surgical Leaders in the US. JAMA Surg. 2023 Dec 1;158(12):1328-1334. DOI: 10.1001/jamasurg.2023.4777. PMID: 37819633; PMCID: PMC10568440.

A cross-sectional analysis of 2,165 surgical leaders across 154 U.S. departments (data collected January–July 2022) found that women comprised only 14.1% of chairs, 31.6% of vice chairs (VCs), and 12.9% of division chiefs (DCs), while just 8.9% of all leaders were from underrepresented in medicine (URiM) groups. URiM leaders were disproportionately concentrated in DEI-related VC roles (51.6%), and no American Indian, Alaska Native, or Native Hawaiian/Pacific Islander individuals held leadership positions, highlighting structural barriers to advancement into top surgical leadership roles.

• Hiemstra LA, Kerslake S, Fritz JA, Clark M, Temple-Oberle C, Boynton E, Lafave M. Rates of Burnout in Female Orthopaedic Surgeons Correlate with Barriers to Gender Equity. J Bone Joint Surg Am. 2023 Jun 7;105(11):849-854. DOI: 10.2106/JBJS.22.01319. Epub 2023 Apr 21. PMID: 37083849.

A national cross-sectional survey of 218 Canadian female orthopaedic surgeons (September 2020–February 2021; 66.1% response rate) found that 50.5% (110/218) reported career burnout (median score 4), with burnout positively correlated with gender-bias domains including Male Privilege (r=0.215; p<0.01), Devaluation (r=0.166; p<0.05), and Disproportionate Constraints (r=0.152; p<0.05). Despite 77.1% reporting job satisfaction, younger age was associated with higher burnout, underscoring the link between structural gender inequities and occupational distress.

• Saif A, Demblowski LA, Blakely AM, Zeiger MA. NIH Funding Across Surgical Specialties; How Do Women Fare? Surgery. 2022 Sep;172(3):890-896. DOI: 10.1016/j.surg.2022.04.053. Epub 2022 Jul 11. PMID: 35835627; PMCID: PMC9467910.

This cross-sectional analysis of NIH-funded surgeon-scientists using iSearch Grants data (2010 vs 2020) showed that although the proportion of NIH-funded women increased in most specialties, funding equity remained uneven, with women holding a smaller share of total grant dollars than their representation in several fields. For example, in 2020 women comprised 57% of NIH-funded obstetrics and gynecology surgeons but held only 46% of funding, and in vascular surgery 40% of funded surgeons were women but held 32% of total grant costs, highlighting persistent disparities in high-level research funding.

• Saif A, Demblowski LA, Blakely AM, Zeiger MA. Current Status of National Institutes of Health Research Funding for Women Surgeon-Scientists. JAMA Surg. 2022 Dec 1;157(12):1134-1140. DOI: 10.1001/jamasurg.2022.5157. PMID: 36260312; PMCID: PMC9582970.

This cross-sectional analysis of 715 NIH-funded surgeons in 2010 and 1,031 in 2020 (NIH iSearch Grants data, 2010–2020) showed that women increased from 19.0% (136/715) of funded surgeons in 2010 to 25.4% (262/1031) in 2020 (P<.001), with total funding rising from $75.9M (12.3%) to $189.7M (21.7%) (P<.001). However, in 2020 women comprised 27.4% of the surgical workforce but received only 21.7% of total NIH surgical funding, indicating persistent funding inequities despite growth in representation.

• Radford DM, Parangi S, Tu C, Silver JK. h-Index and Academic Rank by Gender Among Breast Surgery Fellowship Faculty. J Womens Health (Larchmt). 2022 Jan;31(1):110-116. DOI: 10.1089/jwh.2020.8579. Epub 2021 Feb 24. PMID: 33626311.

This retrospective cross-sectional bibliometric study of 209 academic breast surgery fellowship faculty across 52 North American programs (data collected February 2019; published 2022) showed that although women comprised 69.9% of faculty, they were underrepresented at the professor level (46.4%) and had significantly lower mean h-index overall (16.4 vs 33.9 for men; p<0.001). Men professors had higher mean h-index than women professors (45.3 vs 33.2; p<0.001), highlighting persistent gender disparities in academic advancement despite female majority representation in the specialty.

•  Ferrari L, Mari V, De Santi G, Parini S, Capelli G, Tacconi G, Chessa A, Verdi D, Frigerio I, Spolverato G, Gumbs A. Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them: A Systematic Scoping Review. Ann Surg. 2022 Aug 1;276(2):246-255. DOI: 10.1097/SLA.0000000000005510. Epub 2022 Jul 4. PMID: 35797642.

A systematic scoping review of 120 studies published between 2000 and 2020 identified persistent barriers to women’s recruitment, training, and advancement in surgery, including discrimination, harassment, limited operative autonomy, and lack of maternity support. Female residents reported markedly higher rates of discrimination (77.1% vs 17.1% of men, P<0.001), harassment (42.5% vs 21.5%, P<0.001), burnout (42.4% vs 35.9%), and were more likely to leave training (OR 1.54, 95% CI 1.16–2.06), underscoring structural gender inequities across surgical careers.

• Trinh LN, O'Rorke E, Mulcahey MK. Factors Influencing Female Medical Students' Decision to Pursue Surgical Specialties: A Systematic Review. J Surg Educ. 2021 May-Jun;78(3):836-849. DOI: 10.1016/j.jsurg.2020.08.050. Epub 2020 Sep 12. PMID: 32933885.

A systematic review (2012–2020) identified mentorship, specialty exposure, and the intellectual appeal of surgery as key factors encouraging women to pursue surgical careers, while lifestyle concerns, gender discrimination, and societal expectations were major deterrents. Women placed less emphasis on prestige and salary than men and were more influenced by the presence - or absence - of role models and supportive training environments.

• Riner AN, Herremans KM, Neal DW, Johnson-Mann C, Hughes SJ, McGuire KP, Upchurch GR Jr, Trevino JG. Diversification of Academic Surgery, Its Leadership, and the Importance of Intersectionality. JAMA Surg. 2021 Aug 1;156(8):748-756. DOI: 10.1001/jamasurg.2021.1546. PMID: 33950242; PMCID: PMC8100917.

This cross-sectional and longitudinal analysis of 15,653 U.S. surgical faculty using AAMC data (2013–2019) showed that women comprised 24.8% of faculty in 2019, yet White surgeons held 77.7% of full professorships and 77.4% of chair positions. Black (2.7%) and Hispanic/Latinx (4.4%) surgeons were markedly underrepresented among full professors, and while minority male representation increased slightly, Black female representation remained stagnant (annual change 0.00004%) and Hispanic/Latinx female representation declined (−0.16%), with only one Black and one Hispanic/Latinx woman ascending to chair during the study period, highlighting intersectional barriers in surgical leadership.

• Hill K.A., Samuels E.A., Gross C.P., et al: Assessment of the prevalence of medical student mistreatment by sex, race/ethnicity, and sexual orientation. JAMA Intern Med 2020; 180: pp. 653-665. 

  A cohort study (2016–2017 AAMC Graduation Questionnaire data) analyzed 27,504 U.S. medical graduates (72.1% response rate) and found that mistreatment was reported by 40.9% of female vs 25.2% of male students (P < .001), 38.0% of URM, 31.9% of Asian, and 32.9% of multiracial students vs 24.0% of White students (P < .001), and 43.5% of LGB vs 23.6% of heterosexual students (P < .001). Discrimination based on sexual orientation was reported by 23.1% of LGB vs 1.0% of heterosexual students, and multiple forms of mistreatment were more common among female (17.8% vs 7.0%) and LGB students (16.4% vs 3.6%), demonstrating disproportionate mistreatment among marginalized groups in medical training.

• Samuels EA, Boatright DH, Wong AH, et al. Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students. JAMA Netw Open. 2021;4(2):e2036136. 

  A cross-sectional study (2016–2017 AAMC Graduation Questionnaire data) analyzed 26,123 U.S. medical students (5.4% LGB) and found higher burnout among LGB students compared with heterosexual peers (17.2% vs 11.1%, P < .001), with increased odds of burnout (adjusted OR 1.63, 95% CI 1.41–1.89) that persisted after accounting for mistreatment (OR 1.36, 95% CI 1.16–1.60). LGB students reported substantially higher sexual orientation–specific mistreatment (23.3% vs 1.0%), and mistreatment mediated 31% of the association between LGB identity and burnout, with high mistreatment linked to an 8-fold higher predicted probability of burnout (19.8% vs 2.3%).

• Mori WS, Gao Y, Linos E, et al. Sexual Orientation Diversity and Specialty Choice Among Graduating Allopathic Medical Students in the United States. JAMA Netw Open. 2021;4(9):e2126983.

  This survey study (2016–2019 AAMC Graduation Questionnaire data) analyzed 58,572 graduating U.S. allopathic medical students, of whom 6.3% (3,664) identified as sexual minority (SM). SM representation varied widely by specialty, highest in psychiatry (11.6%) and lowest in orthopedic surgery (1.8%); in ophthalmology, 3.3% (46/1,379) of students identified as SM (2.0% of females; 4.3% of males). SM female students were less likely to pursue primary care (41.2% vs 46.8%, P < .001) but more likely to enter surgical specialties (27.2% vs 24.7%, P < .001), whereas SM male students were more likely to pursue primary care (38.4% vs 34.9%, P < .001) and less likely to enter surgical fields (17.8% vs 26.5%, P < .001), demonstrating specialty- and sex-specific disparities in workforce distribution. 

• Seehra JK, Ellis R, Doleman B, McLarty E, Lund JN. Diversity in Surgery: Ethnic, Gender, and LGBTQ+ Representations Among United Kingdom Surgical Residents and Consultants. J Surg Educ. 2026 Jan;83(1):103761. DOI: 10.1016/j.jsurg.2025.103761. Epub 2025 Nov 3. PMID: 41187605.

  This retrospective cross-sectional national analysis of 7,906 UK surgical trainees and 7,621 consultant trainers (data collected August 2024–April 2025; benchmarked to 2021 UK Census) found that 7.4% of Neurosurgery trainees and 7.1% of Core Surgical trainees identified as LGBTQ+ (vs 3.2% in the general population; OR 2.37 and 2.28, respectively), whereas consultant-level LGBTQ+ representation was significantly lower, e.g., 1.1% in Trauma & Orthopaedics (OR 0.33). Shannon Diversity Index scores for sexual orientation were significantly higher in trainees than consultants (p=0.002), indicating improved LGBTQ+ inclusion at junior levels but persistent underrepresentation in senior surgical roles.

• Mizumoto J, Kono E, Yoshida E. Healthcare professionals' experiences related LGBTQ+ patients and colleagues at their workplace: Descriptive research in Japan. J Gen Fam Med. 2025 Mar 29;26(4):312-325. DOI: 10.1002/jgf2.70012. PMID: 40642126; PMCID: PMC12237821.

  A descriptive cross-sectional survey of 6,216 healthcare professionals in Japan (February–March 2024; published 2025) found that 7.1% witnessed discrimination against LGBTQ+ patients and 5.3% against LGBTQ+ colleagues, while only 2.1% self-identified as LGBTQ+ despite 15.4% reporting non-cisgender or non-heterosexual identities. Among LGBTQ+ staff (n=133), 65.4% had not disclosed their identity at work and 21.1% reported heteronormative assumptions as a workplace difficulty, highlighting underreporting, concealment, and structural barriers to inclusion in healthcare settings.

• Hinkle SN, Okeh CC, Ulloa-Pérez E, Mani A, Higginbotham EJ, Thomas R, Kearney MD, Fahl C, Schisterman EF, Verma SS, Hamilton R, Mumford SL. Perceptions of Institutional Engagement and Inclusion by Sexual Orientation and Gender Identity. JAMA Netw Open. 2025 Jun 2;8(6):e2513772. DOI: 10.1001/jamanetworkopen.2025.13772. PMID: 40465293; PMCID: PMC12138678.

  This repeated cross-sectional survey study at a single U.S. academic medical center (Diversity Engagement Survey, 2015, 2018, 2021, 2023; n=23,708 respondents) found that 8.7% identified as LGB and 0.7% as transgender, queer, or nonbinary (TQNB), with both groups reporting significantly lower institutional engagement than heterosexual or cisgender peers (e.g., TQNB vision/purpose AD −4.1; 95% CI −5.5 to −2.6). LGB (ARR 1.26) and TQNB (ARR 1.48) respondents were more likely to consider job change due to inappropriate workplace behavior, highlighting disparities in belonging, visibility, and retention within academic medicine.

• Xu AJ, Panken EJ, Gonzales-Alabastro CD, Zhang H, Helenowski IB, Murphy AB, Prabhu R, Amarasekera C. Urologists and Lesbian, Gay, Bisexual, Transgender, or Queer Patients: A Survey-based Study of the Practice Patterns, Attitudes, and Knowledge Base of Urologists Toward Their Lesbian, Gay, Bisexual, Transgender, or Queer Patients. Urology. 2023 Sep;179:71-79. DOI: 10.1016/j.urology.2023.05.019. Epub 2023 Jun 5. PMID: 37286139.
  
