As surgeons, our decisions and actions today help shape the future of our field. In addition to providing exceptional patient care, we are committed to increasing diversity in clinical research, mentoring the next generation of ophthalmologists, ensuring equitable patient access to advanced ophthalmic technology and treatment, and promoting sustainable eye care.
CHAMPIONING DIVERSITY IN CLINICAL RESEARCH
Diversity in clinical research is required for ophthalmic advances to benefit all patient populations. In particular, clinical trials that failed to reflect a breadth of patients have led to disparities in treatment efficacy and accessibility.1
Implicit bias can affect patient care in the most unexpected ways. For example, a study found that male patients were more likely than female patients to receive bystander cardiopulmonary resuscitation (CPR), resulting in higher survival rates and improved outcomes for men.2 Reasons for the difference alarmingly included bystanders’ uncertainty over how to administer CPR to female patients. Something as simple as offering CPR training on female mannequins to dispel discomfort around exposure and handling of breasts during CPR may have the potential to dramatically reduce the disparity in survival outcomes.
Ophthalmologic care can be profoundly affected by implicit bias as well. For instance, without deliberate intent, women are less likely to be offered cataract surgery than men, particularly in underserved areas of the world, despite similarities in disease severity and the potential for vision improvement.3 Implicit bias and inequities in access to cataract surgery are complex and may be influenced by factors such as work role, literacy, and economic decision-making power.4-8
The enormous disparity in cataract surgical care based on sex results in delayed treatment and worse visual outcomes for female patients. Addressing the issue requires developing more consciously designed, equitable practices and clinical and surgical protocols that account for gender, economic, and literacy biases.
By supporting initiatives that intentionally promote diverse patient recruitment, we can more effectively drive the development of new treatments and technologies that benefit all demographics. Additionally, collaboration with research institutions and industry leaders is essential to increasing diversity in clinical trials, ultimately leading to better outcomes for all.
MENTORING AND EMPOWERING THE NEXT GENERATION
Mentorship is essential to professional growth. Women, underrepresented minorities, and individuals from disadvantaged backgrounds often face barriers to entry and advancement in ophthalmology.
In 2021, one of us (T.T.) delivered an online talk on how unconscious gender bias affects hiring practices and professional development. For example, the language, tone, and level of endorsement in letters of recommendation frequently depends on the candidate’s sex.9,10 Similarly, individuals often hire and promote candidates who resemble themselves.8 AI is also not immune to implicit bias when generating letters of recommendation.11
Implicit bias is more difficult to call out and dismantle than overt bias. Both men and women must be trained to identify and counteract it in themselves and others. Achieving true equality requires a collective effort from both men and women, not just women-led initiatives.
We take pride in providing clinical mentorship, research opportunities, and career development opportunities to a wide range of young ophthalmologists. We emphasize the importance of leadership skills, work-life balance, and self-advocacy to give mentees the confidence and tools necessary for success. We hope to inspire these young professionals by sharing with them our journeys, including challenges we have faced. We also support networking opportunities for a diverse group of medical students and residents to strengthen the field of ophthalmology and improve patient care.
CHAMPIONING SUSTAINABLE EYE CARE
We truly believe that people must be the change they wish to see and put no limitations on what they can achieve. In 2022, one of us (R.R.) founded and cochaired with David Shahnazaryan, MD, the American-European Congress of Ophthalmic Surgery Green Working Group, which has since become a global entity. The group has developed a network of sustainability wardens who are making local changes that collectively contribute to worldwide efforts.
CONCLUSION
We are committed to driving meaningful change by holding ourselves and our profession to higher standards in health care research, design, and delivery. Our commitment extends beyond the OR. By championing diversity in research, mentoring the next generation of surgeons, and advocating for equitable access to cutting-edge care, we are brightening the future of ophthalmology.
1. Mastroianni AC, Faden RR, Federman DD, Institute of Medicine (US) Committee on the Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies. Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies / Volume 2, Workshop and Commissioned Papers. National Academies Press; 1994.
2. Blewer AL, McGovern SK, Schmicker RH, et al; Resuscitation Outcomes Consortium (ROC) Investigators. Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public. Circ Cardiovasc Qual Outcomes. 2018;11(8):e004710.
3. Taryam MO, Rabiu MM, Muhammad N, Oladigbolu K, Abdurrahman H. Prevalence and causes of blindness and visual impairment; and cataract surgical services in Katsina state of Nigeria. Br J Ophthalmol. 2020;104(6):752-756.
4. Nirmalan PK, Padmavathi A, Thulasiraj RD. Sex inequalities in cataract blindness burden and surgical services in south India. Br J Ophthalmol. 2003;87(7):847-849.
5. Joseph S, Ravilla T, Bassett K. Gender issues in a cataract surgical population in South India. Ophthalmic Epidemiol. 2013;20(2):96-101.
6. Finger RP. Cataracts in India: current situation, access, and barriers to services over time. Ophthalmic Epidemiol. 2007;14(3):112-118.
7. Pradhan S, Deshmukh A, Giri Shrestha P, et al. Prevalence of blindness and cataract surgical coverage in Narayani Zone, Nepal: a rapid assessment of avoidable blindness (RAAB) study. Br J Ophthalmol. 2018;102(3):291-294.
8. Desai P, Wang H, Davis L, Ullmann TM, DiBrito SR. Bias perpetuates bias: ChatGPT learns gender inequities in academic surgery promotions. J Surg Educ. 2024;81(11):1553-1557.
9. Trix F, Psenka C. Exploring the color of glass: letters of recommendation for female and male medical faculty. Discourse Soc. 2003;14(2):191-220.
10. Lin F, Oh SK, Gordon LK, et al. Gender-based differences in letters of recommendation written for ophthalmology residency applicants. BMC Med Educ. 2019;19:476.
11. De Roo AC, Newman EA. Best practices in recruitment. In: Telem DA, Martin CA, eds. Diversity, Equity and Inclusion. Success in Academic Surgery. Springer; 2021.
