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Do No Harm: The Importance of Equity in Medicine and Eye Care

The first rule of medicine is to do no harm, but is that enough in a world that is inherently unequal? If we treat unequal people the same, don’t we just perpetuate inequality? These are the questions that drive the American Academy of Ophthalmology to create new programs aimed at narrowing disparities in eye care among racial and ethnic groups.

Tamara R. Fountain, M.D.

Professor, Rush University Medical Center, Former President, American Academy of Ophthalmology

Health disparities exist across all fields of medicine; ophthalmology and vision health are no exception. Studies show Black, Hispanic, Asian, and Native American people are at greater risk of vision loss and blindness compared with White Americans. Glaucoma, diabetic retinopathy, and cataracts are among the eye diseases and conditions that disproportionately affect these populations.

Glaucoma is six times more prevalent in Black Americans compared with Whites, and they are six times more likely to have advanced vision loss. Black and Hispanic patients have more severe diabetic eye disease at the time they receive treatment, and the prevalence of cataracts is disproportionately greater in Black, Hispanic, and Chinese Americans than in White Americans.

Ignoring these disparities in eye care means that millions of Americans will not receive all the benefits of modern eye care. Confronting these disparities is complex and requires an all-hands-on deck approach.

All hands on deck

One strategy ophthalmologists are pursuing is to increase the diversity of the healthcare workforce. Studies show that patients feel more welcome if there is someone in the office whom they can relate to or who has some shared life experience. The problem is that the healthcare system is fundamentally flawed not only in how it delivers care, but also in how it recruits, trains, and motivates physicians.

That’s why the American Academy of Ophthalmology has teamed up with the Association of University Professors of Ophthalmology to create the Minority Ophthalmology Mentoring program. The program seeks to increase diversity in ophthalmology by helping underrepresented medicine students become competitive ophthalmology residency applicants. Students receive one-on-one mentorship, valuable guidance in medical career planning, networking opportunities, and access to a variety of educational resources.

The program has actively supported 206 students since it launched in 2018. Nine out of 12 program students that participated in the 2021-22 ophthalmology match cycle were successfully accepted into an ophthalmology residency program. This 75% match rate is above the 70% success rate reported for all U.S. participants. A recent study credited this program with helping to increase the number of under-represented minorities matching into ophthalmology from 4.9% to 10.8% in just three years.

Shaping the future of eye care

The success of the program is best seen not in the statistics but in the details of individual people. Take Dr. Clara Castillejo Becerra, for example. Dr. Becerra was admitted to the prestigious Mayo Clinic College of Medicine and Science, where she’s currently in her third year of residency.

She came to the United States from Peru with her family when she was just 12 years old. They settled in Gwinnett County, part of the large, diverse Atlanta metropolitan area. She excelled in school and went on to Mercer University in Georgia. While she continued to ace her studies, she struggled to fit in with the mostly White student body. She didn’t linger and graduated in just 2.5 years. For medical school, she sought out a more diverse and welcoming community, and she found it at Ohio State University College of Medicine.  

When it came time to decide what kind of doctor she would become after graduating medical school, she again sought out programs that value diversity. That’s how she heard about the ophthalmology mentoring program. She and her mentor, Dr. Laura Wayman, associate professor of ophthalmology and visual sciences at Vanderbilt University, hit it off right away. Residency is rough, but Dr. Wayman has been her rock, grounding her, reminding her why she chose medicine — to help communities of color get the care they deserve.

“Treating someone of similar background is always a happy experience,” Dr. Becerra said. “They ask, ‘are you really my doctor?’ They light up; they want to know about me and my background. Building that relationship, that trust, is critical to their care. I’ve been lucky to experience it.”

Dr. Becerra is unsure where she’ll practice ophthalmology when she’s done with residency, but she knows she’ll serve an ethnically diverse community and that she’ll give back to the mentoring program.

Bringing social justice to the healthcare system won’t happen with a single program, but this single program is already making a difference.

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