  A cross-sectional survey of 154 U.S. urologists (survey distributed 2022; published 2023) found that while 88% felt comfortable discussing sexual health with LGBTQ patients, 60.4% did not inquire about sexual orientation during history-taking and 57.8% lacked intake forms capturing sexual orientation. Although 74.3% believed more LGBTQ-focused education was needed, mixed knowledge regarding prostate cancer counseling for gay and bisexual men highlights gaps between stated inclusivity and implementation in clinical practice.

• St John A, Goulet N. Enhancing Diversity in Surgery: Association of Out Surgeons and Allies, a New Society to Support and Promote Lesbian, Gay, Bisexual, Transgender, and Queer Surgeons. Am Surg. 2022 Dec;88(12):2810-2816. DOI: 10.1177/00031348221101494. Epub 2022 May 12. PMID: 35549568.
  

  A narrative review and organizational report describing the creation of the Association of Out Surgeons and Allies (AOSA) (published 2022) highlights that in a national 2021 study of 6,381 U.S. general surgery residents, LGBTQ+ trainees reported high rates of discrimination (59.2%), harassment (47.5%), and bullying (74.8%) and were twice as likely to consider leaving training. The article outlines AOSA’s establishment (founded 2019) to address persistent workplace mistreatment through mentorship, sponsorship, bias reduction, and leadership development initiatives aimed at improving LGBTQ+ inclusion in surgery.

• West-Livingston LN, Dittman JM, Park JA, Pascarella L. Sexual orientation, gender identity, and gender expression: From current state to solutions for the support of lesbian, gay, bisexual, transgender, and queer/questioning patients and colleagues. J Vasc Surg. 2021 Aug;74(2S):64S-75S. DOI: 10.1016/j.jvs.2021.03.057. PMID: 34303461.
  

  A narrative review and policy commentary in vascular surgery (published 2021) outlines persistent discrimination affecting LGBTQ+ patients and clinicians and highlights underrepresentation of sexual and gender minorities in surgical research and workforce data. The authors emphasize the need for inclusive clinical practices (e.g., gender-neutral intake forms, pronoun use), improved SOGI data collection, and institutional allyship to address health disparities such as elevated cardiovascular risk factors and HIV-associated vascular disease in LGBTQ+ populations.

• Sinton MC, Baines KN, Thornalley KA, Ilangovan V, Kurt M. Increasing the visibility of LGBTQ+ researchers in STEM. Lancet. 2021 Jan 9;397(10269):77-79. DOI: 10.1016/S0140-6736(20)32626-X. Epub 2020 Dec 16. PMID: 33340457.

A commentary in The Lancet on LGBTQ+ visibility in STEM (published January 2021) highlights persistent underrepresentation and workplace marginalization of LGBTQ+ professionals, noting that nearly 50% of transgender physical scientists in the UK had considered leaving or had left STEM careers and 24% of LGBTQ+ biomedical researchers felt uncomfortable being open at work. The authors emphasize that lack of routine sexual orientation and gender identity (SOGI) data collection and heteronormative workplace cultures contribute to invisibility, calling for institutional-level reforms to improve retention, safety, and inclusion

• Mori WS, Gao Y, Linos E, Lunn MR, Obedin-Maliver J, Yeung H, Mansh MD. Sexual Orientation Diversity and Specialty Choice Among Graduating Allopathic Medical Students in the United States. JAMA Netw Open. 2021 Sep 1;4(9):e2126983. DOI: 10.1001/jamanetworkopen.2021.26983. PMID: 34591110; PMCID: PMC8485175.

This national cross-sectional survey study of 58,572 graduating U.S. allopathic medical students (AAMC Graduation Questionnaires, 2016–2019) found that 6.3% identified as sexual minority (SM), with higher representation in psychiatry (11.6%) and lowest in orthopedic surgery (1.8%). SM female students were less likely than heterosexual peers to pursue primary care (41.2% vs 46.8%; P<.001) but more likely to choose surgical specialties (27.2% vs 24.7%; P<.001), whereas SM male students were less likely to enter surgery (17.8% vs 26.5%; P<.001), highlighting specialty-specific disparities and gender differences in LGBTQ+ representation across medicine.

• Wang K, Burke SE, Przedworski JM, Wittlin NM, Onyeador IN, Dovidio JF, Dyrbye LN, Herrin J, van Ryn M. A Comparison of Depression and Anxiety Symptoms Between Sexual Minority and Heterosexual Medical Residents: A Report from the Medical Trainee CHANGE Study. LGBT Health. 2020 Aug/Sep;7(6):332-339. DOI: 10.1089/lgbt.2020.0027. Epub 2020 Jun 26. PMID: 32598215; PMCID: PMC7475081.

This longitudinal cohort study of 2,890 U.S. medical residents from the Medical Trainee CHANGE Study (medical school 2014 through residency 2017; published 2020) found that 10.1% identified as sexual minority, who reported higher depression (b=1.31; p=0.009) and anxiety (b=1.20; p=0.021) scores in postgraduate year 3 compared with heterosexual peers, even after adjusting for pre-residency mental health. Sexual minority residents also reported lower belonging in year 2 (p=0.006), which partially mediated mental health disparities, highlighting the impact of residency climate on LGBTQ+ trainee well-being.

• Kaakour A, Hua H, Rachitskaya A. Representation of race and ethnicity in randomized clinical trials of diabetic macular edema and retinal vein occlusion compared to 2010 US census data. JAMA Ophthalmol 2022; 140:10961102. 

  A cross-sectional retrospective analysis (2004–2020) evaluated 23 U.S.-based phase 3 RCTs of diabetic macular edema and retinal vein occlusion (n = 9,924 participants) and found racial/ethnic distributions that differed significantly from the 2010 U.S. Census in 22 of 23 trials. Trial enrollment included 80.4% White, 10.1% Hispanic, 9.6% Black, 4.4% Asian, and 0.4% American Indian/Alaska Native or Native Hawaiian/Pacific Islander participants, compared with Census proportions of 63.7% White, 16.3% Hispanic, 12.6% Black, 4.8% Asian, and 1.1% AI/AN/NHPI, demonstrating consistent overrepresentation of White participants and underrepresentation of Hispanic and Black populations in ophthalmology clinical trials.

• Berkowitz ST, Groth SL, Gangaputra S, Patel S. Racial/ethnic disparities in ophthalmology clinical trials resulting in US food and drug administration drug approvals from 2000 to 2020. JAMA Ophthalmol 2021; 139:629637. 

  A cohort study (2000–2020) of 31 clinical trials supporting 13 United States Food and Drug Administration ophthalmology drug approvals (18,410 participants) demonstrated that racial and ethnic distributions differed from expected disease burden for 12 of 13 drugs. Despite increased enrollment of Asian and Hispanic participants over time (odds ratios up to 2.30, P < .001), Black participants decreased in diabetic retinopathy trials (odds ratio 0.58, P < .001), and projections to 2050 show continued overrepresentation of White participants and underrepresentation of Black and Hispanic populations.

• Bowe T, Salabati M, Soares RR, et al. Racial, ethnic, and gender disparities in diabetic macular edema clinical trials. Ophthalmol Retina 2022; 6:531533. 

  This retrospective cross-sectional analysis (2000–2020 trials; IRIS Registry 2012–2020 comparator) evaluated 22 U.S. diabetic macular edema (DME) clinical trials and found Black participants had lower enrollment compared with the IRIS Registry DME population (enrollment fraction 1.78%, OR 0.676, 95% CI 0.617–0.742; P < 0.001) and Hispanic participants had even lower representation (enrollment fraction 1.49%, OR 0.568, 95% CI 0.516–0.625; P < 0.001), while men were overrepresented (enrollment fraction 2.21%, OR 1.208, 95% CI 1.135–1.285; P < 0.001). Overall, trial participants were disproportionately White and male relative to the treated DME population, indicating persistent racial, ethnic, and gender disparities in clinical trial representation.

• Hemmerich C, Jones G, Staggs J, et al. Inequities and research gaps in ophthalmology: a scoping review. JAMA Ophthalmol 2023; 141:6370. 

  This scoping review (2016–2021) screened 8,170 abstracts, assessed 189 full-text articles, and included 75 studies examining health inequities in ophthalmology based on National Institutes of Health–designated disparity groups. The review found that Black and Hispanic patients experienced worse ophthalmic outcomes, lower-income individuals had higher vision impairment and lower eye care utilization, and no included studies examined lesbian, gay, bisexual, transgender, or queer patient inequities since 2016, highlighting major gaps in research on sexual and gender minorities and rural populations in ophthalmic care.

• Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282(6):583-589. DOI:10.1001/jama.282.6.583. 

  A telephone survey study (1996–1998) of 1,816 adult patients and 64 primary care physicians found that African American patients rated visits as less participatory than White patients (58.0 vs 60.6; P = .03), while race-concordant relationships were associated with higher participatory decision-making scores (+2.6 points; P = .02). Patients of female physicians reported more participatory visits than those of male physicians (62.4 vs 59.5; P = .03), suggesting that both racial concordance and physician gender are associated with more patient-centered communication and perceived quality of care.

• Kamel K, Yu AJ, Choi AY, Sadeghi E, Chhablani J. Racial disparities in ophthalmology clinical trials: barriers to participation and potential solutions. Eye (Lond). 2026 Feb;40(3):302-309. DOI: 10.1038/s41433-025-04145-x. Epub 2025 Nov 29. PMID: 41318850; PMCID: PMC12881468.

This narrative review of 16 studies identifies persistent racial and socioeconomic disparities in ophthalmology clinical trials, with race reported in only 37.1% of studies and 43% of 547 ophthalmology articles published in 2019. Significant underrepresentation was observed, including 70.7% of 33,428 primary open-angle glaucoma participants being White versus 16.8% Black and 3.4% Hispanic/Latino, and Black patients being underrepresented threefold in NIH-sponsored and 4.5-fold in industry-sponsored diabetic macular edema trials, with enrollment differing by race (p = 0.01), language (p < 0.05), and insurance status (p = 0.001).

• Tao BK, Xie JS, Leung V, Patel M, Xu J, Lo C, Yan P, Nathoo N, Lam WC, Navajas EV, Muni R, Kohly RP. Enrolment characteristics in age-related macular degeneration clinical trials: a cross-sectional study. Eye (Lond). 2025 Apr;39(6):1153-1159. DOI: 10.1038/s41433-024-03572-6. Epub 2024 Dec 27. PMID: 39730975; PMCID: PMC11978819

A cross-sectional study of 106 randomized AMD trials (77,939 participants, 1990–2020) found female enrolment of 46.3% with a pooled participation-to-prevalence ratio of 0.88 (95% CI 0.82–0.94), indicating representation commensurate with disease burden. However, race was reported in only 69.8% of trials and ethnicity in 34.9%, with White participants comprising 82% (57,917/70,631) of reported race, Black 7.4%, Asian 4.2%, and Hispanic ethnicity only 4.3%, proportions lower than US population benchmarks (24.5% non-White; 19.1% Hispanic), highlighting persistent underreporting and minority underrepresentation.

• Shah J, Pathuri S, Zheng J, Khan B, Okome K, Schultz JS, Shrivastava A. Ethnoracial and Geographic Representation in United States Glaucoma Clinical Trials (2004-2023). Ophthalmol Glaucoma. 2025 Oct 8:S2589-4196(25)00211-X. DOI: 10.1016/j.ogla.2025.09.011. Epub ahead of print. PMID: 41072577.

This retrospective cross-sectional study of 95 US-based phase II–IV glaucoma trials (2004–2023) found race/ethnicity reporting increased significantly from 27.08% in 2004–2013 to 72.34% in 2014–2023 (OR 0.14; 95% CI 0.06–0.35; P < 0.001), while geographic reporting remained unchanged (58.33% vs. 51.06%; P = 0.539). Among 13,744 participants in 47 trials reporting race/ethnicity, Black patients were overrepresented (P < 0.001), whereas Hispanic and Asian participants were persistently underrepresented (P < 0.001), and regionally the Northeast was overrepresented (36.2% of trials vs. 18.1% of disease burden; P = 0.002) while the Midwest had lower enrollment (6.4% vs. 20.4%), highlighting ongoing racial and geographic disparities in trial representation.

• Li M, He J, Vanderbeek BL, Ying GS. Racial and Ethnic Disparities at Enrollment in DRCRnet Clinical Trials for Diabetic Macular Edema. Am J Ophthalmol. 2025 May;273:231-239. DOI: 10.1016/j.ajo.2025.02.029. Epub 2025 Feb 26. PMID: 40020979.

This retrospective cross-sectional analysis of 5468 participants in 17 DRCRnet DME trials (2003–2020) found White (75.8%) and Black (16.7%) participants overrepresented versus the 2020 U.S. census (61.6% and 12.4%), while Asian (1.9%) and Hispanic (11.6%) participants were underrepresented (6.0% and 18.7%; P < .001). Hispanic participants had higher HgbA1c (8.26 vs 7.73), more proliferative DR (22.9% vs 18.7%), and worse visual acuity (logMAR 0.40 vs 0.34), with Hispanic ethnicity independently associated with worse baseline vision (P = .009).

