Socioeconomic deprivation and serious ocular trauma in Scotland: a national prospective study

Association Between Socioeconomic Deprivation and Orbital Trauma in a Hospital-Based Population

PURPOSE

To examine the association between area-level socioeconomic deprivation and orbital trauma among emergency ophthalmology consults.

METHODS

We conducted a cross-sectional study using 5-year Epic data for all hospital-based ophthalmology consults at the University of Maryland Medical System, and the Distressed Communities Index (DCI) data for area-level socioeconomic deprivation. We ran multivariable logistic regression models adjusting for age to compute odds ratios (OR) and 95% confidence intervals (CI) for the association between the DCI quintile 5 distressed score and orbital trauma.

RESULTS

A total of 3,811 cases of acute emergency consults were identified, of whom 750 (19.7%) had orbital trauma and 2,386 (62.6%) had other traumatic ocular emergencies. The odds of orbital trauma among people living in a distressed community were 0.59 (95% CI 0.46-0.76) times the odds for those living in a prosperous community. Among White subjects, the odds of orbital trauma for people living in a distressed community were 1.71 (95% CI 1.12-2.62) times the odds for those living in a prosperous community; among Black subjects, the OR was 0.47 (95% CI 0.30-0.75; p-interaction = 0.0001). Among women, the OR for orbital trauma among those living in a distressed community was 0.46 (95% CI 0.29-0.71); among men, the OR was 0.70 (95% CI 0.52-0.97; p-interaction = 0.03).

CONCLUSION

Overall, we found an inverse association between higher area-level socioeconomic deprivation and orbital trauma among both men and women. The association varied by race, such that there was an inverse association with higher deprivation among Black subjects in contrast to a positive association among White subjects.

Characteristics of ocular injuries associated with mortality in patients admitted with major trauma

BACKGROUND

Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries.

METHODS

A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05.

RESULTS

Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity.

CONCLUSIONS

Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.

Firework-Related Ocular Trauma at a Level 1 Trauma Center During a City-Wide Pandemic Lockdown: A Case Series

Purpose To report six ocular injury cases caused by unlicensed fireworks and subsequent complications at a level 1 trauma center in the setting of coronavirus disease 2019 (COVID-19)-related shelter-in-place orders. Observations All six cases occurred between March 2020 and July 2020 and involved fireworks of non-official use. A majority of subjects were male between the ages of 17 and 53 years old. Ocular trauma presented as the following: Case 1 is a 17-year-old male who sustained a left-sided corneal abrasion and small intraocular foreign body after a firework exploded in his hand. Case 2 is a 47-year-old male who presented with a right globe rupture after being struck with a projectile from a neighborhood fireworks display. Case 3 is a 36-year-old male with corneal abrasion, traumatic iritis, and commotio retinae after a firework injury in the setting of alcohol use. Case 4 is a 35-year-old male who presented with left lid injury, corneal abrasion, and hyphema after being struck by a firework with evidence of penetrating eye trauma on subsequent exams. Case 5 is a 53-year-old male who developed bilateral subconjunctival hemorrhages and a partial-thickness corneal laceration after a firework exploded in his left hand. Case 6 is a 48-year-old woman who sustained bilateral corneal stromal foreign bodies while cooking after a firework exploded near her vicinity. Conclusions and importance Fireworks are a preventable cause of mortality and long-term ocular morbidity. The index of suspicion for open globe injuries related to fireworks should be high given the mechanism of injury. These presenting cases at a level 1 trauma center and safety net hospital may be an unforeseen by-product of COVID-19 lockdowns. Our findings are relevant to trauma centers and safety net hospitals with large cases of firework injuries. Further initiatives to improve awareness of the dangers of fireworks should be prioritized to limit harms for all community members.

COVID-19 pandemic impact on ocular trauma in a tertiary hospital

AIM

To analyze the impact of the coronavirus disease-2019 (COVID-19) pandemic on the presentation and characteristics of patients hospitalized for ocular trauma in a tertiary hospital in China between 2019 and 2020.

METHODS

A retrospective case study was designed to collect information on all cases of ocular trauma in a tertiary hospital from 2019 to 2020 and compare differences in inpatients' data (age, sex, admission vision acuity, type of diagnosis, hospital stays, mechanism of injury and location of injury).

