Gender and Surgical Proficiency in Ophthalmology
There is no evidence that female ophthalmologists are more proficient than male ophthalmologists in performing ophthalmology surgeries. The available evidence demonstrates gender disparities in surgical volume and training opportunities, but does not address differences in surgical skill, patient outcomes, or complication rates between genders.
Key Evidence on Gender and Surgical Performance
Surgical Outcomes and Complications
- No difference in complication rates has been identified between male and female ophthalmology trainees performing cataract surgery, despite significant differences in case volume 1
- The American Academy of Ophthalmology's Preferred Practice Patterns emphasize that appropriate training, clinical experience, and judgment are necessary for performing ophthalmology procedures, without any gender-based distinctions in competency 2
Gender Disparities in Training Volume (Not Proficiency)
The research reveals significant gender gaps in surgical exposure during training, but these reflect opportunity differences rather than skill differences:
- Female ophthalmology residents complete 4.4% fewer cataract procedures (mean difference of -8.3 cases out of 189.2) compared to male residents over a 10-year period in US programs 3
- Female trainees in Australia/New Zealand performed 41.7% fewer cataract operations at the end of training compared to male counterparts, with the gap widening between years 1 and 4 1
- Total surgical volume was 21.1% lower for female trainees at 4 years, though interrupted training (more common in females at 30.6% vs 0.7%) was not a significant predictor of completed cataract numbers 1
Gender Distribution in Subspecialties
Women and men subspecialize at equal rates (46% vs 48%, P=0.15), but choose different practice areas 4:
- Women are significantly more represented in pediatric ophthalmology (20.1% vs 7.9%, P<0.001) and glaucoma (21.8% vs 16.0%, P<0.0001) 4
- Men are significantly more represented in vitreoretinal surgery (47.2% vs 22.0%, P<0.0001) 4
Practice Volume Differences (Not Skill Differences)
Among practicing glaucoma specialists, gender differences in procedural volume persist 5:
- Male glaucoma specialists performed 6.1 more MIGS procedures (95% CI, 0.5-11.8; P=0.03) and 110.2 more cataract procedures (95% CI, 16.9-203.5; P=0.02) than female specialists, even after controlling for clinical volume, years in practice, and group size 5
- No difference existed in trabeculectomy or office-based laser procedures between genders (P=0.38 and P=0.21 respectively) 5
Critical Distinction: Volume vs. Proficiency
The fundamental issue is that all available evidence addresses surgical volume and training opportunities, not surgical proficiency or patient outcomes. Lower case volume during training or practice does not equate to inferior surgical skill or worse patient outcomes. The single study that examined complications found no difference between genders 1.
Clinical Implications
Ophthalmology surgery should be performed only by appropriately trained ophthalmologists, regardless of gender 2. The guidelines emphasize that:
- Training, clinical experience, and judgment determine surgical competency 2
- Surgeons should perform only procedures for which they are adequately trained, experienced, and competent 2
- No gender-based recommendations exist for surgeon selection in any ophthalmology guideline 2
Common Pitfall to Avoid
Do not conflate differences in surgical volume with differences in surgical proficiency. The research demonstrates systemic barriers to surgical exposure for women in ophthalmology training (fewer opportunities to operate, more harassment, less mentorship) 6, but this reflects inequitable training environments rather than inherent differences in surgical capability.