• Ibrahim FN, Sivaprasad S, Cheung CMG. Gender and ethnic diversity in randomised clinical trials in age-related macular degeneration and diabetic macular oedema. Eye (Lond). 2025 May;39(7):1249-1253. DOI: 10.1038/s41433-025-03595-7. Epub 2025 Feb 20. PMID: 39979609; PMCID: PMC12043835.

A review article of 22 pivotal RCTs (2006–2023) in neovascular AMD, DMO, and geographic atrophy found White participants comprised the majority across trials (e.g., 96.7–97.9% in MARINA/ANCHOR; 72–92% in later AMD trials), while Asian representation ranged from 0.1% to 23.2% and Black participants typically <1–13%. Although overall female participation reflected disease epidemiology (55–60% in AMD vs 34.7–44.8% in DMO), women were underrepresented within minoritized subgroups (e.g., 29.4% of Asians in VIEW; 6.4% Japanese females in VIVID), highlighting persistent ethnic and gender disparities despite gradual increases in minority inclusion.

• Goodman D, Prasad M, Sanjiv N, LaMattina KC, Ness S, Subramanian ML. Enrollment of race/ethnicity in ophthalmic clinical trials before and after the Final Rule. J Natl Med Assoc. 2025 Aug;117(4):285-292. DOI: 10.1016/j.jnma.2025.06.007. Epub 2025 Jul 10. PMID: 40640051.

This retrospective database study of 872 US-based ophthalmic clinical trials on ClinicalTrials.gov found that after implementation of the Final Rule (2017), race/ethnicity disclosure increased significantly from 38.39% to 91.00% (p < .001), but minority enrollment did not improve. White enrollment increased and “unknown race” decreased post-requirement (p < .005), while American Indian/Alaskan Native and Native Hawaiian/Other Pacific Islander enrollment was higher in NIH-funded trials pre-requirement only (p < .005), indicating improved reporting without meaningful gains in minority representation.

• Bondok M, Selvakumar R, Bondok MS, Khan M, El-Hadad C, Ing E. The reporting of equity-relevant sociodemographics in the Canadian ophthalmology literature. Can J Ophthalmol. 2025 Jun;60(3):e357-e365. DOI: 10.1016/j.jcjo.2024.10.003. Epub 2024 Oct 23. PMID: 39461365.

A cross-sectional study of 213 full-length primary studies published in the Canadian Journal of Ophthalmology (2020–2022) found that while age (97.18%) and sex (88.26%) were frequently reported, only 25.35% reported race/ethnicity and just 2.82% reported socioeconomic status. Canadian studies were 1.84 times less likely than non-Canadian studies to report race/ethnicity (17.20% vs 31.67%; p = 0.018), and none of the 10 studies including Indigenous participants reported engagement with Indigenous partners, highlighting substantial gaps in equity-relevant sociodemographic reporting.

• Bondok M, Dewidar O, Al-Ani A, Selvakumar R, Ing E, Ramke J, El-Hadad C, Damji KF, Li T, Welch V. Inequities in glaucoma research: an analysis of Cochrane systematic reviews and randomized trials. J Clin Epidemiol. 2025 May;181:111717. DOI: 10.1016/j.jclinepi.2025.111717. Epub 2025 Feb 8. PMID: 39929324; PMCID: PMC12147557.

A methodological study of 40 Cochrane systematic reviews and 122 included RCTs on glaucoma found that although 72.5% of reviews acknowledged populations experiencing inequities, none performed subgroup analyses due to unavailable primary data, and only 15.0% discussed applicability to specific populations. Among RCTs, 50.0% reported race/ethnicity, 87.7% reported sex (51.7% female participants), none reported socioeconomic status, place of residence, occupation, or social capital, and 72.1% were conducted in high-income countries, highlighting limited sociodemographic reporting and underrepresentation of low-income regions.

• Appelbaum J, Virk A, Patel D, Allison K. An Examination of Demographic Involvement in Minimally Invasive Glaucoma Surgery and Cataract Surgery Clinical Trials: A Systematic Review. J Clin Med. 2025 Nov 5;14(21):7861. DOI: 10.3390/jcm14217861. PMID: 41227255; PMCID: PMC12610233.

This systematic review (2003–2017 trials) of 21 cataract surgery (CS), minimally invasive glaucoma surgery (MIGS), and combined (MACS) clinical trials (N = 3330) found adequate female representation (53.6%; PPR = 1.00) but marked underrepresentation of Black participants (10.0%; PPR = 0.44) compared with their disease prevalence (22.9%). Black participation was lowest in CS (6.3%; PPR = 0.27) and MACS (5.1%; PPR = 0.22) trials and in medical device–sponsored studies (9.4%; PPR = 0.41), whereas university-sponsored trials showed higher representation (28.8%; PPR = 1.25), highlighting persistent racial disparities in glaucoma surgical research.

• Xie JS, Kaur H, Tao B, Lee J, Solish D, Kohly R, Margolin E. Sex or Gender Reporting in Ophthalmology Clinical Trials Among US Food and Drug Administration Approvals, 1995 to 2022. JAMA Ophthalmol. 2024 Feb 1;142(2):123-130. DOI: 10.1001/jamaophthalmol.2023.6088. PMID: 38236588; PMCID: PMC12285576.

A retrospective cross-sectional study (1995–2022) of 85 FDA ophthalmology drug approval trials (34,740 participants) found that only 19.5% correctly applied sex and gender terminology, none reported how sex or gender were collected, and no trials included sexual and gender minority populations. Although 96.5% reported sex-disaggregated demographics, few conducted sex- or gender-based analyses for primary outcomes (28.2%), adverse events (9.4%), secondary outcomes (2.4%), or dropout (1.2%), demonstrating substantial gaps in equity-focused reporting and analytic rigor.

• Vidal GA, Chalela P, Curry AN, El-Rayes B, Halmos B, Herrera AF, Kapoor KG, Kaur S, Mahadevan D, Mesa R, Ramirez A, Sleckman B, Wagner AL, Bhagat R, Brown I, Cruz L, Funwie A, Highsmith Q, Richie N, McKenzie M. Advancing Inclusive Research (AIR) Site Alliance: Facilitating the inclusion of historically underrepresented people in oncology and ophthalmology clinical research. Contemp Clin Trials. 2024 Feb;137:107416. DOI: 10.1016/j.cct.2023.107416. Epub 2023 Dec 16. PMID: 38109966.

A programmatic implementation study (2020–2023) describing the Advancing Inclusive Research (AIR) Site Alliance reported that AIR oncology sites enrolled Black or Hispanic/Latinx patients twice as fast as non-AIR sites and had clinical trial populations 81% more diverse than study peers, while ophthalmology AIR sites were 36% more diverse and enrolled Black or Hispanic/Latinx patients 83% faster. Among the inaugural four oncology sites, active trials increased 42% (38 to 54), Black enrollment rose from 7% to 10%, and in 19% of trials AIR sites were the sole recruiters of Black or Hispanic/Latinx patients, demonstrating measurable improvements in representation through structured equity-focused infrastructure.

• Tao BK, Xie JS, Xia M, Marzban S, Vosoughi AR, Ahuja N, Rocha G. Diversity in enrollment to clinical trials for cataract medicine and surgery: meta-analysis. J Cataract Refract Surg. 2024 May 1;50(5):460-467. DOI: 10.1097/j.jcrs.0000000000001395. PMID: 38237071.

This cross-sectional database study (trials registered through January 23, 2023; initiation 1982–2020) of 100 high-quality U.S.-registered cataract RCTs (N = 67,874) found adequate female representation by pooled participation-to-prevalence ratio (PPR = 0.89; 95% CI, 0.85–0.94), yet women comprised only 28.2% (19,062/67,697) of participants. Race was reported in 26 trials (N = 23,181), with 84.4% White participants, and ethnicity in only 9 trials (N = 1,792; 17.8% Hispanic/Latino), demonstrating substantial racial/ethnic underrepresentation and marked underreporting of sociodemographic data.

• Montazeri F, Wang M, Atkuru A, Estrada MM, Liu YA, Emami-Naeini P. Racial, Ethnic, and Gender Diversity in United States Ophthalmology Clinical Trials. Ophthalmol Sci. 2023 Sep 27;4(1):100402. DOI: 10.1016/j.xops.2023.100402. PMID: 38027420; PMCID: PMC10654370.

A retrospective cross-sectional study (1997–2022) of 293 completed U.S. phase II/III–IV ophthalmology trials (69,082 participants) found that only 43.6% reported race/ethnicity, although reporting increased by 12.2% per year after 1997. Among reporting trials, White participants were overrepresented (median 76.6% vs 72.4% U.S. Census; P = 0.001), Asians (median 1.8% vs 4.8%), Hispanics (12.5% vs 16.3%), and “other” groups (1.7% vs 10.2%) were underrepresented (P ≤ 0.001), Black enrollment was comparable (12.4% vs 12.6%; P = 0.44), and females were overrepresented (median 57.5% vs 50.8%; P < 0.001), highlighting persistent racial/ethnic disparities despite improved reporting.

• Kuo A, Yazji I, Abbass N, Chong DD, Fane L, Örge FH. Lack of racial and ethnic diversity in pediatric ophthalmology clinical trials from 2000 to 2022. J AAPOS. 2024 Apr;28(2):103870. DOI: 10.1016/j.jaapos.2024.103870. Epub 2024 Mar 8. PMID: 38460595.

This systematic review (2000–2022) of 170 pediatric ophthalmology RCTs published in high-impact journals found that only 52.4% reported race/ethnicity, with a non-significant 1.0% annual increase in reporting (P = 0.18). In U.S.-based trials (n = 93; 22,837 participants), White participants were overrepresented (+16.7%; 95% CI 11.8%–21.7%) and Hispanic participants underrepresented (−7.6%; 95% CI −11.2% to −4.1%) compared with 2010 U.S. Census data, while Black and Asian representation was not significantly different, highlighting persistent racial disparities despite gradual reporting improvements.

• Hicks PM, Newman-Casey PA, Woodward MA. Suggested Principles for Sex and Gender Data in Ophthalmology Clinical Trials. JAMA Ophthalmol. 2024 Feb 1;142(2):131-132. DOI: 10.1001/jamaophthalmol.2023.6281. PMID: 38236617; PMCID: PMC10984142.

A commentary (2024) discussing 85 FDA ophthalmology trials (1995–2022) highlights that sex and gender terminology were misapplied in 80.5% of trials, and although 96.5% reported sex-disaggregated demographics, only 23.5% analyzed primary outcomes, 2.4% secondary outcomes, and 3.5% adverse events by sex or gender. The authors advocate for standardized 2-step sex and gender data collection and implementation of FAIR principles to improve equity, transparency, and inclusion of sex and gender–diverse populations in ophthalmology clinical trials.

• Dihan QA, Alzein AF, Ibrahim OM, Hassan AK, Chauhan MZ, Oke I, Sallam AB, Hunter DG, Raghuram A, Phillips PH, Elhusseiny AM. Race, Ethnicity, and Sex in Pediatric Eye Disease Investigator Group Clinical Studies. JAMA Ophthalmol. 2024 Oct 1;142(10):926-933. DOI: 10.1001/jamaophthalmol.2024.3281. PMID: 39235786; PMCID: PMC11378066.

A retrospective cross-sectional study (1997–2022) of 41 US-based PEDIG pediatric trials (N = 11,658) found White participants overrepresented (ECD +0.19; P < .001), while Black (ECD −0.07), Hispanic (ECD −0.09), and Asian (ECD −0.03) participants were underrepresented compared with the 2010 US Census (all P < .001). Female participants were proportionately represented (50.8%; P = .21), with increasing Hispanic enrollment (CAGR 7.2%) and decreasing White enrollment (CAGR −1.5%) over time.

• Collins ME, Scott AW. Racial and Ethnic Disparities in Pediatric Ophthalmology Research. JAMA Ophthalmol. 2024 Oct 1;142(10):933-934. DOI: 10.1001/jamaophthalmol.2024.3627. PMID: 39235829.
  
  
•  Yu AJ, Masalkhi M, Brown R, Chen B, Chhablani J. Racial and Ethnic Distribution in Diabetic Macular Edema Clinical Trials in the United States (2002-2021). Ophthalmol Retina. 2023 Dec;7(12):1035-1041. DOI: 10.1016/j.oret.2023.07.015. Epub 2023 Jul 19. PMID: 37479084.

This retrospective cross-sectional study (2002–2021) of US-based DME clinical trials found race reporting increased from 40% (2002–2011) to 87% (2012–2021) (OR 10.00; 95% CI 2.21–45.16; P = 0.0032). Although Asian enrollment rose from 2.4% to 8.0% (OR 3.47; P < 0.0001) and Hispanic enrollment from 13.4% to 19.5% (OR 1.56; P < 0.0001), Black, Asian, and Hispanic participants remained significantly underrepresented compared with diabetes prevalence (all P < 0.001), indicating persistent disparities despite improved reporting.