RESULTS

The total number of patients admitted to the Ophthalmology Department was 883 (mean 73.58±11.25 patients per month) in 2019 and 714 (59.50±17.92 patients per month) in 2020. The injury number of in work was also the most within the four types of location in this two year (42.36% in 2019, 43.84% in 2020). The mean hospital stays were 12.66d in 2019 and 10.81d in 2020. The highest incidence of ocular trauma was the middle-aged (41-65y) groups in 2019 and 2020. The most common cause of ocular trauma was sharp object in 2019 (47.34%) and 2020 (47.58%). The mechanical ocular trauma reaches 98.98% in 2019 and 99.72% in 2020.

CONCLUSION

The number of patients with ocular trauma decreased in 2020, but middle-aged (41-65y) are still high incident groups. Mechanical ocular trauma remains the leading cause of hospitalization for ocular trauma patients and the proportion of patients injured at home increases. It is necessary to arouse social attention and the public's awareness of eye trauma protection should be strengthened during the pandemic.

Social determinants associated with loss of an eye in the United States using the All of Us nationwide database

PURPOSE

To identify common factors associated with the loss of an eye using the NIH All of Us database.

METHODS

In this case-controlled study, we extracted electronic health record and socio-demographic data for 231 cases of eye loss from All of Us enrollment sites. Controls (N = 924) matched the demographic characteristics of the 2020 United States Census. Bivariate analyses and multivariable logistic regression identified variables significantly associated with increased odds of eye loss.

OUTCOME MEASURES

Medical and social determinants associated with increased odds of losing an eye.

RESULTS

Among cases, the average age (standard deviation) was 60.1 (14.4) years. The majority (125, 54.1%) were male. 87 (37.7%) identified as African American, and 49 (21.2%) identified as Hispanic or Latino. Loss of eye was more likely in those with ocular tumor (odds ratio [OR] 421.73, 25 95% confidence interval [CI] 129.81-1959.80, p < .001), trauma (OR 13.38, 95% CI 6.64-27.43, p < .001), infection (OR 11.46, 95% CI 4.11-32.26, p = .001) or glaucoma (OR 8.33, 95% CI 4.43- 15.81, p < .001). African American (OR 2.39, 95% CI 1.39-4.09, p = .002) and Hispanic or Latino (OR 1.80, 95% CI 1.01-3.15, p = .04) participants were disproportionately affected.

CONCLUSIONS

Racial and ethnic disparities exist among those with loss of an eye from underlying conditions. Addressing health inequities may mitigate the risk of this morbid outcome.

Ocular Trauma During COVID-19 Pandemic: A Systematic Review and Meta-analysis

PURPOSE

This study aimed to summarize the latest literature on the trends and incidence of ocular trauma during the COVID-19 pandemic.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic literature search was conducted to identify the relevant literature. The search period was between January 1, 2020, and September 20, 2021. The incidence of overall and various types of ocular trauma during the COVID-19 pandemic and the control period was analyzed. The data from different studies were pooled. The odds ratio (OR) and 95% confidence interval (CI) were calculated.

RESULTS

A total of 32 articles were included. After pooling the data from all included studies, the incidence of total and pediatric ocular trauma during the COVID-19 pandemic was 67.7% and 54.3% of those in the control period, respectively. However, the proportion of ocular trauma in eye emergency visits increased during the pandemic (OR, 95% CI: 1.46, 1.04-2.06). The proportion of domestic ocular trauma increased (OR, 95% CI: 3.42, 1.01-11.62), while ocular trauma related to sports and outdoor activities and occupational ocular trauma decreased (OR, 95% CI: 0.64, 0.09-4.29 and 0.18, 0.10-0.33, respectively). It was also reported that chemical injury caused by alcohol-based sanitizers, photokeratitis caused by ultraviolet lamps, and mechanical eye injury caused by masks increased during the COVID-19 pandemic.

CONCLUSIONS

There was a reduction in overall eye injuries and substantial differences in the spectrum of ocular trauma during the COVID-19 pandemic. Proper health education and supervision should be strengthened to prevent ocular injuries related to COVID-19 preventive interventions.

