Global Gender Disparities in Access to Refractive Error Services: A Systematic Review and Meta-Analysis

Area of Science:

• Ophthalmology
• Public Health
• Global Health Equity

Background:

• Refractive error (RE) is a leading cause of vision impairment globally.
• Gender disparities in access to refractive error correction are not well understood.
• Lower access for women and girls can lead to prolonged vision impairment and functional limitations.

Purpose of the Study:

• To summarize existing evidence on global gender disparities in access to refractive error correction.
• To analyze these disparities among adults and children.
• To identify populations most affected by limited access to vision correction.

Main Methods:

• Systematic search of multiple databases (MEDLINE, Embase, Global Health) and gray literature up to February 2024.
• Inclusion of population-based observational studies reporting refractive error coverage stratified by sex.
• Meta-analysis of age-adjusted female:male odds ratios for refractive error correction, stratified by age, setting, and region.

Main Results:

• Analysis of 43 studies across 18 countries involving over 91,000 adults and 790,000 children with refractive needs.
• Adult women had significantly lower refractive error correction coverage than men globally (OR: 0.85; 95% CI: 0.75-0.96).
• Urban women showed significantly lower access (OR: 0.70), with disparities most pronounced in Southeast Asia, East Asia, and Oceania. No significant sex differences were found in children.

Conclusions:

• Targeted interventions are necessary to address barriers to refractive services for women and girls.
• Focus should be on adult women, urban settings, and low-income regions.
• Improving access to refractive correction is vital to reduce vision impairment and enhance quality of life.