Beyond Sight: A Clearer Vision for Equity in Ophthalmology

In a specialty defined by precision, clarity, and vision, ophthalmology has made extraordinary strides in science and technology. But beneath the surface of these advances lies a less visible challenge—our collective blind spot when it comes to diversity, equity, and inclusion (DEI). As a female ophthalmologist training in the Middle East, I’ve seen first-hand how unconscious bias shapes who gets to lead, who gets chosen, and who gets seen—not just in the operating theatre, but in our systems, language, and even the patients we serve.

I currently train and practice at Watany Eye Hospital in Egypt, a hub of excellence in our region. But despite the clinical sophistication, I still encounter an invisible obstacle: gender-based bias. I’ve had patients bypass me as a surgeon solely because I am a woman. I’ve walked into operating rooms where the unspoken assumption is that the lead surgeon must be male. And I’ve seen the hesitation in patients’ eyes—not because of my skill, but because of my gender.

This isn’t just a Middle Eastern issue. Around the world, women in ophthalmology still face slower promotion, unequal pay, and underrepresentation in leadership roles. And those from minority ethnic or socioeconomic backgrounds often face even steeper climbs. These aren’t isolated cases—they are symptoms of a system built on centuries of imbalance.

Yet, [through] these barriers, I was fortunate. I found a mentor who saw my potential before I could fully see it myself.

Professor Ahmed Assaf didn’t just teach me how to perform surgery. He taught me how to edit surgical films, how to explain complications with humility and confidence, how to make patients feel safe. He brought me to international conferences, pushed me to contribute to papers, and opened doors that would have otherwise remained closed. His mentorship didn’t just shape my skill—it shaped my belief in what I could become. Every young ophthalmologist deserves a mentor like that.

When bias reaches the bedside

Bias in ophthalmology isn’t limited to career trajectories—it affects patients, too. One of my most unforgettable cases was a man with a single functioning eye, clouded by a dense brown cataract. He had been turned away by others because he couldn’t afford the surgery. His world had narrowed to shadows and shapes, and yet, no one had offered him hope. I performed the surgery for free.

A week later, he returned beaming. For the first time, he could see his grandchildren’s faces. That moment reminded me why equity matters—not just in who gets to train, but in who gets to see.

It is far too easy for disadvantaged patients to fall through the cracks of our healthcare systems. Whether because of poverty, language, disability, or culture, countless patients are underserved, misdiagnosed, or delayed in care. And when the physicians who treat them do not reflect their diversity, communication gaps only widen.

A narrow lens in research

These disparities echo into our research, where many clinical trials still lack representative samples. In global ophthalmology studies, patients from the Middle East, Africa, and South Asia are underrepresented. So are female patients, especially in interventional trials. Without diversity in data, our conclusions are biased before the first statistic is run.

Worse still, diverse investigators are often left out of leadership roles in research. We risk building the future of eye care on incomplete evidence—and leaving millions behind.

The case for change

We often say that ophthalmology is about restoring vision. But real vision isn’t just about what the eye sees—it’s about what the mind perceives. Addressing unconscious bias and embedding DEI into our profession is not an ethical add-on; it is essential to clinical excellence.

When patients see themselves in their doctors, trust deep­ens. When diverse trainees are supported, the entire system benefits. When research reflects the full spectrum of humanity, our innovations gain power.

From words to action

To move from ‘talking the talk’ to ‘walking the walk,’ we must:

1. Reimagine training: Blind reviews, structured interviews, and mentorship programmes must be standard. Diversity should be seen as a strength, not a checkbox.

2. Confront clinical bias: Patients should choose surgeons based on skill—not gender or ethnicity. Institutions must educate patients and empower all doctors equally.

3. Decolonize research: Funders and journals must demand inclusive trial design and diverse leadership. Global data should represent global people.

4. Create mentorship pipelines: Every young ophthalmologist deserves a Professor Assaf—someone who lifts them as they rise.

5. Measure and report: DEI metrics in hiring, publishing, and outcomes must be transparent and acted upon. What we do not measure, we cannot improve.

A new lens

To the young ophthalmologist reading this: find a mentor who believes in you—and be that mentor for someone else. Challenge what is assumed. Advocate for who is excluded. Equity is not a destination; it is a discipline.

In the end, we are a specialty of visionaries. Let us sharpen our lens—not just to treat cataracts, but to clear the cultural fog that holds our field back. Let us make it possible for every patient to see, and for every doctor to be seen.

Because true vision demands more than sight—it demands insight.

Noha Fawky Abdelfattah MD is a post-residency fellow, Watany Eye Hospital, Egypt.

Each year, young ophthalmologists are invited to participate in the John Henahan Writing Prize, responding to an essay prompt provided by the medical editors of EuroTimes. Noha Fawky Abdelfattah MD’s essay scored among the top three in a very competitive field.

Applicants responded to the following prompt:

Diversity, equity, and inclusion (DEI) programmes, however well-intentioned, stir a variety of responses in the corporate and political worlds and in the scientific and medical spheres. What DEI and unconscious bias issues are present in the current culture of ophthalmology training, practice, and clinical research? What are the potential benefits of addressing these issues for patients and ophthalmologists? What kind of meaningful changes need to happen to move beyond ‘talking the talk’ to ‘walking the walk’?