• Tao BK, Vosoughi AR, He B, Ling J, Xia M, Rocha G, Ing E, Khosa F. Representational disparity of sex, race, and ethnicity in presbyopia clinical trials: a cross-sectional study. Eye (Lond). 2023 Dec;37(18):3871-3873. DOI: 10.1038/s41433-023-02621-w. Epub 2023 Jul 12. PMID: 37438570; PMCID: PMC10697932.

This cross-sectional study (trials initiated 2009–2021) of 20 US-registered presbyopia RCTs (N = 2471) found women overrepresented relative to disease burden (71.43%; PPR 1.53, 95% CI 1.42–1.63), while race/ethnicity reporting was limited (race reported in 11 trials; ethnicity in 7). Among reported data, Caucasian participants comprised 78.88%, with significantly higher enrollment in quadruple- vs double-masked and drug vs device trials, highlighting persistent racial underrepresentation and inconsistent demographic reporting.

• Soares RR, Huang C, Sharpe J, Cobbs L, Gopal A, Rao W, Samuelson A, Parikh D, Zhang Q, Bailey R, Dunn JP, Minor J, Moster ML, Penne RB, Shields C, Shukla AG, Syed Z, Wisner D, Haller JA, Yonekawa Y. Geographic and socioeconomic access disparities to Phase 3 clinical trials in ophthalmology in the United States. Eye (Lond). 2023 Jun;37(9):1822-1828. DOI: 10.1038/s41433-022-02244-7. Epub 2022 Sep 19. PMID: 36123561; PMCID: PMC10275860.

A retrospective cross-sectional study (Phase 3 trials initiated 2017–2020) mapping 100 US ophthalmology trials (2330 sites; 71,897 census tracts) found that rural tracts had markedly higher odds of living >60 minutes from a trial site (aOR 7.60; 95% CI 5.66–10.20; p < 0.0001), and higher travel burden was also associated with Midwest, South, and West regions versus Northeast (all p ≤ 0.01), higher poverty (4th vs 1st quartile aOR 2.26; p < 0.0001), lower education (high school vs bachelor’s aOR 1.02; p = 0.0072), and greater visual impairment prevalence (aOR 1.07 per 1% increase; p = 0.0004). Although minority census tracts had shorter travel times, the study highlights substantial geographic and socioeconomic access disparities that may limit equitable trial participation.

• Nakayama LF, Mitchell WG, Shapiro S, Santiago APD, Phanphruk W, Kalua K, Celi LA, Regatieri CVS. Sociodemographic disparities in ophthalmological clinical trials. BMJ Open Ophthalmol. 2023 Feb;8(1):e001175. DOI: 10.1136/bmjophth-2022-001175. PMID: 37278426; PMCID: PMC9950885.

A cross-sectional review (1990–2022) of 654 completed phase III–IV ophthalmology clinical trials found that race was reported in only 37% of studies, with White participants comprising 77.7%, Black 10.9%, Asian 7.9%, and American Indian 0.4%. Most trials were conducted in high-income countries (84%), with only 0.2% in low-income countries, highlighting persistent racial and global socioeconomic disparities that limit generalisability of ophthalmic trial findings

• Cao JA, Patel SB, Wong CW, Garcia D, Munoz J, Cone C, Zamora D, Reagan M, Nguyen TV, Pearce W, Fish RH, Brown DM, Chaudhary V, Wykoff CC, Fan KC. Demographic and Socioeconomic Factors in Prospective Retina-Focused Clinical Trial Screening and Enrollment. J Pers Med. 2023 May 23;13(6):880. DOI: 10.3390/jpm13060880. PMID: 37373869; PMCID: PMC10303745.

This retrospective cohort study (January 1–December 31, 2022) of 1477 patients referred to retina-focused prospective clinical trials found that 43.0% enrolled and 15.7% declined, with enrollment significantly associated with younger age (OR 0.98 per year; p = 0.01), English preference (Spanish vs English OR 0.35; 95% CI 0.17–0.72; p = 0.004), insurance coverage (94.5% enrolled vs 87.9% declined; p = 0.001), and SSN status (93.4% vs 77.2%; p < 0.001). Hispanic ethnicity and Spanish language preference were more common among those who declined, highlighting socioeconomic and language-related barriers to equitable retinal trial participation.

• Bains A, Osathanugrah P, Sanjiv N, Chiu C, Fiorello MG, Siegel NH, Peeler CE, Distefano AG, Lee HJ, Ness S, Desai MA, Titelbaum JR, Pira T, LaMattina KC, Christiansen SP, Cabral HJ, Subramanian ML. Diverse Research Teams and Underrepresented Groups in Clinical Studies. JAMA Ophthalmol. 2023 Nov 1;141(11):1037-1044. DOI: 10.1001/jamaophthalmol.2023.4638. PMID: 37856135; PMCID: PMC10587823.

This retrospective cohort study (January 2015–December 2021) of 1380 patients approached for 10 prospective ophthalmic clinical studies found that Black (OR 0.32; 95% CI 0.24–0.44; P < .001) and Hispanic/Latino (OR 0.31; 95% CI 0.20–0.47; P < .001) patients were significantly less likely to consent compared with White patients, and lower socioeconomic status was also associated with reduced participation (OR 0.43; 95% CI 0.33–0.53; P < .001). Race/ethnicity concordance between patients and research staff increased odds of consent (OR 2.72; 95% CI 1.99–3.73; P < .001), highlighting structural and workforce-related factors influencing equitable trial enrollment.

• Baxter SL. Representation Matters-Diversity in Retina Clinical Trials. JAMA Ophthalmol. 2022 Nov 1;140(11):1103-1104. DOI: 10.1001/jamaophthalmol.2022.3930. PMID: 36201217.

An invited commentary in JAMA Ophthalmology (2022) argues that racial and ethnic underrepresentation in retina clinical trials threatens the generalizability of evidence guiding care for diabetic macular edema and retinal vein occlusion. The author emphasizes that minority populations -particularly Hispanic/Latino and Black communities- bear disproportionate disease burden yet remain inadequately represented in pivotal trials, calling attention to structural barriers and inconsistent demographic reporting. The commentary advocates for standardized reporting, regulatory guidance, intentional recruitment strategies, and workforce diversity efforts to close representation gaps and advance equity in ophthalmic research.

• Fountain TR, Lee P, Parke DW II. Why ophthalmologists should care about disparities in vision health. Ophthalmology 2022; 129:10751076. 

  This editorial (published 2022) from the American Academy of Ophthalmology Task Force on Disparities in Visual Health emphasizes that vision impairment is projected to increase substantially by 2050, disproportionately affecting aging and non-White populations, and that social determinants such as race, socioeconomic status, education, and ZIP code significantly influence access to eye care and outcomes. The authors argue that reducing disparities in diseases such as glaucoma and diabetic retinopathy is essential to prevent widening inequities in access to ophthalmic services and vision health outcomes.

• Elam A., Tseng V., Coleman A., et al: Disparities in vision health and eye care. Ophthalmology 2022; 129: pp. e89-e113. 

  This position statement and narrative review published in 2022 analyzing data from 1968–2020 reports that 4.2 million U.S. adults ≥40 years have visual impairment or blindness, projected to reach 6.95 million by 2050, with blindness rates up to 2.8 times higher in Black than White individuals. The authors show persistent disparities by race, socioeconomic status, and access to care, noting that 80–90% of health outcomes are driven by social determinants of health, underscoring the need for structural equity reforms in ophthalmology.

• Besagar S, Yonekawa Y, Sridhar J, et al. Association of socioeconomic, demographic, and healthcare access disparities with severe visual impairment in the US. JAMA Ophthalmol 2022; 140:12191226. 

  A cross-sectional quality improvement study conducted in 2019–2020 using BRFSS data analyzed 820,226 U.S. adults, of whom 42,412 (5.17%) self-identified as blind or having serious difficulty seeing, and found higher odds of severe visual impairment among American Indian/Alaska Native (OR 1.63), Hispanic (OR 1.65), Black (OR 1.50), and multiracial individuals (OR 1.33) compared with White non-Hispanic adults. Long-term unemployment (OR 1.78), inability to work (OR 2.90), poor mental health ≥14 days/month (OR 1.87), low income, low education, and lack of insurance were also significantly associated with SVI, underscoring the need for targeted SDOH-based interventions to reduce inequities in eye care.

• Besagar S, Yonekawa Y, Sridhar J, et al. Association of socioeconomic, demographic, and healthcare access disparities with severe visual impairment in the US. JAMA Ophthalmol 2022; 140:12191226.
  
  
• Uhr JH, Chawla H, Williams BK Jr, et al. Racial and socioeconomic disparities in visual impairment in the United States. Ophthalmology 2021; 128:11021104. 

  This cross-sectional study (2018 BRFSS data) analyzing 426,302 U.S. adults (from 437,436 respondents; median state response rate 49.9%) demonstrated that racial minority status and lower socioeconomic status were independently associated with higher odds of self-reported visual impairment. In multivariable analysis of 342,295 participants, Black (OR 1.32), Hispanic (OR 1.61), multiracial (OR 1.47), income <$25,000 (OR 4.56), less than high school education (OR 1.68), and uninsured status (OR 1.07) were all significantly associated with increased odds of visual impairment (all P < 0.05), indicating persistent racial and socioeconomic disparities in visual health across the United States.

• Elam AR, Nwanyanwu KH, Scott AW. Elevating social determinants of health and community engagement in eye care: the time is now. JAMA Ophthalmol 2022; 140:453454. 

  A viewpoint article (2022) discussing contemporary disparities in ophthalmology emphasizes that social determinants of health account for 80%–90% of health outcomes, while medical care contributes only 10%–20%, underscoring structural drivers of inequity in eye care. The authors advocate integrating social care into ophthalmic practice through multisector partnerships, community-engaged research, expanded community-based eye care delivery, and trust-building initiatives, concluding that addressing upstream determinants is essential to achieving equitable vision care now.

• Lee TC, Radha Saseendrakumar B, Nayak M, et al. Social determinants of health data availability for patients with eye conditions. Ophthalmol Sci 2022; 2. 

  This retrospective cohort study conducted from 2014–2021 analyzed 23,806 All of Us participants and 80,548 single-center EHR patients with major eye diseases, finding >99% completion for mandatory demographic surveys but <1.35% coverage for housing, food security, and social isolation in All of Us. In local EHRs, lifestyle factors had high documentation (≈78–93%), whereas education, finances, and transportation were recorded in <7%, highlighting substantial SDoH data gaps that limit equity-focused ophthalmic research and care.

• Ervin A, Solomon SD, Shoge RY. Access to eye care in the United States: evidence-informed decision-making is key to improving access for underserved populations. Ophthalmology 2022; 129:10791080. 

  This commentary and systematic review summary published in 2022 synthesizing 196 studies (search conducted April 2021) identifies persistent disparities in U.S. eye care access driven by race, ethnicity, income, geography, insurance status, transportation, and health literacy. The authors highlight evidence-based interventions including Medicaid expansion (associated with increased dilated eye examination rates within 2 years), state children’s insurance programs (reducing unmet eyeglass needs from 20% to 2%), school-based screening, community health centers, and teleophthalmology, emphasizing evidence-informed policy and community partnerships as key to improving equitable access to eye care.

• Capó H, Edmond JC, Alabiad CR, et al. The importance of health literacy in addressing eye health and eye care disparities. Ophthalmology 2022; 129:e137e145. 

  A narrative review published in 2022 based on literature reviewed from March–August 2021 examines health literacy as a driver of eye care disparities, noting that only 12% of U.S. adults have proficient health literacy, with “basic or below basic” levels affecting 28% of White adults and 65% of Hispanic adults, and 76% of adults without a high school diploma. The review highlights knowledge gaps such as only 19% of surveyed adults identifying the three leading causes of blindness and 8–11% recognizing early glaucoma or diabetic retinopathy as asymptomatic, emphasizing health literacy optimization and culturally tailored education as essential strategies to reduce inequities in ophthalmology.

• Elam AR, Tseng VL, Coleman AL. Disparities in vision health and eye care: where do we go from here? Ophthalmology 2022; 129:10771078. 

  This position paper commentary published in 2022 synthesizes evidence on disparities in vision health across sociodemographic factors and major eye diseases, emphasizing that social determinants of health account for approximately 80–90% of health outcomes, while medical care contributes only 10–20%. The authors outline disparities by race/ethnicity, socioeconomic status, geography, and workforce diversity, and propose a multilevel framework targeting access, education, research gaps, and workforce diversification to advance equity in ophthalmology.

