Research Illuminates Gender and Racial Disparities in Ophthalmology Resident Surgical Volume

A new study in JAMA cuts deep into who’s getting surgical reps and who’s getting left behind.

Turns out, not all scalpel time is created equal. A comprehensive U.S. study examining surgical case volumes among ophthalmology residents over a ten-year period has uncovered persistent disparities based on gender and underrepresented in medicine (URiM) status.

Published in JAMA Ophthalmology, the study analyzed data from 4,811 graduates of Accreditation Council for Graduate Medical Education (ACGME)-accredited ophthalmology residency programs between 2014 and 2023.¹

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Key findings

Female residents performed, on average, 4.4% fewer cataract surgeries and 7.4% fewer total surgical procedures compared to their male peers. And this disparity is certainly not fleeting; the study also revealed a trend that held steady over the entire decade.¹

URiM trainees—defined as those identifying as American Indian, Alaska Native, Black, African American, Hispanic, Latino, Spanish Origin, Native Hawaiian or Pacific Islander—did not show a significant difference in cataract case volume, but still recorded 5.3% fewer total procedures compared to non-URiM residents.¹

“The results of this study suggest a gender and URiM disparity in surgical experience during ophthalmology residency training in the U.S. over the last decade,” noted the research team led by Dr. Susan Culican.¹

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Who was studied? 

Among the residents, 41.6% were women and 58.4% were men. URiM individuals made up 7.1% of the total cohort.¹

Interestingly, while the gender split remained consistent across the decade, the representation of URiM residents showed a promising upward trend, from just 2.8% in 2014 to 11.3% in 2023.¹ 

Where else did the gaps show? 

The discrepancies extended into several subspecialties. Female residents reported lower case volumes in globe trauma, intravitreal injections, keratorefractive surgery and oculoplastics.¹

Despite these disparities, it’s worth noting that all resident groups exceeded ACGME minimum requirements in every category. Still, quantity often paves the way for confidence and autonomy—two factors bound to long-term clinical success. ¹

Why the gap? 

The study builds on previous research that has already ruled out factors like parental leave. The authors suggested possible contributing factors may include disparities in surgical autonomy granted by faculty, differences in trainee confidence, or systemic biases that shape clinical opportunity. 

The consequence could be more symbolic, “because surgical volume dictates compensation, undertraining residents may have career-long implications for pay equity,” the researchers pointed out. 

The authors called for further studies to explore program-level factors and the intersectional impact of race and gender in residency training. Identifying where disparities emerge—and why—could help ensure more equitable hands-on experience in a field where every case sharpens skill and future opportunity.¹ 

After all, if the eye is the window to the soul, maybe it’s time to take a hard look at who’s being handed the tools to peer through it.

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Reference

1. Culican SM, Syed MF, Park YS, et al. Gender Differences in Case Volume Among Ophthalmology Resident Graduates, 2014-2023. JAMA Ophthalmol. 2025;143(6):490-497.