Articles

Is there a different predisposition to develop eye diseases between women and men? And if so, what are the reasons for this important gender difference?

The American population study

In support of this hypothesis, a large cohort study was published in Ophthalmology Science in 2025 by Victoria A. Bugg and her research team, which tested the differences between men and women with low vision or blindness in the United States.

The study considered 14,549,105 patients, aged between 50 and 99 years, whose data had been included in the American Academy of Ophthalmology's IRIS (Intelligent Research in Sight) Registry between 1 January 2018 and 31 December of that year. Patients were divided, based on best corrected visual acuity in the dominant eye, into four categories: mild, moderate, severe low vision and blindness. The causes of vision loss were identified according to the International Classification of Diseases and included: age-related macular degeneration, glaucoma, retinal detachment, retinal vein occlusion, corneal opacity, and amblyopia. Blind patients were obtained by subtraction of visually impaired subjects from the total number.

Results

The end result was that American women included in the study were more likely to be diagnosed with eye disease or vision loss than men. This finding may to some extent be influenced by the greater frequency with which women visit eye laboratories than men when they experience visual discomfort.

However, when comparing similar data by age, women were found to be at higher risk of developing cataracts, age-related macular degeneration, diabetic retinopathy and macular holes.

Men, on the other hand, have a higher risk of retinal detachment.

Focus on details

According to the IRIS database data, women had a much higher risk profile than men with these detailed specifications:

• the risk of mild to moderate vision loss in women was 30% higher than in men
• severe vision loss was 35% more frequent in women
• total blindness was 54% more prevalent in females.

Female sex and the retina

In support of the hypothesis of a greater ocular fragility associated with the female sex, one must consider the influence that a physiological event such as the menopause can have on the health of the eye and in particular the retina.

The risk of retinal diseases increases in women after the age of 50 and particularly after the menopause.

An analysis by pathology shows that post-menopausal women present:

• a higher risk than 32% of developing macular degeneration and macular holes
• a higher risk than 8% of developing diabetic retinopathy
• a 10% increase in the risk of retinal vascular occlusions.

Part of this vulnerability can be explained by the lowering of oestrogen levels due to the menopause. Oestrogens are protective hormones against oxidative stress that can affect all ocular tissues and in particular the retinal photoreceptors.

Anatomical differences between the female and male eye

A 2023 study, published in Frontiers in Medicine and based on machine learning techniques, analysed eye scans of healthy young adults and identified anatomical differences between female and male eyes. In particular, the structure of the retina was found to be different between men and women, as in men the inner layers of the retina are on average thicker, while in women they are thinner.

Consider that AI algorithms were able to recognise the gender of participants based on retinal thicknesses.

Quantitative proteomic profiling and gender differences

A preclinical study, published in Biology of Sex Differences then identified the biomolecular basis of the diversity between male and female eyes. By examining differences in protein expression in tissues, they identified 21 proteins expressed differently in the retinas of men and women and 58 proteins different in the retinal pigment epithelium.

These differences in the proteome influence fundamental processes such as cell activation, repair, survival and death of retinal cells.

Diversity observed in clinical practice

Moving from research laboratories to clinical practice, it was found that:

• women develop autoimmune-based uveitis more often, because they have a more reactive immune response.
• men are more affected by infectious uveitis,
• retinal detachment is less common in women (-30%), often because it is more common in men following trauma.

Conclusions

We need to rethink certain aspects of ophthalmological clinical practice in relation to the gender differences that we now know in order to avoid late diagnoses, adoption of incorrect therapies, inadequate patient compliance or side effects that could be prevented.

With the development of clinical protocols that take into account gender differences, more effective, personalised and equitable care could be ensured.

Finally, it is necessary to consider that in order to promote the transition to a more precise and truly tailor-made ocular medicine, women are on average 'longer-lived patients' and, moreover, they are people with specific clinical needs, linked to biological, hormonal and genetic patterns that make them physiologically different from male patients.

• Bugg VA, Eppich K, Blakley MS, Lum F, Greene T, Hartnett ME. Vision Loss and Blindness in the United States: An Age-Adjusted Comparison by Sex and Associated Disease Category. Ophthalmol Sci. 2025 Feb 7;5(4):100735. doi: 10.1016/j.xops.2025.100735.
• Farias FM, Salomão RC, Rocha Santos EG, Sousa Caires A, Sampaio GSA, Rosa AAM, Costa MF, Silva Souza G. Sex-related differences in the retinal structure of young adults: a machine learning approach. Front Med (Lausanne). 2023 Dec 14;10:1275308. doi: 10.3389/fmed.2023.1275308.
• Jang GF, Crabb JS, Grenell A, Wolk A, Campla C, Luo S, Ali M, Hu B, Willard B, Anand-Apte B. Quantitative proteomic profiling reveals sexual dimorphism in the retina and RPE of C57BL6 mice. Biol Sex Differ. 2024 Oct 30;15(1):87. doi: 10.1186/s13293-024-00645-9.