AAO 2023: Do women in the US face a greater burden from blindness and vision loss?


In a conversation with Ophthalmology Times, Mary Elizabeth Hartnett, MD, FACS, discussed her AAO presentation, focusing on the impact of blindness and vision loss on women in the United States

At this year's American Academy of Ophthalmology meeting, Dr Mary Elizabeth Hartnett of the Byers Eye Institute at Stanford University presented on gender disparities in vision loss and blindness. David Hutton of Ophthalmology Times spoke to Dr Hartnett about her research and the data she shared at the meeting.

Editor's note: This transcript has been lightly edited for clarity.

David Hutton: I'm David Hutton of Ophthalmology times. The American Academy of Ophthalmology is hosting its annual meeting this year in San Francisco. At that meeting, Dr Mary Elizabeth Hartnett presented "Blindness and Vision Loss in the United States: Do Women Bear a Greater Burden?" Thank you so much for joining us today to talk about this. Tell us about your presentation.

Dr Hartnett: Well, thank you, David. It's really wonderful to have you – wonderful to be here and have you interview me about this really important question. So we uses the IRIS registry database from the American Academy of Ophthalmology and mined data to be able to address the question if women, or if there were differences in blindness or vision loss in ophthalmology patients based on sex within the United States. And I say sex because most of the data that were collected were based on birth sex.

And the reason we did this was because of previous studies worldwide. The Vision Loss Expert Group published that women had a greater burden of disease worldwide, even after age adjustment. So this is important because many of the age related eye diseases are associated with vision loss, and women have a longer life expectancy than men. But the VLEG, this, this study I just presented, did not distinguish the United States from all of North America. And another meta analysis published that visual acuity loss and blindness had a higher prevalence in women than men. But there was no examination based data on vision loss in the better-seeing eye, or associated etiologies from disease.

So when we designed our study, we used data from the IRIS registry. And that did allow us to have patient level data grouped by best-corrected visual acuity and the better-seeing eye based on the WHO classification of mild, moderate, severe and blind. And we were also able to look at several eye conditions: cataract, age-related macular degeneration, glaucoma, diabetic retinopathy, retinal vein occlusion, retinal detachment, amblyopia and corneal opacity.

So we looked at patients within one year, 2018. And this was pre-pandemic. We chose that on purpose because of the disruption in eye examination that occured with the pandemic. And when we looked at patients in our group, we had 955,857 patients. And we, what we found, we compared them. So the vision loss group, we compared to patients at the same time period, who did not have vision loss, and that was a much, much higher number. And what we found was that, in the vision loss group, women made up about 63%, compared to the non-vision loss group of 60%, whereas males made up 37% in the vision loss group compared to 40% in the non-vision loss group. So what does that mean?

When we did an odds ratio, that meant that women had a 15% increased odds of having vision loss when compared to men...We also found that vision that women had vision loss at every category of vision loss – mild, moderate, severe and blind – compared to men, and that age adjustment also led to the same outcomes. And when we looked at eye condition, we found that women...were in the vision loss group, more often than were men, for every condition except for retinal detachment. So using the IRIS registry database, we were able to provide a look at examination-based data with visual acuity in the better-seeing eye and diagnosis codes.
And we found that women were overrepresented in the vision loss relative to the non vision loss group. And in fact, there was a 15% increased odds of women having vision loss, and this occurred even with age adjustment. And women also made up a majority of patients with vision loss in every condition except retinal detachment.

Now there is a limitation with any registry. It doesn't really provide population-based data, but it does provide some information of a potentially useful sample of patients that physicians might see in their offices in the United States.

I also want to acknowledge the study team: Victoria Bugg from the University of Oklahoma; Kaleb Eppich from the University of Utah; Tom Greene from the University of Utah; and Flora Lum from the American Academy of Ophthalmology. Thank you very much.

Dr Hartnett also included a "thank you" to the investigators' funding sources:

Support from the Research to Prevent Blindness for the RPB/AAO Intelligent Research in Sight (IRIS) grant

UM1TR004409 University of Utah Study Design and Biostatistics Center with funding from the National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH

NEI R01s EY015130 and EY017011

Michael F. Marmor, M.D., Professor of Retinal Science and Disease

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