Global gender disparities in access to refractive error services: A systematic review and meta-analysis.

Abstract

Topic: Summarize existing evidence on global gender disparities in access to refractive error (RE) correction, among adults and children.

Clinical relevance: Uncorrected refractive error, remains the leading cause of vision impairment worldwide. Women and girls experience disproportionate levels of vision impairment, but gender disparities in access to RE correction are not well understood. Lower coverage among females may lead to prolonged vision impairment and functional limitations, impacting education, employment and quality of life.

Methods: We searched MEDLINE (Ovid), Embase (Ovid), Global Health and grey literature sources from inception to 15 February 2024 for population-based, observational studies reporting effective or overall refractive error coverage (REC), stratified by sex. There were no restrictions on language, publication date or location. Titles and abstracts were independently reviewed. Quality appraisal was performed in duplicate using the Joanne Briggs Institute tool. Random effects models were made of the age-adjusted female:male odds ratio of REC, stratifying for age (0-17, >18 years), geographic setting and super-region. The protocol was registered on The International Prospective Register of Systematic Reviews (identifier, CRD42021271297).

Results: Across 43 studies in 18 countries, 33,534 (36.7%) of 91,487 adults and 23,008 (2.91%) of 790,145 children had refractive needs. The certainty of evidence for gender disparities in REC was rated as moderate for adults and very low for children using the GRADE approach. Females had lower refractive error coverage than males (OR: 0.86; 95% CI: 0.78-0.96; p = 0.01). Urban, but not rural, females were significantly less likely than males to access RE correction (OR: 0.70; 95% CI: 0.60-0.83; p < 0.01). Gender disparities were most evident in Southeast Asia, East Asia and Oceania, where females were significantly less likely than males to access RE correction (OR: 0.75; 95% CI: 0.62-0.91; p < 0.01). Globally, adult women were less likely to access RE correction than men (OR: 0.85, 95% CI: 0.75-0.96; p = 0.01), but no significant sex differences were observed among children (OR: 0.86, 95% CI: 0.68-1.10; p = 0.24).

Conclusion: Targeted interventions are needed to address barriers to refractive services among women and girls, with a particular focus on urban settings, adult women and low-income regions.