• Adomfeh J, Jastrzembski BG, Oke I. Association of race, ethnicity, and socioeconomic status with visual impairment in adolescent children in the US. JAMA Ophthalmol 2022; 140:10061010 

  A cross-sectional study conducted from 2005–2008 using National Health and Nutrition Examination Survey data analyzed 2,833 adolescents aged 12–18 years (representing 57 million U.S. youths) and found higher odds of self-reported poor vision among Black (OR 2.85), Mexican American (OR 2.83), and low-income adolescents (OR 2.44). Objective visual acuity worse than 20/40 was also more likely among Black (OR 2.13), Mexican American (OR 2.13), and non–U.S. citizen adolescents (OR 1.96), highlighting early emergence of racial, ethnic, and socioeconomic vision inequities and the need for targeted adolescent eye health interventions.

• Mothy D, Patel RH, Choudhry HS, Sarabu N, Kasi R, Khouri AS. Geographic Analysis of Access to Glaucoma Care by Provider Type and Population Demographics. Ophthalmic Epidemiol. 2026 Jan 29:1-8. DOI: 10.1080/09286586.2026.2621416. Epub ahead of print. PMID: 41607255.

  This cross-sectional geographic analysis (provider data June 2024; 2018–2022 ACS data) of 2183 glaucoma ophthalmologists and 622 glaucoma optometrists found that 78.61% of 3143 U.S. counties had no glaucoma eye care providers, and only 6.94% had both provider types. Counties with both providers had higher median income ($82,712 vs. $60,369), higher educational attainment (38.54% vs. 21.02%), lower poverty (11.28% vs. 14.25%), and higher insurance coverage (90.89% vs. 89.17%) compared with counties with none (all p < 0.001), demonstrating significant geographic and socioeconomic disparities in access to glaucoma care.

• Edwards C, Love AMA, Cai RY, Constable PA, Love DC, Parmar K, Gowen E, Doherty M, Gibbs V. Improving eye care access for autistic people: applying the autistic SPACE framework. Clin Exp Optom. 2026 Jan 11:1-4. DOI: 10.1080/08164622.2025.2606937. Epub ahead of print. PMID: 41520361.

A viewpoint article (published online January 2026) highlights that autistic people, who comprise approximately 3% of the population, experience significant barriers to eye care access despite higher rates of refractive error, amblyopia, and strabismus and lower uptake of recommended vision assessments. The authors propose applying the Autistic SPACE framework (Sensory, Predictability, Acceptance, Communication, Empathy) to address structural, sensory, and communication-related disparities and improve equitable access and patient engagement in eye care settings.

• Edwards C, Love AM, Cai RY, Constable P, Love DC, Parmar K, Gowen E, Gibbs V. Understanding eye care access for autistic adults and families: A convergent mixed-methods study. Autism. 2026 Jan;30(1):122-133. DOI: 10.1177/13623613251371509. Epub 2025 Sep 20. PMID: 40974272; PMCID: PMC12717288.

A convergent mixed-methods study (January–April 2025) of 196 participants (127 autistic adults; 69 parents) in Australia and Aotearoa New Zealand found that 34% of autistic adults and 38% of parents reported at least one instance of being unable to access needed eye care, with 83% of adults citing sensory sensitivities and 65% anxiety as major barriers. Financial exclusion was prominent, with some participants avoiding exams because they could not afford glasses or specialist fees, highlighting intersecting sensory, communication, and socioeconomic determinants limiting equitable eye care access.

• Dogan AB, Barber KG, Devine BC, Kuo B, Drummond CK, Mehra AA, Eleff ES, Sobol WM. Expanding Access to Retinal Imaging Through Patient-Operated Optical Coherence Tomography in a Veterans Affairs Retina Clinic. Bioengineering (Basel). 2026 Jan 5;13(1):61. DOI: 10.3390/bioengineering13010061. PMID: 41595993; PMCID: PMC12837598.

A prospective feasibility study (May 2025; recruitment during routine VA retina visits) of 100 Veterans (mean age 74.7 years; 98% male) evaluated patient-operated OCT (SightSync) and found 72% eye-level scan success (118/164 eyes) and 81.7% patient-level success in ≥1 eye, with no association between scan success and age or visual acuity. Among 121 high-quality scans, referral sensitivity ranged from 80.5%–83.9% and specificity from 75.6%–90.0%, with a high negative predictive value (up to 93.2%), supporting scalable community-based retinal imaging to improve access for rural, mobility-limited, and VA populations facing logistical and socioeconomic barriers.

• Allen LN, Kim MJ, Gichangi M, Macleod D, Carpenter J, Tlhajoane M, Karanja S, Bolster N, Bunywera C, Rono H, Merletti F, Tadesse D, Odero K, Munyendo D, Njeru A, Murira S, Omoga T, Mutunga A, Burton M, Bastawrous A. Enhanced patient counselling and SMS reminder messages to improve access to community-based eye care services in Meru, Kenya: an embedded, pragmatic, individual-level, randomised, controlled, adaptive platform trial. Lancet Glob Health. 2026 Jan;14(1):e112-e120. DOI: 10.1016/S2214-109X(25)00401-2. PMID: 41386236.

Embedded Bayesian adaptive randomized controlled trial (May 21–June 20, 2024) of 2321 referred adults in Meru, Kenya, found that enhanced counselling plus an additional SMS reminder increased clinic attendance among younger adults (18–44 years) from 32.1% (147/458) in the control group to 39.0% (164/421) in the intervention group, with a 98.6% posterior probability of superiority and a mean difference of 6.4%. Overall attendance across all adults rose from 46.6% to 49.4% (90.8% probability of superiority), demonstrating that low-cost, equity-focused service modifications co-designed with underserved populations can measurably improve access to community-based eye care.

• Xie WY, Rustam Z, Tran D, Han D, Bahrainian M, Channa R, Cai CX. Association of Neighborhood Socioeconomic Disadvantage with Proliferative Diabetic Retinopathy. Ophthalmol Retina. 2025 Feb;9(2):98-104. DOI: 10.1016/j.oret.2024.10.012. Epub 2024 Oct 18. PMID: 39426522; PMCID: PMC11798716.

This retrospective cohort study (JHH 2013–2023; UW 2010–2022) of 73,618 adults with diabetes found that higher neighborhood socioeconomic disadvantage (Area Deprivation Index [ADI]) was independently associated with greater odds of proliferative diabetic retinopathy (PDR), with a dose-response among patients living ≤8 miles from clinics (ADI Q2 OR 1.36; Q3 OR 1.79; Q4 OR 2.60; all P < .001). Living >8 miles from an ophthalmology clinic further increased odds of PDR across ADI quartiles (e.g., ADI Q1 OR 3.15; 95% CI 2.61–3.80), with an average 5.76% higher predicted probability of PDR, demonstrating compounding geographic and neighborhood-level socioeconomic disparities in access to sight-saving care.

• Webber E, Lu MC, Woodward MA, Elam A, Bicket A, Wood SD, John D, Johnson L, Kershaw M, Heisler M, Newman-Casey PA. Understanding Patient Experience With Past Barriers to Eye Care and How Barriers Were Addressed in the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program. Am J Ophthalmol. 2025 Aug;276:157-169. DOI: 10.1016/j.ajo.2025.04.007. Epub 2025 Apr 11. PMID: 40222576; PMCID: PMC12245581.

A qualitative community-engaged study (October 29–December 22, 2021) of 42 MI-SIGHT participants found that cost was the most common prior barrier to eye care (32 mentions; 22/42 participants), followed by work schedule and transportation, with 26.5% earning <$10,000 and 16.7% uninsured. Free screenings and low-cost glasses (67 mentions) and convenient community locations (54 mentions) improved access, and 97.7% reported satisfaction, demonstrating that community-based telemedicine can reduce socioeconomic barriers to glaucoma care.

• Wasser LM, Liang HW, Li C, Cassidy J, Tallapaneni P, Osterhoudt H, Wang Y, Williams AM. Identifying Transportation Needs in Ophthalmology Clinic Notes Using Natural Language Processing: Retrospective, Cross-Sectional Study. JMIR Med Inform. 2025 Sep 5;13:e69216. DOI: 10.2196/69216. PMID: 40913248; PMCID: PMC12413321.

This retrospective cross-sectional study (January 2016–February 2023) of 1,801,572 ophthalmology clinic notes from 118,518 adults used NLP to identify transportation insecurity in 726 patients (0.6%), with algorithm precision 0.860 and F1-score 0.778. Patients aged ≥80 years had higher odds of documented transportation need (OR 3.01; 95% CI 2.38–3.78), while Asian patients had lower odds (OR 0.04; 95% CI 0–0.18), demonstrating age-related disparities and highlighting NLP as a scalable tool to identify social determinants limiting access to eye care.

• Virk A, Qin H, Shahid MM, Liu H, Feng C, Allison K. The Impact of Social Determinants of Health on Ocular Diseases in Western New York: A Comparative Ecological Study of Two U.S. Counties. Healthcare (Basel). 2025 Nov 27;13(23):3089. DOI: 10.3390/healthcare13233089. PMID: 41373306; PMCID: PMC12691987.

A descriptive ecological study (2019 prevalence data; ADI 2022) comparing Monroe and Erie Counties, NY, found higher AMD (9.56% vs 6.61%; p < 0.0001) and glaucoma (13.05% vs 11.71%; p < 0.0001) prevalence in Erie County, which also had fewer primary care physicians (1:1230 vs 1:960), greater Black–White residential segregation (74 vs 63), and higher air pollution (PM2.5 10.7 vs 8.9). Racial disparities were evident, with Black (15.08%) and Asian (15.84%) populations in Erie County experiencing the highest glaucoma prevalence, highlighting the association between social determinants—healthcare access, segregation, and environmental exposures—and ocular disease burden.

• Villabona-Martinez V, Schulman A, Chirravuri B, Kamel K, Sepulveda-Beltran PA, Hobson Z, Waxman EL. Complexity and Barriers to Vision Care: A Narrative Review Informed by a Mobile Eye Program. Int J Environ Res Public Health. 2025 Dec 18;22(12):1880. DOI: 10.3390/ijerph22121880. PMID: 41464513; PMCID: PMC12732856.

This narrative review informed by a mobile eye program (literature 2000–2025; cases 2024) identifies structural barriers limiting access to eye care, including insurance classification of time-sensitive conditions as “non-urgent,” language discordance, transportation instability, and fragmented coordination. Illustrative cases show delays of up to 2 years for glaucoma surgery due to insurance and administrative barriers, underscoring how rigid systems and lack of navigation support contribute to preventable vision loss in underserved populations.

• Tooth C, Rogowski J. Children with Additional Support Needs Risk Missing Out on Effective Vision Screening: Audit and Survey Considering Attendance Rates and Parent Reported Barriers to Service Access, including Recommendations for Improvement. Br Ir Orthopt J. 2025 Apr 3;21(1):43-50. DOI: 10.22599/bioj.451. PMID: 40226486; PMCID: PMC11987887.

This retrospective audit with caregiver survey (2021–2024 cohorts) of 354 preschool children referred after failing vision screening found a first-time hospital attendance rate of 61%, with children with additional support needs (ASN) 1.8× more likely to miss two appointments and 88% of incomplete screening tests occurring in children with ASN. Among surveyed caregivers (n = 37), common barriers included unawareness of appointments, ASN-related needs, and transport/scheduling challenges, highlighting inequitable follow-up access despite high initial screening uptake.

• Silwal PR, Pirouzi M, Murphy R, Harwood M, Grey C, Squirrell D, Ramke J. Barriers and enablers of access to diabetes eye care in Auckland, New Zealand: a qualitative study. BMJ Open. 2025 Jan 30;15(1):e087650. DOI: 10.1136/bmjopen-2024-087650. PMID: 39890153; PMCID: PMC11784328.

This qualitative study (October 2022–March 2023) of 30 adults with diabetes in Auckland—predominantly Māori and Pacific peoples—who had interrupted eye care identified transport costs, parking fees, inflexible appointment times, limited awareness of screening importance, and language barriers as key access barriers. Decentralised community clinics with free parking, reminder systems, and positive provider communication improved engagement, highlighting modifiable system-level determinants contributing to inequitable diabetes eye care access.

• Sabherwal S, Allen L, Javed M, Mazumdar A, Thaker N, Tlhajoane M, Rathore D, Singh A, Sood I, Bastawrous A. Rapid sequential mixed-method study to identify barriers and explore solutions for improving equitable access to community-based eye care services in Uttar Pradesh, India. BMJ Open. 2025 Nov 12;15(11):e108422. DOI: 10.1136/bmjopen-2025-108422. PMID: 41224295; PMCID: PMC12612719.

A sequential exploratory mixed-methods study (October 2023–January 2024) of 7,578 referred individuals in rural Uttar Pradesh found that only 38.5% (2937/7627) attended after referral, with adults >16 years with dependents and non-cataract conditions less likely to attend (35.3% vs 42.5%; p<0.001). Identified access barriers included transport cost, low perceived need, unclear counselling, and fear of treatment cost, and community-prioritized solutions included free group transport (mean score 2.95/3) and personalized follow-up calls, supporting equity-focused system interventions to improve rural eye care uptake.

