Demography

For many years in eye care, gender differences were overlooked. Both at a program level and the national level, this issue was not actively addressed. In my experience as manager of the Seeing is Believing (SiB) program at the International Agency for the Prevention of Blindness, I was surprised that project managers had to be challenged to consider gender. Once SiB projects managed to collect and report with gender disaggregated data, project reports still arrived with the statement: “Cataract surgery outputs of men and women are 50:50; therefore, we are doing fine.” Unfortunately, this was not and is not the case. There are many reasons why not. One is demographics: Women tend to live longer than men. According to the World Population Ageing (WPA) 2019 report of the United Nations, at the global level, in 2015 to 2020, women’s life expectancy at birth exceeds that of men by 4.8 years. Longer life expectancy results in a higher proportion of older women as compared with men, and this disparity increases in older age groups. The sex ratio at older ages can be stark. In Europe, at older than 80 years, the ratio is 53 men to 100 women; in Asia, 71 men to 100 women, according to WPA 2017 data. Also, gender intersects with other causes of inequality and inequity. Therefore, if eye care is being delivered in a ratio 50:50 at many locations, we are not “doing fine.”

The National Poll on Healthy Aging revealed significant demographic and socioeconomic differences in self-reported eye examination rates in adults 50 to 80 years old.