From Research to Action—Implementing Initiatives to Address Ophthalmologic Health Disparities

Abstract

Hemmerich et al 1 highlight that the ophthalmology literature is beginning to call more attention to ophthalmologic health disparities that disproportionately affect people based on their race, sex, sexual orientation, zip code, income, education level, or employment status. These disparities include unequal access to ophthalmologic care, disproportionate incidence of ophthalmologic disease, and differences in treatment outcomes. The authors identified 75 such articles since 2016, yet their review concluded that far more research is still needed-particularly to evaluate disparities for people in rural communities and for people who are lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+); American Indian/Alaska Native; and Asian or Pacific Islander. This type of research is vitally important for our field. Identifying these disparities allows us as ophthalmologists to focus our profession's resources in areas where they can be most impactful in protecting sight and empowering lives, and more importantly, making these resources and advancements accessible to the people who need them the most.Much of the effort to address the inequities and research gaps highlighted by Hemmerich et al 1 is focused on increasing the diversity of our ophthalmology workforce. Studies have repeatedly shown that patient-physician concordance in race and ethnicity or sex can improve health outcomes and patient satisfaction. 2,3 We also know that ophthalmologists from racial and ethnic groups underrepresented in medicine are more likely to care for these same underserved communities, yet ophthalmology is one of the least diverse specialties in all of medicine, further widening the gap. 4 Only 6% of practicing ophthalmologists identify as Alaskan Native, American Indian, Black, Hispanic, Native Hawaiian, or Pacific Islander (compared with 30.7% of the US population at large). 4 To adequately address health disparities affecting these populations, ophthalmology itself needs to diversify.Similarly, a survey of all US allopathic medical school graduates from 2016 to 2019 found that ophthalmology had the second-lowest percentage of new trainees identifying as LGBTQ+ in all of medicine (ahead of only orthopedic surgery). 5 Hemmerich et al 1 were unable to find a single article addressing LGBTQ+ health disparities in ophthalmology. One distinct obstacle to conducting such research about the LGBTQ+ community is the lack of available demographic information about patients' sexual orientation in electronic health records. This is partly due to inadequate methods of collection or patient willingness to disclose. Many LGBTQ+ patients choose not to disclose gender identity or sexual orientation to their physician, sometimes out of fear of discrimination or simply because the question was not asked. 6 Improving LGBTQ+ representation in the ophthalmology workforce could reduce stigma and increase the attention paid to this understudied