Study Links Lower Socioeconomic Status to Increased Risk of Open Globe Injury and Poorer Outcomes
A research team has explored the connection between socioeconomic status (SES) and the incidence and outcomes of open globe injury (OGI). Using the Social Vulnerability Index (SVI) and Distressed Communities Index (DCI), the study evaluated how SES influences injury characteristics and recovery.
The study highlights that prognosis after OGI is primarily influenced by injury severity. Factors such as lower presenting visual acuity and more posterior injuries are linked to poorer visual outcomes. However, even patients presenting with no light perception may recover some visual function with proper intervention.
Methodology
This retrospective study analyzed data from 899 patients treated for OGI at an academic Level I trauma center between May 2009 and March 2021.
Key data collected included:
• Demographics: Age, injury date, and mechanism of injury.
• Clinical Details: Presenting visual acuity, ocular trauma score (OTS), and presence of orbital wall fractures.
• Socioeconomic Data: SVI and DCI scores based on home zip codes.
• Patients were categorized into non-accidental and accidental injury groups.
Key Findings
SES and Injury Patterns
• Lower SES Scores: Linked to younger age, firearm-associated ocular injuries (FAOIs), and non-accidental injuries such as domestic violence and assault.
• Accidental Injuries: Falls and sports-related injuries correlated with higher SES and lower DCI scores.
• Firearm-Associated Ocular Injuries: Patients with FAOIs showed significantly higher SVI and DCI scores.
• Domestic Violence/Assault: These cases were associated with worse OTS and higher DCI scores.
Complications and Secondary Injuries
Secondary injuries and complications, including proliferative vitreoretinopathy (PVR) and endophthalmitis, significantly influence outcomes:
• Endophthalmitis: Affects up to 16.5% of OGI patients. While systemic antibiotics are routinely used, intraocular antibiotics have stronger evidence supporting their efficacy in preventing infections.
• PVR Prevention: Early vitrectomy within 4-7 days post-injury may reduce the incidence of PVR.
Surgical and Clinical Interventions
• Primary Repair Timing: Prompt surgical repair, ideally within 24 hours, reduces the risk of endophthalmitis and improves visual outcomes.
• Sympathetic Ophthalmia: No evidence supports eye removal to prevent sympathetic ophthalmia when primary repair is feasible, even for severely injured eyes.
Coordinated Care Challenges
The study emphasizes the importance of coordinated care led by a primary clinician due to the complexity of managing ocular trauma cases. These patients often require multidisciplinary care involving multiple subspecialists.
Study Insights
The average patient characteristics were:
• Age: 44.8 ± 22.7 years.
• SVI Score: 0.418 ± 0.207.
• DCI Score: 37.9 ± 24.0.
Key associations:
• Younger patients exhibited higher DCI and lower OTS scores (p ≤ 0.002).
• Non-accidental trauma cases had lower OTS and higher SVI and DCI scores (p < 0.001).
Conclusions
The study underscores the role of lower socioeconomic status as a significant risk factor for specific injury mechanisms, such as firearm injuries and domestic violence-related trauma.
“In our region, among patients with OGIs, lower SES scores were associated with younger age, FAOIs, and non-accidental injuries, including domestic violence/assault,” the researchers noted.
They concluded that prompt primary repair and intraocular antibiotics are critical to reducing complications and improving visual outcomes. This study highlights the need for targeted interventions to address disparities in care for patients with lower SES who face increased risks of severe ocular trauma.
Reference:
Schulz, M., Bonnell, A.C., Chee, Y.E. et al. Associations between socioeconomic status and open globe injury. Eye (2024). https://doi.org/10.1038/s41433-024-03537-9
