Refractions of Bias: Seeing DEI Clearly in Ophthalmology

In a discipline that celebrates clarity of vision, it’s ironic that we sometimes fail to see our own blind spots. Diversity, equity, and inclusion (DEI) in ophthalmology is not just a matter of optics—it’s a matter of outcomes. Whether in the clinic, the classroom, or the research lab, unconscious biases subtly distort the lens through which we view talent, treat patients, and design studies.

As an Indian ophthalmologist who has trained in both London and the US, I’ve experienced this first-hand. While my fellowships were academically enriching, they also came with a sense of cultural distance. In clinical discussions, I was often the only non-Western fellow in the room. Teams rarely reflected the diverse communities they served. It made me ask: in a global specialty, why is the representation within our training and leadership so limited?

This isn’t just about optics. It’s about patients. Data shows diverse medical teams foster trust and improve outcomes, especially for underrepresented groups.¹ And yet, women in ophthalmology still face subtle—but damaging— barriers: fewer surgical opportunities, being mistaken for nurses, or having their leadership ambitions quietly dismissed.² Similarly, Black and Asian populations continue to be underrepresented in trials, even though they bear a disproportionate burden of diseases such as glaucoma and diabetic retinopathy.³

Clinical research also reflects this inequity. Despite the global burden of blindness being highest in low- and middle-income countries, most randomised trials are designed, funded, and published in the Global North.⁴ These studies then dictate global guidelines, often ignoring socioeconomic or cultural nuances. As a result, interventions may be technically sound but practically ineffective or even inappropriate in local contexts.

Even our DEI initiatives sometimes feel performative. Diversity panels filled with the same voices. Committees with no power. Tokenism is easy. Transformation is hard.

So how do we ‘walk the walk’?

First, we widen the pipeline. Let’s reach out to underrepresented students early—with mentorship, shadowing, and scholarships. Diversity must begin before the residency interview.⁵

Second, we commit to transparency. Let’s publish anonymised data on applicant demographics, pay gaps, and promotions. If we track visual acuity so precisely, why not track equity with the same rigour?

Third, we embed bias training into real clinical life. Not just box-ticking modules. We need reflective storytelling, real mentorship, and debriefs on microaggressions. We train our eyes to spot retinal tears—why not train our minds to spot systemic ones?⁶

Fourth, research must reflect reality. Funders and journals should prioritise diversity in trial recruitment and reward innovation that addresses health disparities.⁷

And finally, leadership must reflect the world we serve. That means rethinking who gets the microphone, who gets promoted, and whose voices get heard.

This is not about lowering standards. It’s about understanding that the current standards may have been built to exclude. Just as we correct distorted corneas to sharpen sight, we must correct distorted systems to sharpen fairness.

My vision is of an ophthalmology community where a hijab-wearing woman, a first-gen student, a queer Black doctor, and a disabled surgeon feel not just included, but empowered; where diversity is not performative—but profound.

Until then, DEI must not be an agenda item. It is our collective responsibility.

Declaration: This essay was developed without the assistance of AI tools.

Each year, young ophthalmologists are invited to participate in the John Henahan Writing Prize, responding to an essay prompt provided by the medical editors of EuroTimes. Anuj Kodnani MBBS’s essay scored among the top three in a very competitive field.

Applicants responded to the following prompt:

Diversity, equity, and inclusion (DEI) programmes, however well-intentioned, stir a variety of responses in the corporate and political worlds and in the scientific and medical spheres. What DEI and unconscious bias issues are present in the current culture of ophthalmology training, practice, and clinical research? What are the potential benefits of addressing these issues for patients and ophthalmologists? What kind of meaningful changes need to happen to move beyond ‘talking the talk’ to ‘walking the walk’?

1. Saha S, Beach MC, Cooper LA. J Natl Med Assoc. 2008; 100(11): 1275–1285.

2. Royal College of Ophthalmologists. Facing workforce shortages and backlogs in the aftermath of COVID-19: The 2022 Census. 2023. https://www.rcophth.ac.uk/wp-content/uploads/2023/03/2022-Ophthalmology-census-Facing-workforce-shortages-and-backlogs-in-the-aftermath-of-COVID-19.pdf

3. Adams DR, et al. Ophthalmology, 2022; 129(5): 458–460.

4. Gilbert CE, et al. Br J Ophthalmol, 2020; 104(7): 941–947.

5. Capers Q, et al. Acad Med, 2017; 92(3): 365–369.

6. Sukhera J, Watling C. Acad Med, 2018; 93(1): 35–40.

7. Chen MS, Lara PN, Dang JH, Paterniti DA, Kelly K. Cancer, 2014; 120(Suppl 7): 1091–1096.