Lynn K Gordon, MD, PhDProfessor , Ophthalmology

Associate Dean, Diversity AffairsDavid Geffen School of Medicine at UCLA

DisclosureThe presenter has no financial interest in the

topics discussed

British Columbia Centre for Epidemiologic& International Ophthalmology (BCEIO), 2000

Two-thirds of all blind individuals in the world are female

Most are older than 50 years

90% of blind people live in poverty

Gender bias is not limited to the developing world

Healthy People 2010: The Numbers SpeakUS Department of Health and Human Services

2000: vision objectives were initially included

>80 million people have potentially blinding diseases>4 million individuals in the United States

low vision legally blind severe visual limitations

Economic impact: >50 billion dollars in 2002 for health care for

individuals with visual disorders (both direct and indirect costs)

Estimate: by 2030 the number of visually impaired and legally blind individuals may double

http://www.healthypeople.gov/document/html/volume2/28vision.htm

Visual Loss is Associated With…….

Decreased quality of lifeChanges in independent livingIncreased injury and fallsIncreased depressionIncreased isolation

Untreated poor vision is associated with cognitive decline and onset of dementia

Rogers, MA, Langa KM. Untreated poor vision: a contributing factor to late-life dementia. Am. J. Epidemiol. 2010 171:728

Visual Impairment and Falls

Falls in older adultsOccur in 35-40% of individualsResponsible for 90% of fractures in the elderlyClinical risk factors include vision impairment,

gait abnormality and muscle weaknessFractures associated with

Poor visual acuity in older womenPoor contrast sensitivityDecreased depth perceptionBinocular visual field loss

Coleman AL, el al. J Am Geriatr Soc. 2009; 57:1825. Patino CM el al. Ophthalmology. 2010; 117:199.

Common Eye Diseases in the United States Associated with Vision Loss

Treatable or preventable eye disease: the big 4Age-related macular degenerationDiabetic retinopathyGlaucomaCataract

Less common, important causes for vision loss in womenTraumaImmune-related eye diseaseIdiopathic Intracranial Hypertension (IIH)

British Columbia Centre for Epidemiologic& International Ophthalmology (BCEIO), 2000

What about gender?Female gender bias held true for many diseases

CataractGlaucomaTrachoma

Age-Related Macular Degeneration (ARMD)Age-adjusted risk is about equal for men and

womenPercentage of women in the at-risk population is

larger than the percentage of men

Women and Macular Degeneration

• ARMD: leading cause of legal blindness in the USA• 9 million people have some form of ARMD• 1.6 million have advanced disease

• Age is the greatest risk factor • 55-64: one percent are affected• 65-74: four percent are affected • >75: thirty percent are affected

• Women tend to live longer than men, F:M lifetime risk 2:1• 6% for females • 3% for males

Women’s Eye Health.org

Women with DiabetesYounger women and those of reproductive age

are less likely than older women to receive eye examinationsWomen > 75 years were twice as likely to have

been examined as compared to women < 50 years

Barriers for preventive careLow socioeconomic positionLack of insuranceLow levels of education

Owens, et al. Women with diagnosed diabetes across the life stages: Underuse of recommended preventive care services. 2008. Journal of Women’s Health. 17: 1415

Women and Glaucoma

Prevalence of glaucoma is higher in women than in men

Risk for angle closure glaucoma is higher in femalesNo gender bias in the incidence of open angle

glaucoma

Burden of blindness due to glaucoma is larger for womenRate of visual impairment is higher in womenWomen are 24% less likely to be treated for glaucoma

Vajaranant, TS, et. al. Gender and glaucoma: what we know and what we need to know. Curr. Opin. Ophthalmol. 2010. 21:91.

Women and Glaucoma

Vision loss from glaucoma can be slowed or prevented with adequate therapy

About 50% of individuals with glaucoma are not diagnosed: Must identify affected individuals and provide

adequate therapy Health disparities in glaucoma require

additional study and intervention

Women and Cataract

Cataract prevalence increases with increasing age

Surgery for cataract accounts for 60% of Medicare expenses for vision

Nuclear sclerosis is the most common form of cataractGender association: more common in womenOther associations: diabetes, low education, myopia,

smoking, BMI >35

Women and cataract

Significant cataracts in the Los Angeles Latino Eye StudyFemales 20% more likely than malesPrevalence of cataract:

2.6% in the age range 60-69 17% in individuals > 80

1/3 of patients with cataract had an unmet need for surgeryRisk factors for unmet need

Lack of health insurance Income <$20,000 per year Self-reported barriers to care Last eye exam > 5 years ago

Richter, CM et al. Ophthalmology. 2009; 116:2327.

Women and Eye Trauma

Massachusetts Eye and Ear Hospital experience20% of open globe injuries are in patients > 65 years

old Average age in this group = 79.8 years 65% of these are caused by falls 76% of these occur at home, mid-day and night-time peaks

Women as a percentage of the total 58% of the geriatric patients 14% of the non-geriatric patients

Opportunities for counseling and home preventive care

Andreoli, MT, and Andreoli, CM. Geriatric Traumatic Open Globe Injuries. Ophthalmology. 2010. in press

Women and Eye Disease

Inflammatory eye diseaseMany autoimmune diseases are gender-

associatedOne million Sjögren’s patients in the USA, 90%

are women

Idiopathic intracranial hypertensionOccurs primarily in womenSignificant risk for visual loss

Women and Eye Disease: USA

Gender issues and eye disease: increased eye disease in American womenIncreased incidence

Angle closure glaucoma, cataract, IIH, autoimmunityIncreased prevalence

Aging population: glaucoma, ARMD

Barriers to careAccessEducationCultural sensitivity

Opportunities for the Future

Increase research to understand disease pathophysiology

Enhance importance of prevention educationImprove access to careEnsure treatment equality

Eliminate barriers and reduce co-morbidities!

Together we can effect changeThank you for your attention