Background The magnitude of blindness is unevenly distributed worldwide. This systematic review aimed to study gender differences in the prevalence of blindness, cataract blindness and cataract surgical coverage in India among persons aged 50 years and above.

Methods Literature search was carried out in the Medline, Web of Science, Google Scholar, EMBASE and Trip databases. Data were abstracted and risk of bias was assessed for the selected full-text articles. Pooled prevalence, ORs and risk differences were synthesised by meta-analyses.

Results 22 studies were included in the systematic review. The pooled prevalence of blindness obtained for men was 4.17% and that for women was 5.68%. Women had 35% higher odds of being blind (OR 1.35, 95% CI 1.08 to 1.62) and 69% higher odds of being cataract blind (OR 1.69, 95% CI 1.44 to 1.95). Women had a 27% lower odds of getting cataract surgery (OR 0.73, 95% CI 0.45 to 1.01). In women, around 35% of the prevalence of blindness and 33% of the prevalence of cataract blindness are attributable to their gender.

Conclusion Marked gender differences in blindness, cataract blindness and cataract surgical coverage were seen in India, with the odds being unfavourable for women. Interventions implemented for reduction of blindness, including cataract blindness, need to consider these gender differentials in the Indian context. Further research is needed to ascertain the reasons for these differences and devise interventions to reduce these differences in order to tackle the magnitude of avoidable blindness in India.