• Rustam Z, Amezcua Moreno J, Tran D, Ferguson K, Woods R, Cai CX. Patients' Perspectives on Social Barriers to Care and the Acceptability and Impact of a Community Health Worker Program in Outpatient Ophthalmology. Clin Ophthalmol. 2025 Aug 8;19:2647-2657. DOI: 10.2147/OPTH.S541632. PMID: 40800715; PMCID: PMC12341803.

This prospective semi-qualitative study (January–July 2024) of 50 adults with type 2 diabetes at an urban academic ophthalmology clinic found transportation (66%), scheduling conflicts (50%), forgetfulness (50%), insurance issues (32%), and financial hardship (28%) were the most common barriers to eye care. Most participants (88%) supported discussing social determinants in clinic and 90% favored integrating community health workers, highlighting high patient acceptability of structured SDoH screening and navigation to improve equitable access to ophthalmic care.

• Panchal B, Asanad S, Malek R, Munir K, Schocket LS. Improving Access to Eye Care Through Community Health Screenings Using Artificial Intelligence. Ophthalmic Epidemiol. 2025 Feb;32(1):121-123. DOI: 10.1080/09286586.2024.2317838. Epub 2024 Feb 21. PMID: 38381150.

Prospective cohort study (November 2022) of 53 adults screened at a Baltimore community health fair using AI-based non-mydriatic fundus photography found that 71.4% were recommended for follow-up, 87.5% scheduled appointments, and 61.9% attended. The most commonly reported barriers to eye care were lack of health insurance (22.8%) and transportation (8.5%), and on-site insurance assistance and appointment scheduling facilitated improved follow-up, demonstrating how AI-enabled community screening can mitigate structural access barriers in underserved populations.

• Newman-Casey PA, Niziol LM, Elam AR, Bicket AK, Killeen O, John D, Wood SD, Musch DC, Zhang J, Johnson L, Kershaw M, Woodward MA. Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine Program: First-Year Outcomes and Implementation Costs. Am J Ophthalmol. 2023 Jul;251:43-51. DOI: 10.1016/j.ajo.2023.02.026. Epub 2023 Mar 10. PMID: 36906094; PMCID: PMC10247478.

This clinical cohort study (June 28, 2020–June 27, 2021 at a free clinic; January 27, 2021–January 26, 2022 at an FQHC) of 1,171 low-income adults (54% Black; 70% income <$30,000) implementing a telemedicine glaucoma screening program found higher-than-national rates of visual impairment (10.3% vs 2.2%), glaucoma/suspected glaucoma (24% vs 6–9%), and diabetic retinopathy (7.3% vs 3.4%) (all p<0.0001). While 71% received low-cost glasses and 99% reported satisfaction, high start-up costs ($206,369 total; ~$103,000 per site) and flat Medicaid reimbursement rates highlight structural financing barriers to sustaining subspecialty eye care in underserved community clinics.

• Montazeri F, Sohn A, Radgoudarzi N, Emami-Naeini P. Barriers to Health Care Access and Use among Racial and Ethnic Minorities with Noninfectious Uveitis. Ophthalmology. 2025 Jun;132(6):692-700. DOI: 10.1016/j.ophtha.2025.01.012. Epub 2025 Jan 20. PMID: 39842728.

This retrospective cross-sectional study (All of Us data v7; survey responses 2018–2024) of 810 adults with chronic noninfectious uveitis (NIU) found that 57% of non-Hispanic Black and 66% of other minority participants reported ≥1 barrier to care versus 50% of non-Hispanic White participants. After adjustment, non-Hispanic Black patients had higher odds of perceived discrimination (treated with less courtesy aOR 2.6; poorer service aOR 3.6), and other minority groups had higher odds of delaying care due to out-of-pocket costs (aOR 3.4) and rural residence (aOR 7.1), highlighting financial, geographic, and interpersonal barriers to equitable uveitis care.

• Michail R, Chan E, Holland T. Exploring Barriers To Visual Screening for Canadian Immigrants in a General Primary Care Clinic: A Retrospective Chart Review. J Immigr Minor Health. 2025 Dec;27(6):943-947. DOI: 10.1007/s10903-025-01720-y. Epub 2025 Jun 28. PMID: 40580366.

A retrospective chart review (January 2020–January 2024) of 113 immigrant children (ages 2–6) completing Post-Arrival Health Assessments in Nova Scotia found that only 23.0% (26/113) received complete visual screening compared with 99.1% (112/113) screened for iron deficiency anemia (χ² = 134.46; p<0.001). These findings highlight significant under-prioritization of vision screening in immigrant children, likely driven by language, cultural, and time barriers, contributing to inequitable early detection of amblyopia and strabismus.

• Masemola HC, Nkambule SJ, Baloyi O, Xulu-Kasaba ZN. Eye health promotion in multi-sectoral settings: A systematic review of intervention types and effectiveness. F1000Res. 2025 Sep 18;14:934. DOI: 10.12688/f1000research.168998.1. PMID: 41585456; PMCID: PMC12825120.

A systematic review (studies published 1999–2024) of 80 eye health promotion interventions across multi-sectoral settings (from 15,554 screened records) found most programs significantly improved awareness, screening uptake, and early disease detection, including diabetic retinopathy detection rates up to 39% and telemedicine image gradability of 89.6%. However, consistent gaps were identified in referral completion, spectacle adherence, structured follow-up, and policy integration, highlighting that access gains are often limited by weak monitoring systems and health workforce shortages.

• Liu TYA, Wolf RM. Autonomous Artificial Intelligence for Diabetic Eye Disease Testing Improves Access and Equity in the Pediatric and Adult Populations: The Johns Hopkins Medicine Experience. Diabetes Spectr. 2025 Feb 14;38(1):19-22. DOI: 10.2337/dsi24-0016. PMID: 39959516; PMCID: PMC11825398.

An implementation study (Johns Hopkins Medicine health system) evaluating autonomous AI for diabetic eye disease screening found improved screening rates and increased follow-up with eye care professionals, particularly among underserved adult and pediatric populations. Integration into primary care settings reduced access disparities and enhanced equity in diabetic retinopathy detection, demonstrating AI’s potential to expand screening reach and improve long-term visual outcomes in diverse healthcare environments.

• Lawless F, Gondoe T, Sarr A. Improving access to eye care for women and girls: practical steps. Community Eye Health. 2025;38(126):10-12. Epub 2025 Mar 7. PMID: 40151196; PMCID: PMC11938175.

A practical implementation article (2025) outlines a five-step framework to reduce gender disparities in eye care, noting that globally ~55% of people who are blind or visually impaired are female, yet women often face compounded barriers related to poverty, disability, rural residence, and caregiving roles. Case examples show that gender-responsive strategies—such as separate outreach queues for women in Ethiopia and engaging men in Tanzania to support cataract surgery recovery—increased women’s surgical uptake from 36% to 46%, highlighting the impact of community-engaged, system-level interventions to improve equitable access.

• Kanwar K, Ramachandran R, Stein JD, Andrews CA, Chaudhury AS, Ige M, Zhou X, Marwah S, Li Y, Evans CT, Kho AN, Bryar PJ, French DD; Sight Outcomes Research Collaborative (SOURCE) Consortium. The Association of Social Determinants of Health on Monitoring for Disease Progression Among Patients With Primary Open-Angle Glaucoma. Transl Vis Sci Technol. 2025 Mar 3;14(3):15. DOI: 10.1167/tvst.14.3.15. PMID: 40080012; PMCID: PMC11918092.

This retrospective cohort study (SOURCE consortium data 2012–2022) of 13,582 adults with primary open-angle glaucoma across 12 U.S. tertiary systems found that only 57.5% received optic nerve evaluations in all three guideline-recommended 15-month intervals, while 11.3% had no documented evaluation over 45 months. Black patients had 15% lower odds of complete guideline adherence (aOR 0.85; 95% CI 0.75–0.95), residents of isolated rural areas had 51% lower odds (aOR 0.49; 95% CI 0.30–0.79), and every 10-point increase in community distress (DCI) reduced adherence odds by 3%, demonstrating structural and geographic disparities in glaucoma monitoring quality.

• Jolley E, Bechange S, Atto G, Namukasa L, Guzu B, Flight S, Sentongo J, Kuper H, Wilbur J. Access to eye health services among older people with disabilities in Karamoja, Uganda: a qualitative exploration of successful care seeking. Int J Equity Health. 2025 Oct 14;24(1):269. DOI: 10.1186/s12939-025-02650-9. PMID: 41088386; PMCID: PMC12522851.

A qualitative positive deviance study (February–March 2024) of 20 older adults (≥50 years) with diverse disabilities in Karamoja, Uganda, found that 73.1% of blindness globally occurs in people ≥50 years and locally only 35.4% of those needing cataract surgery had received it, underscoring major access gaps. Participants described disability-specific barriers across the care pathway—including misattributing symptoms to aging, transport dependence, food insecurity affecting medication adherence, and communication challenges—while family support, proactive outreach by trained eye workers, and provision of free transport were key facilitators of equitable access. 

• Ige MO, French DD, Chaudhury AS, Li Y, Andrews CA, Kanwar K, Zhou X, Marwah S, Evans CT, Kho AN, Bryar PJ, Stein JD; Sight Outcomes Research Collaborative (SOURCE) Consortium. Quality of Care in Patients With Newly Diagnosed Glaucoma. JAMA Ophthalmol. 2025 Nov 1;143(11):893-902. DOI: 10.1001/jamaophthalmol.2025.2995. PMID: 40965904; PMCID: PMC12447283.

This retrospective cohort study (January 2010–December 2022) of 1466 patients with newly diagnosed POAG in the SOURCE Consortium found that patients in the lowest wealth quartile had 5- to 9-fold lower odds of achieving ≥15% IOP reduction at 12–18 months compared with higher-wealth groups, and the wealthiest quartile had 61% lower odds of loss to follow-up (OR 0.39; 95% CI 0.18–0.84; P = .02). Rural residence was associated with higher loss to follow-up (OR 5.54; 95% CI 1.13–27.08), while patients with children in the household achieved a 4-mm Hg greater IOP reduction (P = .01), highlighting strong socioeconomic and geographic determinants of glaucoma care quality and continuity. 

• Gopal AD, Soares RR, Momenaei B, Wakabayashi T, Zhang Q, Martin J, Spitofsky N, Zhou A, Kuriyan AE, Klufas MA, Yonekawa Y, Garg SJ, Dunn JP, Deaner JD. Characteristics of Uveitis Specialists and Disparities in Geographic Access to Uveitis Care in the United States. J Vitreoretin Dis. 2025 Dec 30:24741264251404733. DOI: 10.1177/24741264251404733. Epub ahead of print. PMID: 41479850; PMCID: PMC12753342.

This retrospective cross-sectional geospatial study (data queried January 2023; ACS 2014–2018) identified 447 U.S. uveitis specialists, with 6 states lacking any listed specialist and 23.1% of census tracts located >60 minutes from the nearest provider. Rural residence (aOR 6.39; 95% CI 4.62–8.83), Midwest/South/West region, and higher poverty quartiles (Q4 aOR 2.90; P<.001) were independently associated with greater travel burden, demonstrating pronounced geographic and socioeconomic disparities in access to subspecialty uveitis care.

• Girkin C, Balakrishnan P, Gao L, McGwin G Jr, Rhodes L, Owsley C. Alabama Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (AL-SIGHT): The Impact of Financial Incentives on Health Care Engagement Following Telemedicine-Based Vision Screening. Curr Eye Res. 2025 Nov;50(11):1123-1130. DOI: 10.1080/02713683.2025.2535731. Epub 2025 Aug 7. PMID: 40772416.

A prospective quasi-experimental study (November 2020–November 2023) of 900 adults screened via telemedicine at three rural Federally Qualified Health Centers in Alabama found that financial incentives increased 6-month follow-up attendance overall (83.4% vs 74.4%; p = .05), particularly for diabetic retinopathy (94.7% vs 65.4%; p = .02) and refractive error (82.9% vs 72.3%; p = .02). However, after matching, the overall effect was not significant and no improvement was observed for glaucoma referrals, indicating that while modest incentives may improve follow-up for symptomatic conditions, structural socioeconomic barriers in underserved rural populations limit broader impact on eye care access.

• Franco JJ, Pineda R 2nd. Geographic Access to Eye Care in the United States. Ophthalmology. 2025 Jan;132(1):119-121. DOI: 10.1016/j.ophtha.2024.07.032. Epub 2024 Aug 5. PMID: 39111670.

This geospatial analysis report (2024 CMS data; 2018–2022 Census estimates) found that 97.8% of Americans live within 60 minutes of an ophthalmologist and 98.5% within 60 minutes of an optometrist, yet 166 counties (5.3%) had a population majority beyond 60 minutes from either provider. Tracts with higher proportions of Medicare-aged and uninsured residents had significantly higher odds of reduced access, underscoring geographic inequities in eye care access.

• Dong X, Zhao J, Zhao Z, Su C, Ma X. Reducing Primary Healthcare Bypass Behaviour: A Discrete Choice Experiment Study Exploring the Preferences for Primary Eye Care Services in Rural Xinjiang. Patient. 2025 Nov 4. DOI: 10.1007/s40271-025-00781-3. Epub ahead of print. PMID: 41186661.

