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Berlin, September 2024 – The eye health of men and women is not the same. Differences in anatomy and hormones influence the frequency of eye diseases, and women are often more sensitive to medication and contact lenses, but show better treatment results. Professor Dr. med. Maya Müller will explain what findings are available, what impact they could have and why further research, for example with artificial intelligence, is important on October 10, 2024 at the hybrid press conference at the DOG annual congress.

Gender medicine has established itself as an important field of research in recent years. “It is also becoming increasingly important in ophthalmology,” says Professor Dr. med. Maya Müller, Medical Director of the Institute for Refractive and Ophthalmic Surgery (IROC) in Zurich, Switzerland. “For us ophthalmologists, it is important to understand differences between men and women in order to optimize treatment strategies and increase patient safety,” adds the DOG expert, who is also a member of the German Society for Gender-Specific Medicine.

Women lose their eyesight more often

Women in the USA have a 15 percent higher risk of suffering from blindness or visual impairment than men. This is shown by data from the IRIS Registry, the world’s largest database for ophthalmology.¹ For example, women worldwide are 2 to 4 times more likely to suffer from narrow-angle glaucoma, a form of glaucoma.² “This is partly due to anatomical differences, as women often have smaller eyes and narrower anterior chamber angles,” explains Müller. Women also suffer from endocrine orbitopathy 4 to 5 times more often than men.³ – a disease that is noticeable through very bulging eyes. “This is related to the fact that autoimmune thyroid diseases such as Graves’ disease occur much more frequently in women,” says Müller.

Female cornea is thinner and more sensitive

Women in many regions worldwide also develop cataracts up to 1.7 times more often, especially after menopause.⁴ “The decline in estrogen as a protective factor against oxidative stress in the eye could play a role here,” explains the DOG expert. After all, the cornea is also different; it is thinner and more sensitive in women – which could also be due to hormones, as estrogen can influence the function of the nerves in the cornea.⁵ “The increased sensitivity may lead to a greater tendency to dry eyes, a typical eye disease in women, and discomfort that becomes noticeable, for example, when wearing contact lenses,” emphasises Müller.

Gender differences in eye drops

There are also gender differences in the effectiveness and tolerability of therapies. “We know that women are often more sensitive to certain medications or preservatives in eye drops,” explains the ophthalmologist. On the other hand, therapies often work better because women implement their treatment more consistently. “Women use glaucoma drops more regularly and require fewer check-ups for age-related macular degeneration,” explains Müller. Psychosocial factors therefore also play a role.

Gender-specific approaches in therapy and prevention are lacking

There are many aspects that show gender-specific differences in ophthalmology. But implementing these findings in everyday clinical practice is difficult. “Many ophthalmologists are not sufficiently trained to take gender-specific factors into account,” says Müller. Above all, there has not yet been enough research into what this means specifically for therapy and prevention.⁶ “There is a lack of detailed long-term studies that analyze differences in terms of frequency, disease progression and treatment outcomes,” criticizes Müller. “In short: we lack guidelines that suggest gender-specific treatment approaches.”

The ophthalmologist from Switzerland is pinning her hopes on big data and artificial intelligence. “They enable more precise evaluations,” says Müller. In the end, says the DOG expert, both sexes would benefit from optimized, personalized therapy.

Literature:

1. IRIS Registry, Ophthalmology Times, November 4, 2023. Do women bear a greater burden for blindness and visual loss in the United States? See here: AAO 2023: Do women bear a greater burden for blindness and vision loss in the United States? (ophthalmologytimes.com)
2. Tehrani, S. (2015). Gender differences in the pathophysiology and treatment of glaucoma. Current eye research, 40(2), 191-200.
3. Ponto, K. A., et al. (2013). Gender-Specific Aspects in Thyroid-Associated Orbitopathy. Experimental and Clinical Endocrinology & Diabetes, 121(6), 320-325.
4. World Health Organization (WHO). Global Data on Visual Impairments 2010. Available from: https://www.who.int
5. Koskela, T., Manninen, J., & Laitinen, T. (2020). Gender and age-related differences in central corneal thickness. Journal of Cataract and Refractive Surgery
6. Suggested Principles for Sex and Gender Data in Ophthalmology Clinical Trials, JAMA Ophthalmol. 2024;142(2):131-132. doi:10.1001/jamaophthalmol.2023.6281 IRIS Registry, Ophthalmology News, November 3, 2023.

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