Role of Socioeconomic Status (SES) in Globe Injuries: A Review

Globe injury is a serious worldwide public health issue frequently leading to permanent vision impairment. The plethora of different types of globe injuries is classified into categories, including open and closed globe injuries. Globe injury occurs mainly in the workplace and at home, affecting predominantly middle-aged working men. Socioeconomic status (SES) is defined by income level, educational attainment, and employment status. Low socioeconomic status has been associated with a higher incidence of globe injury and can be utilized to identify at-risk populations. For managing open and closed globe injuries, different strategies are applied and the implementation of adequate globe injury prevention measures is needed for reducing the occurrence of globe injury. The following article aims to provide an overview of globe injury characteristics and their correlation with socioeconomic status and to highlight the significance of considering SES as a variable in globe injury prevention.

Epidemiology and outcomes of open globe injuries: the international globe and adnexal trauma epidemiology study (IGATES)

PURPOSE

To detail the methodology for a novel ocular trauma registry and utilize the registry to determine the demographics, nature of injury, and associations of severe visual loss for open globe injuries (OGI).

METHODS

Thirteen hospitals in 7 countries used International Globe and Adnexal Trauma Epidemiology Study (IGATES) platform. Patients presenting between April 2009 and 2020 with OGI (with or without) adnexal involvement or intraocular foreign body (IOFB) were included.

RESULTS

Analyses of presenting and final VA, using "severe vision loss" (VA ≤ 6/60) and "no severe loss" (VA > 6/60), were performed. Four hundred fifty-four (64%) patients had VA < 6/60 at presentation and 327 (44.8%) at final follow-up, with a highly significant association between presenting and final VA (p < 0.0001). From the cohort of 746 patients, 37 were missing VA at presentation and 16 at follow-up and complete clinical data was available for 354 patients. The male to female ratio is 6:1, and mean age 36.0 ± 20.0 years old. Relative afferent pupillary defect (RAPD), zone III injury, IOFB, and eyelid injury at presentation were recorded in 50 (6.7%), 55 (7.8%), 97 (13%), and 87 (11.7%) patients, respectively, and were significantly associated with VA < 6/60 at follow-up. Older age, ≥ 61 years, was associated with 3.39 times (95% CI: 1.95-5.89) higher risk than ≤20-year-old patients (p < 0.0001) and males 0.424 times (95% CI: 0.27-0.70) lower risk than female (p = 0.0001) of severe vision loss (SVL).

CONCLUSION

In OGIs from 13 hospitals, female gender, older age, zone III injury, eyelid injury, and IOFB were associated with higher risk of visual outcome of SVL.

Causes, occupational risk and socio-economic determinants of eye injuries: a literature review

Purpose

This review provides literature views on ocular trauma, with emphasis on common causes of injury, occupational risk, socio-economic factors, management peculiarities and some implications on overall care approach, from prevention to treatment.

Methods

A literature search was performed using key words in PubMed to extract the most relevant articles on ocular injuries, from an occupational point of view. Seventeen relevant articles were included out of seventy-two. Eight relevant articles were found from the references of the articles included and were also added. The total number of articles for this systematic search analysis was twenty-five. Collected information was tabulated in the Appendix.

Results

Most of the included publications were original articles. Many studies were retrospective and cross-sectional with a satisfactory rate of participant recruitment when reported. Most of eye injuries occurred in the workplace. Common eye injuries were due to foreign bodies and corneal abrasions. High-risk occupations included welders, farmers, metalworkers and grinding, construction and manufacturing workers. Most of the injuries could be preventable by using suitable protective eye devices (PED) but appropriate protection is a more complex process than it appears.

Conclusions

Findings of this review showed that it is compulsory to inform people about the risk and consequences of eye injuries. Eye care services should be designed keeping in mind geo-epidemiologic trauma etiology patterns and local health system capacity. Issues of adherence to prevention measures remain object of knowledge dissemination, educational planning and cultural appraisal. Modernizing equipment and respecting workplace regulations are tasks that deserve continuous attention.

Impact of COVID-19 pandemic and national lockdown on ocular trauma at a tertiary eye care institute

Purpose:

To evaluate the impact of the COVID-19 pandemic and the national lockdown on the demographic and clinical profile of patients presenting with ocular trauma.

Methods:

In this retrospective, hospital-based, comparative analysis, patients presenting to the emergency department with ocular trauma in the following COVID-19 period (March 25, 2020 to July 31, 2020) were compared with patients in the pre-COVID-19 period (March 25, 2019 to July 31, 2019).

