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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