Towards a More Inclusive Ophthalmology

As 2024 marks an important year for ESCRS in raising awareness of diversity, equity, and inclusivity (DEI) issues in ophthalmology, many challenges need to be acknowledged and faced, according to ESCRS President Filomena Ribeiro MD, PhD, FEBO and ESCRS consultant Kris Morrill.

Professor Ribeiro stated clearly that social responsibility, equity, and inclusivity are the priorities ESCRS will embrace during her tenure as president.

“Diversity and inclusion are about making sure everyone feels welcomed and respected for who they are,” she said. “It is about understanding and appreciating that people are different in many ways.”

Most know uniqueness is strength, not weakness: in ophthalmology, it can bring different perspectives and experiences, enhancing innovation to achieve better results. Many challenges currently serve as obstacles to more inclusive, equal, and diverse ophthalmology, such as the under-representation of minorities (especially in leadership positions), unequal career, mentorship, and surgical training opportunities. Additional discrimination factors include gender identity, sexual orientation, age, religion, and political views.

The more visible example is the representation of women in ophthalmology, especially as surgeons. A recent survey published by the Journal of Cataract & Refractive Surgery on surgical training in Europe revealed female specialists reported a mean 18% fewer entire cataract surgical procedures than their male counterparts. Women also felt less confident about their surgical skills, and female residents in ophthalmology reported continued gender bias.

“In 2024, we should not see barriers if people want to become surgeons in ophthalmology. There should be pathways to do that,” Kris Morrill stated. “It is very difficult to become a surgeon in certain countries—especially for women, because of family issues, motherhood, et cetera. This should not be happening, and we need to stop it.”

One of the greatest barriers to overcome is unconscious bias, or judging someone based on stereotypes and cultural backgrounds without even realising it. “The first step is to understand nobody is immune to unconscious bias and all decision-making processes we make are influenced by it,” Prof Ribeiro said. In this regard, ESCRS collaborated with Project Implicit, a think tank led by scientists from Harvard University and the University of Virginia, in refining an online tool to measure unconscious biases.

“The immediate reaction I saw from most people was saying they had no biases; they were very open-minded and made no judgements,” explained Ms Morrill. “Then, you start to dig in a little deeper and realise every single decision we make is based on some preconceptions in our minds. So, you start to scratch the surface and start to think twice about decisions and how you react to people. It is a very interesting process.”

ESCRS is tackling this issue by introducing new activities addressing it, such as the workshop last Winter Meeting in Frankfurt. “Leaders need to face this challenge to start a process of change that should be transversal to all members,” Prof Ribeiro affirmed. The next step, she said, is involving membership and industries. Frankfurt’s escape room experience took a step towards that, providing an opportunity for people to work together.

The ESCRS annual meeting in Barcelona will have a DEI symposium, workshops, and instructional courses. Most importantly, ESCRS is preparing a survey for its members to assess the real obstacles to DEI issues they face, using their input to develop a more effective DEI strategy. The survey is based on the one proposed by the British Hip Society and published in the British Medical Journal.

“As their demographics reflect ours, we asked their permission to use their survey with adaptations to ophthalmologists and to benchmark against another surgical society,” Ms Morrill explained. The hope is this survey will establish a baseline as there is no existing data on the topic, according to both Prof Ribeiro and Ms Morrill. A good starting point is reflecting on the issue and working towards a common goal, even if the change will not be fast and smooth.

“I think people should plan to attend activities in Barcelona to learn and understand where we stand today as a Society, as well as where we want to go,” Ms Morrill concluded.

Even if surgeons think they know the way forward, Prof Ribeiro encourages attending the sessions willing to learn.

“It is important to be open-minded and willing to learn from others who are different from us,” she concluded. “By taking these steps, we can help break some barriers and create a more inclusive environment for everyone.”