A discrete choice experiment study (November 2024) of 465 rural adults in Xinjiang found strong preference for county hospital ophthalmologists and lower costs, while township and village doctors were less preferred, requiring compensation of 4.12–11.68 CNY to offset perceived lower quality. Minority status and lower health literacy were associated with bypassing primary care, highlighting trust and structural barriers contributing to inequitable rural eye care access.

• Diehl TH, Malek DA, Cavuoto KM. Predictors of access to pediatric eye care appointments. J AAPOS. 2025 Sep 18:104639. DOI: 10.1016/j.jaapos.2025.104639. Epub ahead of print. PMID: 40975388.

This prospective audit study (calls conducted December 2023–August 2024; published 2025) of 925 pediatric eye care offices (1,528 providers) found overall appointment success of 49.6%, significantly lower for Medicaid (37.2%) versus private insurance (62.0%; P<0.001), and lower in majority-minority counties (41.3%) compared with majority-White counties (50.2%; P=0.014). Ophthalmologists had lower booking rates (39.7% vs 65.6%) and longer waits (52.8 vs 25.4 days; P<0.001) than optometrists, underscoring insurance-, provider-, and demographic-based disparities in pediatric eye care access.

• Del Risco NE, Zuccaro MS, Livingston JJ, Heisler M, Levine H, Woodward MA, Bicket AK, Elam AR, John DA, Newman-Casey PA. Perspectives on eye care access and telemedicine-based glaucoma screening among Latine individuals with limited English proficiency. AJO Int. 2025 Oct;2(3):10.1016/j.ajoint.2025.100144. DOI: 10.1016/j.ajoint.2025.100144. PMID: 40927225; PMCID: PMC12416226.

This qualitative study (July 11–December 19, 2023) of 21 Latine adults with limited English proficiency who screened positive for glaucoma in the MI-SIGHT telemedicine program found that language barriers (65 mentions), cost (27 mentions), lack of insurance (19 mentions), and transportation challenges (17 mentions) were the most common obstacles to eye care. Language-concordant coaching, interpreter access (32 mentions), reduced-cost services, and community partnerships were key facilitators, with nearly all participants recommending the program, highlighting the importance of culturally and linguistically tailored interventions to reduce structural access disparities.

• Chen JL, Lavinsky F, Lee TF, Zambrano R, Schuman JS. The Association between Socioeconomic Status and Structural or Functional Baseline Measurements for Patients Receiving a Trabeculectomy. Ophthalmol Glaucoma. 2025 Dec 27:S2589-4196(25)00274-1. DOI: 10.1016/j.ogla.2025.12.007. Epub ahead of print. PMID: 41461223; PMCID: PMC12764317.

This retrospective cohort study (trabeculectomies 2008–2014; analysis published 2026) of 154 eyes (118 patients) found that higher neighborhood deprivation (Area Deprivation Index, ADI) was independently associated with worse functional glaucoma severity at presentation, with each 1-decile increase in ADI linked to a 0.74 dB lower mean deviation (P<0.001) and 2.12% lower visual field index (P=0.001). Patients in the highest-deprivation decile presented with 6.63 dB worse MD and 19.06% lower VFI than those in the least-deprived areas, demonstrating substantial socioeconomic disparities in glaucoma severity at surgical presentation.

• Chen J, Bentley SA, McKendrick AM, Thompson SC, Turner AW, Alam K. Rural Eye Care Access, Workforce Challenges and Opportunities: Perspectives of the Eye Health Workforce in Western Australia. Aust J Rural Health. 2025 Feb;33(1):e70004. DOI: 10.1111/ajr.70004. PMID: 39887538; PMCID: PMC11780685.

This qualitative descriptive study (May–August 2024) of 17 ophthalmologists and optometrists in rural Western Australia found that workforce maldistribution (only ~16% of ophthalmologists and 20% of optometrists practicing rurally despite 28% of Australians living outside cities) contributed to long public wait times, travel burdens of up to 1630 km for care, and limited access to advanced diagnostics. Participants identified collaborative optometry–ophthalmology models, telehealth, and expanded optometrist roles as key strategies to reduce delays and improve equitable rural access, while workforce isolation, inadequate funding, and reliance on visiting services remained major structural barriers.

• Cardona M, Alwenya K, Rehman AU, Olalo S, Thai A, Rangi M, Perez Y, Lee L. Eye care interventions that reduce access inequities for women, rural residents and older people in low-middle-income countries: a scoping review. Front Public Health. 2025 Jun 23;13:1578848. DOI: 10.3389/fpubh.2025.1578848. PMID: 40626165; PMCID: PMC12230066.

A scoping review (2002–2023) of 39 studies from 16 LMICs found that outreach services, teleophthalmology, and financial support interventions were most effective in improving cataract and diabetic retinopathy screening uptake, particularly among rural populations and women. Health education alone showed limited impact, and few studies demonstrated sustained long-term equity gains, highlighting persistent structural barriers to durable improvements in access to eye care.

• Allison K, Virk A, Alamri A, Patel D. Analysis of the Awareness and Access of Eye Healthcare in Underserved Populations. Vision (Basel). 2025 Jul 11;9(3):55. DOI: 10.3390/vision9030055. PMID: 40700083; PMCID: PMC12286042.

This cross-sectional pilot survey study (April 2025) of 107 community-based adults found that although 61.2% believed regular eye exams are very important and 75% recognized their preventive value, 21.2% had never had an eye exam and only 35.6% had been examined within the past year. Cost (28.2%), long waiting times (26.2%), and lack of nearby providers (14.6%) were key barriers, and 21.2% reported no access to low-cost services, highlighting persistent financial and structural gaps in eye care access despite moderate awareness.

• Ahuja N, Taghaddos D. Global eye care frameworks: a review of strategies, gaps, and recommendations for equitable access. Can J Ophthalmol. 2025 Dec 29:S0008-4182(25)00504-6. DOI: 10.1016/j.jcjo.2025.11.018. Epub ahead of print. PMID: 41418819.

This narrative review (January 2015–January 2025) of 14 international and national eye care frameworks identified common equity-focused strategies including integration of eye care into primary health care and universal health coverage, workforce redistribution to underserved areas, tele-ophthalmology and AI use, and culturally tailored community outreach. Although implemented frameworks reported gains such as increased cataract surgical rates and improved referral coordination, persistent gaps in funding, workforce maldistribution, rural access, and standardized outcome metrics continue to limit equitable global eye care access.

• Abbas M, Abbas KF, Issa M, Tam ES, Somani S. Social Determinants of Health and Barriers in Accessing Eye Care for Refugees in the Greater Toronto Area. Clin Ophthalmol. 2025 Nov 24;19:4281-4291. DOI: 10.2147/OPTH.S557566. PMID: 41321342; PMCID: PMC12661965.

A prospective cross-sectional survey study (October 2022–October 2024) of 94 refugees in the Greater Toronto Area found markedly lower eye care utilization compared with the Canadian population, including fewer recent eye exams (19.1% vs 74.5%; p<0.0001), lower prescription glasses use (51.1% vs 81.0%; p<0.0001), and greater dissatisfaction with vision (55.3% vs 1.7%; p<0.0001). Financial barriers were reported by 50% of those encountering access challenges, only 9.6% were aware of the Interim Federal Health Program, and prior abuse was independently associated with barriers to eye care (aOR 7.65; p=0.005), highlighting intersecting socioeconomic and trauma-related determinants limiting equitable access.

• Swaminathan SS, Medeiros FA. Socioeconomic Disparities in Glaucoma Severity at Initial Diagnosis: A Nationwide Electronic Health Record Cohort Analysis. Am J Ophthalmol. 2024 Jul;263:50-60. DOI: 10.1016/j.ajo.2024.02.022. Epub 2024 Feb 22. Erratum in: Am J Ophthalmol. 2024 Nov;267:308-310. DOI: 10.1016/j.ajo.2024.08.001. PMID: 38395325; PMCID: PMC11162936.

Cross-sectional EHR cohort study (January 1, 2013–June 1, 2023) of 245,669 adults with open-angle glaucoma in Epic Cosmos found that 29.3% presented with severe disease, and higher social vulnerability was independently associated with worse severity at diagnosis. Black race (OR 1.61; 95% CI 1.58–1.65), Hispanic ethnicity (OR 1.15; 95% CI 1.11–1.18), Medicaid (OR 1.33) or uninsured status (OR 2.53), and highest socioeconomic SVI quartile (OR 1.25) were associated with advanced presentation, with Black and Hispanic patients diagnosed at younger ages (67.8 and 68.1 vs 73.3 years; p<0.001), demonstrating persistent racial and socioeconomic disparities in timely glaucoma diagnosis.

• Swain TA, McGwin G Jr, Girkin CA, Owsley C. Telemedicine Screening for Eye Disorders in Federally Qualified Health Centers: Relationship to Vision-Targeted Health-Related Quality of Life. Telemed J E Health. 2024 Jun;30(7):e2080-e2086. DOI: 10.1089/tmj.2023.0695. Epub 2024 Apr 25. PMID: 38662523; PMCID: PMC11296149.

This cross-sectional telemedicine study (June 28, 2020–June 27, 2021) of 500 adults screened for glaucoma risk at three rural Alabama Federally Qualified Health Centers found that visual acuity ≤20/40 (40.6%) and diabetic retinopathy (6.8%) were independently associated with lower vision-related quality-of-life scores. Sociodemographic factors—including being uninsured (18%), unemployed (38.6%), or dependent on others for transportation (25.8%)—were also strongly associated with worse VFQ-9 scores, highlighting how socioeconomic barriers intersect with ocular disease to affect functional outcomes in underserved populations.

• Siegler NE, Walsh HL, Cavuoto KM. Access to Pediatric Eye Care by Practitioner Type, Geographic Distribution, and US Population Demographics. JAMA Ophthalmol. 2024 May 1;142(5):454-461. DOI: 10.1001/jamaophthalmol.2024.0612. PMID: 38602687; PMCID: PMC11009863.

A cross-sectional geospatial study (April–July 2023) of 586 pediatric optometrists and 1060 pediatric ophthalmologists found that only 6.5% and 9.7% of U.S. counties, respectively, had at least one provider, and 96.4% of counties without a pediatric ophthalmologist also lacked a pediatric optometrist. Counties with specialists had higher household incomes (ophthalmology counties $76,127 vs $57,714 in counties with neither; P<.001) and higher educational attainment, demonstrating pronounced socioeconomic and geographic disparities in pediatric eye care access.

• Shaheen A, Medeiros FA, Swaminathan SS. Association Between Greater Social Vulnerability and Delayed Glaucoma Surgery. Am J Ophthalmol. 2024 Dec;268:123-135. DOI: 10.1016/j.ajo.2024.07.019. Epub 2024 Jul 30. PMID: 39089357; PMCID: PMC11606798.

A retrospective cohort study (January 2002–February 2022) of 10,553 eyes (6,934 patients) with open-angle glaucoma found that higher neighborhood social vulnerability (SVI) delayed time to glaucoma surgery (time ratio [TR] 1.11 per 25% increase; 95% CI 1.03–1.20; p=0.006), independent of disease severity. Patients in the highest national ADI quartile experienced a 68% longer time to surgery (TR 1.68; 95% CI 1.20–2.36; p=0.003), demonstrating that socioeconomic deprivation and transportation-related vulnerability contribute to delayed access to sight-saving glaucoma interventions.

• Piano M, Nguyen B, Hui F, Pond CD. Access to primary eye care for people living with dementia: a call to action for primary care practitioners to 'think vision'. Aust J Prim Health. 2024 Mar;30:PY23200. DOI: 10.1071/PY23200. PMID: 38422501.

This forum paper (published March 2024) highlights that over 400,000 Australians live with dementia (projected to double by 2058), yet people with dementia are less likely to receive regular eye examinations despite >40% of vision impairment being correctable with simple optometric management. Barriers include limited domiciliary optometry access, inadequate workforce training, cost of spectacles, and poor interprofessional communication, underscoring the need for primary care practitioners to integrate routine vision care into post-diagnosis dementia management to reduce preventable sight loss.

• Nelson LB. Eye Mobile Units and Their Effect on Access to Pediatric Eye Care. J Pediatr Ophthalmol Strabismus. 2024 Sep-Oct;61(5):304. DOI: 10.3928/01913913-20240909-01. Epub 2024 Sep 1. PMID: 39301828.

This editorial (2024) discusses pediatric eye mobile units as a strategy to improve access for low socioeconomic families who may forgo preventive care due to cost, lost wages, or limited awareness. Programs such as the University of California Irvine Eye Mobile for Children and the Eagles Eye Care Mobile Unit have successfully identified children requiring subspecialty referral, highlighting mobile outreach as a practical solution to workforce shortages and geographic disparities in pediatric eye care access.

