A recent study¹ published by Parisa Emami-Naeini, MD, MPH, and colleagues found that ophthalmology had the fewest number of minority residents of any specialty and that nationwide, only 7.2% of practicing ophthalmologists are from underrepresented minority groups. (Read the study here.) 

Ore-Ofe O. Adesina, MD; Tayyeba K. Ali, MD; Benjeil Z. Edghill, MD; and Dr. Emami-Naeini, recently discussed the current lack of diversity, equity, and inclusion (DEI) in ophthalmology and efforts to address it. This article features a synopsis of that discussion.

Panel Discussion | Led by Dr. Ali

Throughout the United States, the medical field in general and the ophthalmology specialty in particular face multiple challenges to increasing DEI, as outlined below.

Late identification of qualified applicants. Dr. Emami-Naeimi acknowledged that, because the pool of DEI candidates is so small, the top ophthalmology residency programs vie for them. There is a need to identify a broader pool of qualified minority candidates earlier in the process, she said (many medical schools do not introduce ophthalmology until the third or fourth year). One solution, suggested Dr. Emami-Naeimi, is to improve medical students’ residency applications by connecting them to CV-boosting research opportunities and mentors.

Scarcity of senior mentorship of diverse backgrounds. Dr. Adesina acknowledged diverse representation among ophthalmic mentors as a critical need. Currently, he noted, there are not enough senior practitioners of diverse backgrounds in ophthalmology available to mentor every trainee. “We need more and broader support to increase our numbers of minorities in ophthalmology.” Colleague-allies are needed, he said, to increase mentorship opportunities until a critical mass of minority mentors is achieved.

Limited introductory pathways to ophthalmology. Dr. Edghill feels that practicing ophthalmologists of all backgrounds need to be proactive about increasing the number of DEI applicants to ophthalmology. He suggested various methods of outreach, including attendance at job fairs and hosting information sessions (in person and remotely) at schools without ophthalmology programs.

The Importance of Professional Representation and Support | By Dr. Edghill

“A lot of us want to turn our tests into testimony.”

Dr. Edghill was encouraged to pursue a career in ophthalmology by two key people: his mother, who was a nurse and thought that ophthalmology might fit his personality; and his own ophthalmologist, an African American man who provided Dr. Edghill with mentorship and access to someone in the field.

The ophthalmology section meeting at the National Medical Association’s Annual Assembly was for Dr. Edghill a “holy grail,” where he witnessed a roomful of successful ophthalmologists who looked like him. These practitioners were writing research papers and being called upon for their expert opinions. Such representation and the connections he forged there made Dr. Edghill feel that there was a rightful place for him in the specialty.

As a participant and winner of the Rabb-Venable Research Competition, Dr. Edghill received preparation and speaker training, which boosted his confidence in public speaking. Genuine encouragement from senior ophthalmologists of color helped with imposter syndrome, which minority students often feel because they lack role models to whom they can relate and make them feel like they belong. Twelve years later, Dr. Edghill became the president of the National Medical Association Ophthalmology Section. One of his more recent initiatives was to help launch the Dr. David K. McDonogh Scholarship in Ophthalmology/Otolaryngology Specialties, which connects minority students to research opportunities, mentors, and funding. 

How Representation Affects Patient Care | By Dr. Adesina

“While this hasn’t always been recognized as an issue in the past, I believe we are recognizing this more.”

A truly therapeutic doctor-physician relationship is based on more than the frequency of visits, said Dr. Adesina. “The fact that you may be seeing a physician regularly does not necessarily mean that a therapeutic relationship has been established, and since we know that patient-physician concordance of race and ethnic background are factors that affect compliance and patient outcomes, these have to be included in this conversation,” he explained. In his neuro-ophthalmology practice in Houston, where he performs eyelid, orbital, and strabismus surgery for a diverse population, nearly half of his patients with severe idiopathic intracranial hypertension are Black (unpublished data) and present with vision loss that necessitates surgical intervention via optic nerve sheath fenestration. The fact that these patients can relate to him and his background is rewarding to Dr. Adesina, and he believes it fosters a level of trust that helps improve patient compliance and outcomes.

Dr. Adesina has been a student educator, and he agrees that workshops, webinars, and town hall meetings are all good ways to expand outreach to prospective minority students. He lauded the programs that are working to recruit more minority students into ophthalmology: the National Medical Association’s Rabb Venable Program; the Association of University Professors of Ophthalmology; the American Academy of Ophthalmology, through its Minority Ophthalmology Mentoring Program; the AAO’s DEI taskforce, and toolkit that includes an expanding chapter on social determinants of health. He noted that certain subspecialties, such as glaucoma and retina, also have programs aimed at increasing their numbers of minority students. Dr. Adesina said that these programs and others like them should continue the work that has already been started.

Representation Beyond Ophthalmology | By Dr. Ali 

“Following your passions and dreams won't get you where you want to go. You have to gather and hone rare and valuable skills while in training.”

Dr. Ali recommends that all prospective medical students read Cal Newport’s book, So Good They Can't Ignore You, which introduces the concept of career capital and dives deeper into the concept quoted above. Although those in the medical profession have the advantage of a structured foundation that allows for natural career capital compared to the general public, she advises that all trainees take advantage of additional opportunities in areas such as health tech, bio tech, health economics, medical humanities, or other areas that will help you stand out from your colleagues. This will allow you more control over your professional life, which will ultimately increase you career satisfaction and overall well-being and will enable you to be a better physician.

Dr. Ali follows a few personal guidelines for focusing her attention on being the best physician she can be:

• She reminds herself that she is privileged with the task of preserving and restoring vision.
• She spends 10 minutes per day on reflective reading and writing, as this helps her to define the personal values that guide her practice.
• The act of reflective reading has made her a better listener, able to pick up on subtle details. Dr. Ali pauses and listens to her patients while looking them in the eye and working to understand them and their concerns. She feels that going beyond making a textbook diagnosis to provide nuanced advice for patients to lead healthy lives is rewarding for the patient and the physician.  

1.  Atkuru A, Lieng MK, Emami-Naeini P. Trends in racial diversity among United States ophthalmology residents. Ophthalmology. 2022;129(8):957-959. doi:10.1016/j.ophtha.2022.03.020