Results:

Overall, 242 patients (COVID-19 period: 71 and pre-COVID-19 period: 171) presented with ocular trauma. The mean age of the patients in COVID-19 and pre-COVID-19 periods were 26.7 ± 17.3 and 34.1 ± 20.3 years, respectively (P = 0.008). A majority of patients (68.6%) in both groups were from the rural background. Home-related injuries were common in the COVID-19 period (78.8%) as compared to pre-COVID-19 period (36.4%) (P < 0.0001). Iron particles (29.5%) were the common inflicting agents in the COVID-19 period while it was plant leaves (25.5%) in the pre-COVID-19 period. The most common ocular diagnosis was open globe injury (40.8%) in the COVID-19 period and microbial keratitis (47.9%) in the pre-COVID-19 period. Surgical intervention was required in 46.4% of patients in the COVID-19 period and 32.1% of patients in the pre-COVID-19 period (P = 0.034).

Conclusion:

During the COVID-19 period, there was a significant decline in the number of patients presenting with ocular trauma. In this period, a majority of patients sustained ocular trauma in home-settings. About half the patients required surgical intervention which was most commonly rendered in the form of primary wound repair.

Socioeconomic Status and Decreasing Incidence of Ocular Injuries in Bosnia and Herzegovina

Purpose: To examine the epidemiologic and clinical characteristics of ocular injuries and their association with socioeconomic status (SES).Material and Methods: All cases of ocular injuries hospitalized in Department of Ophthalmology of University Clinical Center Tuzla, Bosnia and Herzegovina, from January 2009 to December 2012 and January 2017 and December 2019 were prospectively followed. The injuries were classified according to Ocular Trauma Classification System (OTCS) and Birmingham Eye Trauma Terminology (BETT).Results: This study included a total of 420 eyes from 396 patients. There were 162 (38.57%; 95%CI: 32.86-44.99) open globe injuries (OGI) and 258 (61.43%; 95%CI: 54.16-69.4) closed globe injuries (CGI). The decrease in incidence of ocular trauma requiring hospitalization was noted from 16.7 per 100 000 (95%CI: 13.11-20.97) in 2009 to 9.25 per 100 000 (95%CI: 6.64-12.55) in 2019 (p=0.006). Most injuries occurred in males 341 (81.19%; 95%CI: 72.8-90.28), active working patients 258 (61.43%, 95%CI:54.16-69.4), and patients with rural residence 285 (67.86%; 95%CI: 60.21-76.21). Almost all ocular injuries 418 (99.52%; 95%CI: 90.21-109.54) occurred in patients with middle and lower SES categories, and home was the most prevalent place of injury in 258 (61.43%, 95%CI: 54.16-69.4) patients. The total of 289 (70.49%; 95%CI: 62.59-79.1) patients had good final best corrected visual acuity (BCVA). Poor final BCVA was associated with lower ocular trauma score (OTS) (p=0.000), poor initial BCVA (p=0.000), penetrating injuries of cornea (p=0.004) and sclera (p=0.001), Zone III injuries (p=0.000), intraocular foreign body presence (p=0.000), cataract (p=0.002), retinal detachment (p=0.001), endophthalmitis (p=0.000) and vitreous hemorrhage (p=0.010).Conclusion: This study provides a detailed insight into epidemiology and socio-economic characteristics of patients hospitalized for ocular injuries.

Epidemiology and Clinical Patterns of Ocular Trauma at a Level 1 Trauma Center in Korea

BACKGROUND

To evaluate the patterns of distribution and clinical manifestations of ocular injuries referred to the level 1 trauma center of Pusan National University Hospital (PNUH) in Korea.

METHODS

We analyzed 254 of 4,287 patients who were referred to the Department of Ophthalmology at the level 1 trauma center of the PNUH, from January 2016 through December 2018. Data on the incidence of ocular injuries, sex, age, monthly and seasonal distribution, day and time of injury, side of injury, cause, residence of patients, referral time to an ophthalmologist and subsequent examination time, final visual acuity (VA), and complications were obtained from medical records and retrospectively reviewed. The patients were grouped according to their main diagnosis using the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS).

