There is a gender gap present in almost every aspect of women's lives. Access to education, political representation, employment opportunities, wage disparity, and even physical safety are areas where women across the world are frequently at a disadvantage. What is less commonly known is the gender gap that exists when it comes to sight. At least 55 percent of the world’s blind are women and most live in low and middle-income countries. Women are also 1.3 times more likely to be blind or vision impaired than men, and most significantly, four out of five of them don’t need to be blind, as their eye conditions can be easily prevented or treated.
The high prevalence of cataract blindness in women is a result of a combination of biological and social factors. Evidence from epidemiological studies suggests that biological sex differences play a significant part in this excess of cataracts among women but the mechanisms behind this are not yet clear. Women tend to live longer than men making them more susceptible to age-related illnesses like macular degeneration and cataracts. Additionally, theories about estrogen withdrawal are being studied to further try to elucidate the disparity in cataract prevalence.
Social factors play an enormous role in the prevalence of blindness for women as well. As a group, women receive less than half of the services provided. The reasons for this are varied. In many families, the health of women is simply not prioritized, particularly if a woman has a condition that’s not life-threatening. For some women, it can be harder to travel for treatment because of family responsibilities. For others, a lack of education means they aren't even aware they can get help. Additionally, in some communities, there is a sense of shame surrounding any type of disability, including vision impairment. In Pakistan, for example, women are often afraid to be seen as a burden on the family and ashamed about being blind, so may not seek services.
The second major example of inequities in vision between women and men is trachoma which is still endemic in more than 50 countries. Over time, repeated infections result in the development of scar tissue on the inside of the eyelid. This may eventually lead to trichiasis, from resultant entropion, eventually leading to a corneal abrasion, ulceration, perforation, and ultimately the loss of sight.
The Vision 2020 Initiative aims to eliminate all avoidable blindness by 2020 but pays little or no attention to issues of gender equity. Similar criticisms can be made of the most recent initiative from the WHO. Through it is Universal Eye Health: A Global Action Plan for the Prevention of Blindness 2014–2019 did adopt the principles of universal health coverage (UHC) it paid almost no attention to goals, targets, and indicators related to equality between women and men. Unless this ‘gender blindness’ is tackled in both research and service delivery, it seems likely that a large percentage of people who are still blind will be women living in the poorest parts of the world.
It is time to make this a priority for women to get the care they need. More than 20 million women in the world are blind and further 120 million women are visually impaired. We are advocating for our sisters, mothers, daughters, grandmothers, and girlfriends.
Cataracts are warned... we are coming for you.