Not Seen, Not Heard? Representation of Skin of Colour in Ophthalmology Educational Texts

The underrepresentation of skin of colour in medical educational textbooks has been demonstrated in a variety of specialties. The representation of skin colour in UK ophthalmology textbooks remains unquantified. Without adequate racially diverse educational resources for medical trainees, there is a risk to patient outcomes and diagnostic delays. In this paper, we aim to analyse the representation of skin colour to inform the development of future textbooks on the importance of racial inclusivity and diversity.

Four bestselling UK ophthalmology textbooks were reviewed using the Fitzpatrick's skin phototype scale to categorise images into Caucasian (Fitz I-III), medium (Fitz IV) and richly pigmented (Fitz V and VI). To assess reliability, a second observer reclassified a 10% sample. Images where skin colour was not representable were excluded. A total of 1644 images were reviewed, of which 460 were included for analysis.

Across the 460 images, 86.5% demonstrated Fitz I-III skin, and only 7.60% and 5.87% demonstrated Fitz IV and Fitz V and VI skin, respectively.

The proportion of richly pigmented images was statistically significantly lower than the national demographic data suggesting an inadequacy in the representation of those from non-Caucasian backgrounds. Addressing this gap is essential to ensure equitable care for patients of all backgrounds.