ASCRS News: 2021 ASCRS Annual Meeting 
September 2021

by Liz Hillman
Editorial Co-Director

The past year has been a year of dual pandemics, said Leon Herndon, MD—the COVID-19 pandemic, as well as the “pandemic of racism rearing its ugly head.” The ASCRS Annual Meeting hosted a symposium on “Redefining Our Vision for Future Generations: Implicit Bias in Ophthalmology.”

While the past year highlighted healthcare inequities with COVID-19, previous studies have been done showing inequity in care and within the medical profession for years, Dr. Herndon, co-moderator of the session with Ann Caroline Fisher, MD, said.

Benjamin Reese Jr., PsyD, gave a keynote lecture ahead of an in-depth panel discussion. He gave historical context to the ongoing racial reckoning in the U.S., going back to slavery and the “pseudoscience” that at the time said black people weren’t really human, Dr. Reese said. Dr. Reese also referenced the historic, unethical experimentation on black people in the U.S.

These notions of pseudoscience still exist in a subtle, ingrained way today. Implicit biases are unconscious and include both favorable and unfavorable associations with powerful ramifications, Dr. Reese said.

Disparity in healthcare can be linked, in part, to implicit bias, which he said is impacted by race, gender, and perceived sexual orientation.“In spite of the training [and] the oath of providers, none of us are immune to implicit bias,” he said, adding later that implicit bias is a “reflection not of our character but a reflection of the fact that we’re human.”

Things that can help reduce implicit bias, according to Dr. Reese, are introducing an objective standard to reduce discretion, slowing down in exams and patient discussions, and creating reminders for yourself about implicit bias, keeping it within your mind and decision making.

Dr. Reese later addressed the importance of identifying the systemic structures that support bias and inequities. The panel was discussing how recognizing and addressing inequities that stem from implicit bias starts at the top, and while Dr. Reese said that leadership is critically important, the systems and structures that reinforce these inequities need to be addressed. 

Keith Warren, MD, said he has seen implicit bias within his own position of leadership. He said when he would ask to move a decision in a certain direction, he found he would have to provide solid evidence to justify why. “I got the impression it’s because maybe there was a lack of confidence and comfort having someone who looks different give advice for the direction we should move in,” Dr. Warren said, adding later that he has noted that in most instances when people can see a benefit from changing their bias, they will act to do so. 

Dr. Reese asked the panel what some of the obstacles are to reducing implicit bias in medicine and healthcare delivery. Richard Lindstrom, MD, said one is a perceived negative personal impact. He shared a story that he was on the board of directors of a public company. They looked around the table, saw they all looked the same, recognized that they should increase diversity on the board, and voted to do so. But everyone, Dr. Lindstrom said, thought it was someone else who would be removed. “Everyone was in favor of diversity and inclusion as long as it didn’t impact them,” he said. 

From a structural change perspective, it also has to start “from the bottom,” Dr. Warren said, explaining that the first step is to increase the pool of diverse candidates to choose from. O’Rese Knight, MD, said that residency selection is from a seemingly limited group. Over the past 8–9 years, the number of positions available to graduates has grown, but the number of underrepresented minorities who match in ophthalmology hasn’t followed, Dr. Knight said. 

Cassie Ludwig, MD, agreed that a big issue continues to be underrepresentation of historically excluded groups in ophthalmology. As patient-provider social concordance improves patient trust, underrepresentation itself is adding to disparities in patient care in ophthalmology. She also noted that when demographic data is collected on providers and patients, it needs to be done so in a thoughtful way that asks questions about all races, ethnicities, gender identities, and sexual orientations. When efforts aren’t made to recruit and include diverse participants, the effects of study interventions on historically excluded groups become uninterpretable. 

Relevant disclosures

Herndon: None
Knight: None
Lindstrom: None
Ludwig: None
Reese: None
Warren: None