How to combat accessibility challenges in refractive error services with Noelle Whitestone

A systematic review published in Ophthalmology found that women are less likely than men to receive glasses for refractive errors, the leading cause of vision impairment worldwide, according to research highlighted by Orbis International.

The study reported that disparities in access to vision care are most pronounced in Southeast Asia, East Asia, and Oceania, as well as in low-income and urban settings. Among the studies reviewed in low- to middle-income regions, 56% found that women had less access to glasses than men. Contributing factors include limited awareness of eye care, restricted access to household finances, and time constraints related to caregiving and household responsibilities.

Gender differences were not observed among school-aged children but emerged in adulthood.

The report notes that vision impairment can affect education, employment, and daily functioning. Women account for two-thirds of the world’s illiterate adult population, and untreated vision problems may contribute to these outcomes.

Orbis stated that its efforts to address these barriers include expanding access to care in community settings, supporting treatment for conditions that disproportionately affect women and girls, and training more female eye health professionals.

Lead researcher of the study and Orbis’s Director of Clinical Strategy and Impact Noelle Whitestone sat down with Optometry Times to discuss the implications of these findings.

Transcript

Edited lightly for clarity and length.

Jordana Joy: Can you provide an overview of what we will be discussing today?

Noelle Whitestone, MHA: We're discussing the review that we [Orbis International] did on global gender disparities in access to refractive error services. So, this review summarized existing evidence on these disparities, and what we saw was that globally, women do have less access than men to refractive error correction. We also saw that—this was somewhat surprising—[refractive error was] more pronounced in urban settings and also in Southeast Asia and Oceania.

What was unique about our review was that we looked at both adults and children. Previous reviews have looked at mainly just adults, and that was somewhat interesting. What we found, our results have to be taken with a little bit of a caveat, because there was a limited number of studies regarding children. Actually, we could see an increase in studies that looked at children in refractive error coverage. But what we saw was that there actually wasn't a difference [between children and adults]. The difference in accessing refractive error coverage became much more pronounced later in life.

Joy: What takeaways could be taken from that finding? Does that counteract anything that we previously knew about the prevalence of refractive error globally?

Whitestone: I don't think it changes that. I think it could actually be seen as a success story. The articles that we did include in the review that we were able to analyze actually were looking at school screenings, and that is where we get a lot of our data and evidence on refractive error coverage for children. I think it shows that these are actually good ways to have interventions, because we do see equal numbers of boys and girls presenting in school. What that leaves out is the kids who aren't in school, so we do have to take that into consideration and have targeted interventions potentially outside of schools. But I think it shows that school screenings are actually a very effective means of intervention.

Joy: To kind of switch gears a little bit, you mentioned the urban disparity for women in refractive error correction. Is this something that had previously been found? Why do we think that this disparity exists globally?

Whitestone: We always are thinking about remote and rural areas having limited access to services. I think while that still holds true, that's true for both men and women, and when we're in urban environments where there maybe aren't as many geographic limitations, we now have socio-cultural barriers and access to care, and that's probably our greatest hypothesis on what is addressing that.

Joy: What, overall, would you say contributes to that lack of women's access to eye care on that international scale?

Whitestone: Women have greater caregiving duties, so finding services and places of care where maybe the children can come with them, so that they don't have to find additional childcare support. Maybe sometimes, it's bringing those services to the workplace. We've seen a lot of workplace screenings, but that's sometimes more in traditional [male] workplaces. And now, at least Orbis International is certainly looking at bringing those to areas where there are more women working—so different ways to look at those indirect barriers and access to care within time and accessibility.

Joy: In the review, there was a discrepancy between countries, and income plays a big factor in that access as well. If you're segmenting the countries into those 2 categories [ie, low- vs high-income], how does that approach to improving access to eye care change?

Whitestone: I think that we have to look at ways to subsidize care, ways to make care affordable and available, whether that's within the infrastructure of a high-income vs a low-income country, or if that's looking at ways that once you seek that care, [determine whether it] is treatable. Certainly, getting glasses for refractive error is a very affordable intervention, but we have to make sure that those glasses are still affordable within the context of the environment where we're screening.

Joy: How can practitioners who are practicing in the US interpret these findings into their own patient care?

Whitestone: I think that it's everywhere. I think that we see advances within the US of being able to address this, and maybe it's not as pronounced, but I think there are still ways to make more women-friendly clinics or parent-friendly clinics. It's not even just always the women, especially in the US, who are taking care of families at home, but it is about how we make accessing care accessible. Even for myself, as a working mom, I have to juggle: When do I do it? During the day? Can the kids come with me? Is there a waiting area that might be comfortable, a place to do homework, etc? Is there an opportunity at a health fair that I may be going through at the farmers market there? I think there are creative solutions to find areas where we can access care in kind of women-friendly, or parent-friendly, or all types of friendly environments.

Joy: Anything else that you wanted to add that we haven't touched on?

Whitestone: I think that it is always exciting to look at reviews and see where the gaps are in the evidence base and where there are opportunities for new research and where they can address and direct us toward program interventions, policy, and advocacy overall.