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

TOPIC: Summarize existing evidence on global gender disparities in access to refractive error (RE) correction, among adults and children. CLINICAL RELEVANCE: Uncorrected RE 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 women 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 gray literature sources from inception to 15 February 2024 for population-based observational studies reporting effective or overall RE 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 Joanna Briggs Institute tool. Random-effects models were made of the age-adjusted female:male odds ratio (OR) of REC, stratified by 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 low for adults and very low for children using the Grading of Recommendations Assessment, Development and Evaluation approach. Women had lower REC than men (OR: 0.86; 95% confidence interval [CI]: 0.78-0.96; P = 0.01). Urban, but not rural, women were significantly less likely than men 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 women were significantly less likely than men 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). CONCLUSIONS: 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. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.