Cataract surgery and gender equality

September 1, 2009

Are the years of research and advocacy at last reaping rewards?

I would like the answer to this question to be a resounding "yes!" However, it still needs to be a qualified response.

It is interesting to look back at something that seems obvious and wonder why it took so long to be recognised. We found in 1989 that there were far more blind women than blind men in the Hamar tribe in Ethiopia.1 However, there was a reasonable explanation. Men who could not see, for whatever reason, died, because after all, men in that setting were either herders or warriors.

When I lived in Malawi between 1990 and 1994, I was aware that the women's end of the eye ward was a lot smaller than the men's, but it was also more crowded, so I figured it all balanced out.

However, I was thinking from my clinical experience and not from an epidemiological point of view. Women only have a slightly higher risk of cataract than men, but of course they live longer. Thus, when we actually did the meta-analysis in 2001 and looked at it, I started to understand what a difference length of life could make.2

Following that, I was surprised and impressed when I found that approximately two-thirds of people operated for cataract in industrialised countries are female. This is consistent with what should happen when women receive cataract services at the same rate as men. (It is interesting that many surgeons from industrialised countries, if asked, are not aware of this gender issue in their own practices.)

In 2002, available data allowed us to look at developing country cataract surgical rates by gender. This highlighted the inequity and really brought home the extent of it.3 Unfortunately, we still have a long way to go because a similar, and larger, analysis of cataract surgical rates that we did recently shows that the numbers have not changed.4

However, it is heartening to see the issue finally getting the attention it deserves. That's the first step. Now we need to find ways to change the underlying conditions that lead to the inequities. The real rewards are to be reaped by the women in developing countries who need surgery and other eye care. When these women start to reap the rewards, I'll answer my original question with a resounding "yes!"


1. Courtright P, Klungsoyr P, Lewallen S, Henriksen TH. The epidemiology of blindness and visual loss in Hamar tribesmen of Ethiopia. The role of gender. Trop.Geogr.Med. 1993;45(4):168-170.

2. Abou-Gareeb I, Lewallen S, Bassett K, Courtright P. Gender and blindness: a meta-analysis of population-based prevalence surveys. Ophthalmic Epidemiol. 2001;8(1):39-56.

3. Lewallen S, Courtright P. Gender and use of cataract surgical services in developing countries. Bull World Health Organ. 2002;80(4):300-303.

4. Lewallen S, Courtright P. Cataract surgical coverage remains lower in females. Br J Ophthalmol. Dec 17 2008.