RESULTS

The incidence of ocular injuries with major trauma was higher in men (n = 207, 81.5%), the median age at time of injury was 54 years, and Pusan recorded the most cases. The incidences of ocular injury were 1.47/100,000, 1.57/100,000, 1.48/100,000 in 2016, 2017 and 2018, respectively. The most common cause was by a motorbike accident, followed by a pedestrian traffic accident and falls. According to the BETTS classification, open-globe injuries represented 4% of cases, closed-globe injuries represented 12.6%, and other injuries represented 83.1%. Open-globe injuries were significantly associated with low final VA (P = 0.01). In the OTS, 79.4% of patients received 4 or 5 points and 13.7% of patients received 1 or 2 points. The patients who received 1 or 2 points in the OTS score showed final VA below hand movement (P < 0.001), except for two patients. Lid laceration and low initial VA were highly correlated with poor final VA (P < 0.001).

CONCLUSION

This is the first study on the epidemiology and clinical manifestations in trauma patients with ocular injuries at a level 1 trauma center. The incidences of ocular injuries with major trauma were about 1.47-1.57/100,000. BETTS, OTS, lid laceration and initial VA were associated with final VA. We expect our study to provide a basis of data for the evaluation, prevention, and management of ocular injuries in patients with systemic trauma.

Demographic trends of open globe injuries in a large inpatient sample

PURPOSE

To evaluate demographic trends of open globe injuries (OGIs) using a large dataset representative of United States population.

METHODS

Retrospective cross-sectional observational study using the National Inpatient Sample (NIS) database from 2002 to 2013. Only patients with a primary admitting diagnosis of OGI were included. Data included age (in years), gender, race, type of OGI, death rate and length and cost of stay.

RESULTS

During the 12-year period, 27,467 adults (age > 20) with acute OGIs were admitted to the US hospitals. The incidence of OGIs in the adult US population was 10.6 cases per 1,000,000 persons. The mean age was 50.4 years (SD 21.52); the average ages of men and women were 44.34 (SD 17.63) and 65.69 (SD 22.77), respectively. Men accounted for 71% of all cases, with 84% of patients under 60. A decrease in the number of OGIs was seen with advancing age in men, whereas the opposite was true for women. Men, elderly over 80 and Blacks were at the highest risk of sustaining an OGI. The most and least common types of injuries were penetrating injuries (73%) and IOFBs (11%), respectively. Over half of young adults in the 21-40 cohort and 43% of men were uninsured (p < 0.001). The average length of hospital stay increased with age and was significantly much higher in women than men (3.4 vs 2.5 days).

CONCLUSIONS

Racial, gender and age disparities are prevalent in patients with OGIs. Although the majority of cases were seen in Whites and young men age 21-40 years, the incidence of OGIs per 1,000,000 persons per year was the highest in Blacks and Hispanics, elderly over 80, and men. One-third of all cases were uninsured. These disparities should be the basis of future public health safety measures.

Ocular trauma during COVID-19 stay-at-home orders: a comparative cohort study

PURPOSE OF REVIEW

The aim of this study was to report characteristics of patients presenting with serious ocular injuries during the COVID-19 stay-at-home orders.

RECENT FINDINGS

Of 1058 patients presenting for emergency evaluation during the stay-at-home order, 62 (5.9%) patients [mean (SD) age, 41.1 (19.2) years; 19 (31%) women; 31 (50%) white] presented with severe ocular trauma. The daily mean (SD) number of patients who presented for emergency evaluation decreased from 49.0 (9) to 36.4 (6) during the quarantine (P < 0.001). Patients presenting during the stay-at-home order were less likely to have health insurance [odds ratio (OR), 0.33; 95% confidence interval (95% CI), 0.13-0.90, P = 0.024], more likely to have a delayed presentation (difference, 22.7 h, 95% CI, 5.8-39.5, P < 0.001, more likely to travel farther to seek emergency care (difference, 10.4 miles, 95% CI, 2.6-18.2, P < 0.001) and more likely to have an injury occur at home (OR, 22.8; 95% CI, 9.6-54.2, P < 0.001). Of injuries occurring at home, there was a significant increase in injuries arising from home improvement projects during the stay-at-home order (28 vs. 0%, P = 0.02).

SUMMARY

During the COVID-19 pandemic, patients with ocular trauma were more likely to have injuries sustained at home and have additional barriers to care. These changes underscore a need for targeted interventions to optimize emergent eye care during a pandemic.