An Eye on Gender and Health

By Jennifer Walker

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alumn_claytonIn 2003, on the National Institutes of Health campus in Bethesda, Maryland, ophthalmologist Janine Austin Clayton ’84 had a serendipitous experience at a health exhibit for the National Eye Institute. There, a young woman, about 20 years old and wearing baggy, cartoon-covered pajama bottoms, asked her about treatment for her red and burning eyes. During a consult, Clayton, who was in the middle of a seven-year stint as NEI’s deputy clinical director, saw that the young patient, who was already being treated at NIH for premature ovarian failure, also had dry eye, a condition that primarily affects older women. After reading that young women with this disease often have estrogen and androgen levels low enough to indicate menopause, Clayton designed a study and discovered that dry eye can be a symptom of premature ovarian failure in 18- to 25-year-old women. (Her research was published in Archives of Ophthalmology in 2004.) This experience, which drove home how sex and gender can influence health and disease, is one of many that has prepared Clayton for her recent appointment to director of the Office of Research on Women’s Health and associate director for Research on Women’s Health at NIH.

Clayton, who has authored or co-authored more than 65 research papers about eye diseases, did not plan to become an advocate for women’s health. As an undergraduate natural sciences student at Johns Hopkins, however, she “got bitten by the research bug” while working in a genetics lab, where she developed her first research questions and then designed studies to answer them. “[Hopkins’] focus on research does make a difference,” says Clayton, who married fellow graduate Robert B. Clayton ’84, an attorney, in 2008. “Every school does not have that focus.” Later, a class about delivering health care, which covered population issues and access to services, introduced her to the policy side of medicine.

In medical school, Clayton chose to specialize in ophthalmology. In the mid-1990s, she became aware of the role that sex and gender influences play in health and disease during her fellowship in cornea and external diseases at the Wilmer Eye Institute at Johns Hopkins Hospital. While there, she developed an interest in Sjögren’s syndrome, an autoimmune disease that affects nine women for every one man. Today, Clayton still remembers a 70-year-old patient with the syndrome whose “immune cells were attacking her eyes and melting the tissue”; the legally blind woman needed four corneal transplants. Then, during her next fellowship at NEI, she noticed that more female patients had uveitis, another autoimmune ocular disease that can cause calcium deposits, cataracts, and scarring.

Clayton, who in September 2012 became the second director of ORWH since the office was established in 1990, now wants other researchers and physicians across specialties to consider how sex and gender influence their work. “Understanding these influences could change the way [physicians] practice,” she says. Take, for example, the sleep-inducing drug Ambien, which is processed more slowly in women’s bodies. If women take the same dosage as men, the drug may impair their functioning the next day. “[This reaction] is not related to women being smaller than men or weighing less than men,” Clayton says. “[It’s] a basic biological difference between females and males in how they respond to the drug.”

Guided by a mission to ensure that NIH’s 27 institutes and centers have women’s health research on their agendas, Clayton is focused on achieving ORWH’s six strategic goals by 2020, including encouraging the medical community to design technologies, medical devices, therapeutic drugs, and prevention and treatment plans with women and girls in mind. This year, she’ll concentrate on increasing the number of scientists who think about sex differences when designing studies, from formulating hypotheses to reporting findings. “We’re trying to infuse this [thought] process throughout the entire research continuum,” she says.

This is a new frontier for many of her peers, but Clayton is ready for the challenge, as long as she is making a difference.