• Lee KE, Sussberg JA, Nelson LB, Thuma TBT. Review of the Disparities in Access to Pediatric Eye Care Among Low Socioeconomic Status and Underrepresented Racial Minority Groups Exacerbated by the Economic Downturn in Pediatric Ophthalmology. J Pediatr Ophthalmol Strabismus. 2024 May-Jun;61(3):172-178. DOI: 10.3928/01913913-20231026-05. Epub 2023 Dec 19. PMID: 38112388.

A narrative review (literature period not specified) examining racial and socioeconomic disparities in pediatric eye care reports limited racial diversity within the pediatric ophthalmology workforce and highlights that children from lower socioeconomic backgrounds face significant barriers to accessing care, particularly for asymptomatic conditions. The authors emphasize workforce diversification, mobile eye clinics, school-based vision programs, and health literacy initiatives as key strategies to improve physician–patient concordance and expand equitable access to pediatric vision services in vulnerable populations.

• Diamond DF, Hirji S, Xing SX, Gorroochurn P, Horowitz JD, Wang Q, Park L, Harizman N, Maruri SC, Henriquez DR, Liebmann JM, Cioffi GA, Hark LA. Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): optometric exam improves access and utilization of eye care services. Graefes Arch Clin Exp Ophthalmol. 2024 May;262(5):1619-1631. DOI: 10.1007/s00417-023-06344-2. Epub 2024 Jan 8. PMID: 38189973; PMCID: PMC11748831.

A prospective cluster-randomized clinical trial (March 1, 2021–May 31, 2022) of 708 adults aged ≥40 years living in NYC affordable housing found that 54.9% were African American and 39% Hispanic, yet 78.2% of those examined (241/308) had not had a dilated eye exam in the past year and 71.4% lacked an eye care provider. African American participants were less likely than Hispanic participants to have a recent dilated exam (p=0.004), highlighting racial disparities in access, while on-site optometric evaluation achieved high attendance (84.3%) and facilitated referral for ocular disease in 70.5%, improving access in this underserved population.

• Cotton CC, Goerl BA, Kaplan EF, Krause MA. Demographic, Socioeconomic, and Clinical Factors Associated with Severe Vision Loss in Patients with Neovascular Glaucoma. Clin Ophthalmol. 2024 Jul 19;18:2137-2145. DOI: 10.2147/OPTH.S452884. PMID: 39051021; PMCID: PMC11268748.

This retrospective cohort study (January 2010–December 2020) of 89 patients (99 eyes) with neovascular glaucoma found that uninsured patients were significantly more likely to progress to severe vision loss (light perception or worse) compared with those with Medicare (OR 0.098; p=0.005) or private insurance (OR 0.110; p=0.006), highlighting insurance-related disparities in outcomes. Older age (OR 1.074 per year; p=0.008) and female sex (OR 3.281; p=0.036) were also associated with severe vision loss, whereas race, area deprivation index, income, and travel distance were not significantly associated, underscoring the role of insurance coverage as a key access-related determinant in NVG progression.

• Copado IA, Hallaj S, Radha Saseendrakumar B, Baxter SL. Disparities in Eye Care Utilization Among Refugee and Migrant Populations. Transl Vis Sci Technol. 2024 Feb 1;13(2):14. DOI: 10.1167/tvst.13.2.14. PMID: 38376863; PMCID: PMC10883335.

A retrospective cross-sectional EHR study (January 1, 2005–March 1, 2022) of 64 refugees/migrants and 95 matched controls in San Diego found that refugees were more likely to have Medicaid (55% vs 24%; P<0.01) and had fewer ophthalmology encounters after adjustment (β = −1.66; 95% CI −2.89 to −0.44; P=0.009). Refugees also had shorter duration of eye care engagement (median 3 vs 4 years; P=0.03) and lower follow-up rates (66% vs 81%; P=0.03), highlighting insurance-related and structural barriers contributing to reduced specialty eye care utilization in migrant populations.

• Choi A, Nawash BS, Du K, Ong J, Chhablani J. Barriers to care in neovascular age-related macular degeneration: Current understanding, developments, and future directions. Surv Ophthalmol. 2024 Jan-Feb;69(1):160-164. DOI: 10.1016/j.survophthal.2023.09.001. Epub 2023 Sep 15. PMID: 37716480.

This narrative review (literature 1990–2022; published 2024) of 18 studies found seven major barrier categories to neovascular age-related macular degeneration (nAMD) care, most commonly travel burden (50%), psychological barriers (50%), and financial/socioeconomic factors (44%). Travel distance, caregiver dependence, injection-related anxiety (reported by 54–71% of patients), treatment costs, and long clinic wait times were frequent contributors to nonadherence, and only 14% of included studies were US-based, highlighting gaps in understanding insurance- and equity-related disparities in access to anti-VEGF therapy.

• Allison K, Hodges B, Shahid MM, Feng C. Racial and Gender Disparities for Glaucoma Treatment Rates in Upstate New York. J Clin Med. 2024 Nov 28;13(23):7225. DOI: 10.3390/jcm13237225. PMID: 39685684; PMCID: PMC11642291.

This cross-sectional Medicare claims analysis (2019) using CDC VEHSS data found that prescription drugs were the most common glaucoma treatment in Monroe County (36.82%), followed by laser surgery (3.26%), drainage devices (1.47%), and other surgery (0.58%). Black non-Hispanic patients had higher rates of laser (3.39%) and drug therapy (47.20%) but lower rates of drainage (1%) and no other glaucoma surgery (0%) compared with White patients, who were the only group undergoing other surgeries (0.78%) (p<0.001), demonstrating significant racial disparities in treatment patterns.

• Akinyemi OA, Jones Md LS, Ochoa A 3rd, Nelson L, Weldeslase TA, Yousuf SJ. Socioeconomic Disparities and Emergency Department Visits for Diabetic Retinopathy in California. J Vitreoretin Dis. 2024 Feb 26;8(3):293-298. DOI: 10.1177/24741264241234132. PMID: 38770079; PMCID: PMC11102713.

A retrospective cross-sectional study (January 2018–December 2020) of 39,693 California emergency department visits for diabetic retinopathy found that residence in distressed neighborhoods (Distressed Communities Index highest quintile) was independently associated with higher odds of presenting with proliferative DR (aOR 1.63; 95% CI 1.20–2.23; P=.002). Hispanic (aOR 2.21) and Black patients (aOR 1.46), and those with Medicaid (aOR 1.37) or Medicare (aOR 1.34), also had higher odds of advanced presentation, demonstrating compounded neighborhood-level, racial, and insurance-related disparities in timely diabetic eye care access.

• Acuff K, Wu JH, Varkhedi V, Baxter SL. Social determinants of health and health disparities in glaucoma: A review. Clin Exp Ophthalmol. 2024 Apr;52(3):276-293. DOI: 10.1111/ceo.14367. Epub 2024 Feb 22. PMID: 38385607; PMCID: PMC11038416.

This narrative review (literature search July 10–24, 2023; no temporal restrictions) synthesizes evidence that Black race is associated with approximately 3-fold higher glaucoma prevalence and earlier diagnosis (mean 60 vs 66 years), while lower socioeconomic status, lower income, Medicaid insurance, and transportation barriers are linked to more severe disease at presentation, reduced testing, delayed referrals, and poorer medication adherence. The review highlights that social deprivation independently contributes to advanced visual field loss, lower treatment adherence, and reduced surgical access, emphasizing the need for community outreach, telemedicine, and AI-supported interventions to mitigate structural disparities in glaucoma care.

• Li C, Lum F, Chen EM, Collender PA, Head JR, Khurana RN, Cunningham ET Jr, Moorthy RS, Parke DW 2nd, McLeod SD. Shifts in ophthalmic care utilization during the COVID-19 pandemic in the US. Commun Med (Lond). 2023 Dec 14;3(1):181. DOI: 10.1038/s43856-023-00416-4. PMID: 38097811; PMCID: PMC10721809.

A retrospective cross-sectional study (January 2019–December 2021) of 44.6 million patients across 2,455 U.S. ophthalmology practices demonstrated that during the COVID-19 pandemic, visits declined 67% below expected levels in April 2020 and remained 13% below expected through the end of 2021. Although emergent conditions were relatively prioritized, sustained reductions occurred for glaucoma, diabetic retinopathy, AMD, and cataract care, indicating pandemic-related disruptions that likely worsened delays and access disparities in essential eye services.

• Jamal O, Mallipatna A, Hwang SW, Dimaras H. Social Determinants of Health in Pediatric Ophthalmology Patients: Availability of Data in the Electronic Health Record and Association With Clinic Attendance. Transl Vis Sci Technol. 2023 Nov 1;12(11):36. DOI: 10.1167/tvst.12.11.36. PMID: 38019501; PMCID: PMC10691384.

This retrospective cohort study (June 1, 2018–May 23, 2022) of 26,102 pediatric ophthalmology patients at a Canadian tertiary center showed that key social determinant data were poorly captured in the EHR, with ethnicity recorded in only 0.1% despite 100% availability of postal code. Female sex (P=0.002), age 0–13 years (P≤0.001), low–medium neighborhood income (P≤0.001), Northern Ontario residence (P≤0.001), and rural residence (P≤0.001) were associated with higher clinic cancellations and no-shows, demonstrating that socioeconomic and geographic factors significantly influence pediatric eye care attendance.

• Huang BB, Radha Saseendrakumar B, Delavar A, Baxter SL. Racial Disparities in Barriers to Care for Patients With Diabetic Retinopathy in a Nationwide Cohort. Transl Vis Sci Technol. 2023 Mar 1;12(3):14. DOI: 10.1167/tvst.12.3.14. PMID: 36928128; PMCID: PMC10029769.

A cross-sectional study (All of Us data version 6; published 2023) of 885 adults with diabetic retinopathy responding to healthcare access surveys and 385 responding to SDoH surveys demonstrated that Hispanic individuals had higher odds of delaying care due to lack of childcare (aOR 6.57; 95% CI 1.67–27.8), while non-Hispanic Black individuals had higher odds of reporting being treated with less respect (aOR 2.62), less courtesy (aOR 2.51), and receiving poorer service (aOR 2.85) compared with non-Hispanic White individuals. These disparities persisted after adjusting for income, education, and insurance, highlighting racial inequities in both structural and interpersonal barriers to diabetic eye care access.

• Gervasio KA, Camarena J, Hampton J, Chopra N, Kalosza B, Shumate L, Wu AY. Demographic and socioeconomic disparities in receipt of ophthalmology consultation for facial trauma. BMJ Open Ophthalmol. 2023 Oct;8(1):e001259. DOI: 10.1136/bmjophth-2023-001259. PMID: 37797981; PMCID: PMC10551933.

This retrospective cohort study (January 2014–May 2016) of 264 adults with facial trauma at a New York Level I trauma center found that only 30% received ophthalmology consultation, and privately insured patients had 2.57-fold greater odds of consultation compared with Medicaid/corrections patients (95% CI 1.37–4.95; p=0.004). Patients aged ≥60 years had one-third the odds of consultation (OR 0.33; 95% CI 0.16–0.68; p=0.003), while race/ethnicity and language were not independently associated, highlighting age- and insurance-based disparities in access to timely ophthalmologic evaluation for trauma.

• Acuff K, Delavar A, Radha Saseendrakumar B, Wu JH, Weinreb RN, Baxter SL. Associations between Socioeconomic Factors and Visit Adherence among Patients with Glaucoma in the All of Us Research Program. Ophthalmol Glaucoma. 2023 Jul-Aug;6(4):405-412. DOI: 10.1016/j.ogla.2023.01.008. Epub 2023 Feb 4. PMID: 36746242; PMCID: PMC10400726.

A cross-sectional study (All of Us data version 6; analysis conducted 2022–2023) of 4,517 adults with glaucoma found that 16.3% had not seen an eye care provider in the prior 12 months, despite guideline recommendations for annual follow-up. Lower education (less than high school as reference) and lowest income (≤$25,000) were independently associated with poorer visit adherence, whereas some college (OR 1.91; 95% CI 1.19–3.04), college/advanced degree (OR 2.25; 95% CI 1.39–3.60), and income ≥$200,000 (OR 1.64; 95% CI 1.10–2.45) were associated with higher odds of adherence, demonstrating persistent socioeconomic disparities in glaucoma care access.

• Hamm LM, Yashadhana A, Burn H, Black J, Grey C, Harwood M, Peiris-John R, Burton MJ, Evans JR, Ramke J. Interventions to promote access to eyecare for non-dominant ethnic groups in high-income countries: a scoping review. BMJ Glob Health. 2021 Sep;6(9):e006188. DOI: 10.1136/bmjgh-2021-006188. PMID: 34493531; PMCID: PMC8424858.

This scoping review (database search through August 2020) of 67 studies (82 reports) on interventions to improve eyecare access for non-dominant ethnic groups in high-income countries found that 90% of studies were conducted in the USA, primarily targeting Black (48%) and Latinx (28%) communities. Only 30% of studies involved the target population in intervention design, and among 48 evaluated interventions (72%), strategies providing personalized support (e.g., behavioral activation or patient navigation) were most effective in improving follow-up attendance, while broader structural barriers related to poverty and racism remained insufficiently addressed.