Inequities and Research Gaps in Ophthalmology

Abstract

ImportanceDeficient ophthalmologic care is costly to patients, making the identification of groups not receiving adequate care of vital importance. The current landscape of equity in ophthalmic care has yet to be thoroughly investigated and is important to ensure inclusivity and patient-centered care.ObjectiveTo perform a scoping review of the literature pertaining to health care inequities in the field of ophthalmology.Evidence ReviewA comprehensive database search using MEDLINE (via PubMed) and Ovid Embase was done in July 2022. English-language articles published from 2016 to 2021 were included and encompassed all article types except commentaries or correspondence. The search modeled the National Institutes of Health list of designated US health inequity populations, which includes income, education level, occupational status, rural and underresourced area, sex and gender, lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity, and race and ethnicity. A total of 8170 abstracts and titles were screened by 2 independent investigators, and 189 studies were assessed in full text for eligibility. For inclusion, articles needed to be an ophthalmic study discussing health inequities. In a masked, duplicate fashion, 2 independent investigators screened 75 full-text studies for data extraction using a pilot-tested form. Data extraction included general publication characteristics and health inequity data based on the National Institutes of Health’s defined inequity groups.FindingsA total of 75 publications were included. Notable inequities were found among Black and Hispanic patients associated with negative ophthalmic outcomes and mixed associations regarding sex or gender. Overall, lower-income patients were more likely to have vision impairment, use eye care services less, and have lower adherence to eye examinations. No articles within our sample examined LGBTQ inequities among ophthalmology patients since the 2016 National Institutes of Health classification of sexual and gender minority populations. Substantial research gaps were observed within the ophthalmic literature pertaining to the LGBTQ community, race and ethnicity, and rural and underresourced areas.Conclusions and RelevanceThis scoping review found substantial findings associated with the LGBTQ community, race and ethnicity, and the role of telemedicine in rural and underresourced areas. Because of the importance of ophthalmic care in overall patient health, it is vital to understand the various inequities present and strive to improve the current gaps in the literature. Future studies should (1) examine barriers to clinical study and medical trainee recruitment as well as patient values and preference studies and (2) investigate the implementation of telemedicine in underresourced areas.

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

“…The Basic and Clinical Science Course, long considered a cornerstone of ophthalmology resident education, has recently added a new chapter dedicated entirely to social determinants of health, ensuring that our future workforce will be well versed in these issues and propelled to work to address them. These efforts will drive further attention and research into reducing ophthalmologic health disparities to augment the 75 articles identified by Hemmerich et al 1 and fill in gaps in our knowledge of these inequities. This research will be invaluable in guiding future initiatives to ensure that high-quality ophthalmology care is available for all patients regardless of their identity.…”

“…However, research is not enough. Many medical and ophthalmology societies have developed active initiatives seeking to address the issues raised in the articles cited by Hemmerich et al 1 For the American Medical Association (AMA), health equity has become one of its highest priorities. In 2019, the AMA created its Center for Health Equity, to embed a commitment to health equity in all aspects of AMA's work and mission.…”

“…10 Particularly since the onset of the COVID-19 pandemic, there has been increasing implementation of telemedicine in ophthalmology. Telemedicine can improve access to eye care for many of the vulnerable communities highlighted by Hemmerich et al, 1 in particular, patients from rural areas. Telemedicine has long been used in the screening of diseases such as retinopathy of prematurity, allowing premature infants from rural communities to receive their care in neonatal intensive care units closer to home and closer to their families.…”

“…Hemmerich et al 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.…”

“…Much of the effort to address the inequities and research gaps highlighted by Hemmerich et al 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 .…”