The roles of sex and gender in women’s eye health disparities in the United States

Abstract

Background In the United States, women are at a higher risk of developing vision impairment or a serious eye disease (such as age-related macular degeneration, thyroid eye disease, or chronic dry eye disease) than men. Disparities in eye diseases due to biology widen even further when considering factors such as social determinants of health; gaps in research data, literature, and policy; insufficient provider and patient education; and limitations in screening and treatment options. Sex and gender disparities in eye health are clinically under-addressed and burdensome on both patient quality of life and the health care and economic systems, resulting in a pressing population health issue that negatively impacts women. Design The Society for Women’s Health Research convened a working group of expert clinicians, researchers, and patient advocates to review the current state of science regarding sex and gender disparities in women’s eye health, identify knowledge gaps and unmet needs, and explore better means to advance research, improve patient care, and raise awareness of key issues. Discussion The SWHR Women’s Eye Health Working Group identified priority areas in research, clinical care, and education to reduce disparities and improve patient care in women’s eye health. The working group recommends using a systems approach that incorporates a comprehensive research framework with a sex and gender lens to guide future work and that increases health care provider and public education, as well as engagement by expanding partnerships among ophthalmologic providers, researchers, and non-vision stakeholders.

Evaluation of sex differences in laser-induced choroidal neovascularization severity, phenotype and disease progression

“…Women are more likely to develop AMD, beginning with the onset of dry AMD pathologies such as RPE atrophy, drusen formation and photoreceptor degeneration [6,9,10].…”

“…Preventing or alleviating CNV are also primary targets for ongoing research efforts to identify new therapeutic approaches. Women are more likely to develop AMD, beginning with the onset of dry AMD pathologies such as RPE atrophy, drusen formation and photoreceptor degeneration [6,9,10]. Women are also more likely to progress from dry AMD to wet AMD [11,12,35].…”

“…However, once CNV develops, neither the severity of CNV nor the response to anti-VEGF therapy differs between sexes [15,16]. However, because women are underrepresented in clinical and epidemiological studies, and are less likely to seek medical treatment, including for ophthalmic disease [6], epidemiological studies should be interpreted with caution.…”

“…The "NIH Strategic Goals for Women's Health outlines the need to integrate sex/gender perspectives in basic science and translational research [8] to identify sex-specific disease mechanisms, which can be utilized to develop sex-specific approaches to treatment or potentially to uncover novel disease mechanisms in the context of basic research. Importantly, women are at increased risk for developing major blinding disorders, including AMD [6,9,10]. Women are also more likely to advance from the early "dry" stage of AMD to advanced "wet" neovascular AMD, which is characterized by CNV [11,12].…”

“…An accumulating amount of evidence suggests that the sequalae of many diseases are highly dependent on male or female sex [5]. Despite robust evidence for sex-specific disease processes, basic and translational research to identify approaches to treatment has historically not taken sex-specific disease pathologies into account [6]. In most studies male animals are used, in part for the sake of convenience, as more female animals are needed to maintain the breeding colony, and excess males can then be used as experimental animals.…”