Study links lower socioeconomic status to increased risk of open globe injury and poorer outcomes
A study investigating the impact of socioeconomic status on open globe injury (OGI) found that lower SES, measured by the Social Vulnerability Index and Distressed Communities Index, correlates with younger age, non-accidental injuries, and poorer visual outcomes in OGI patients.
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A team of researchers has investigated the relationship between socioeconomic status (SES), as assessed by the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) and the Distressed Communities Index (DCI), and the characteristics of open globe injury (OGI).
Prognosis is primarily determined by injury severity, with lower presenting visual acuity and more posterior injuries linked to poorer visual outcomes. However, even eyes with no light perception at presentation may recover some visual function.
This retrospective study reviewed electronic medical records of patients treated for OGI at an academic Level I trauma center from May 2009 to March 2021. Patient data included age, injury date, injury mechanism, presenting visual acuity, presence of concomitant orbital wall fractures, and ocular trauma score (OTS). SVI and DCI scores were assigned based on the patient’s home zip code. Patients were categorized by the specific mechanism of injury and grouped into non-accidental versus accidental cases.1
In addition to the severity of the primary injury, secondary injuries and complications play a significant role in poor outcomes, particularly proliferative vitreoretinopathy (PVR) and endophthalmitis. Endophthalmitis is a common complication following open globe injury, affecting up to 16.5% of patients. Systemic antibiotic prophylaxis is routinely used, although its evidence base is limited. In contrast, intraocular antibiotics, though less commonly employed, have stronger evidence supporting their efficacy in preventing infection.
Prompt primary repair of the injury can reduce the risk of endophthalmitis and may also improve visual acuity outcomes. While PVR cannot currently be prevented or treated with pharmacologic interventions, early vitrectomy within the first 4-7 days after injury may decrease the incidence of post-traumatic PVR. Timely surgical intervention remains a critical factor in mitigating long-term complications.
Ocular trauma training in Western ophthalmic surgical programs is often limited, and patients with ocular trauma frequently require the involvement of multiple subspecialists. Given the complexity of care, it is crucial for patients to have a coordinated management plan, with a lead clinician overseeing and ensuring comprehensive care across all specialties involved.
The researchers included 899 patients (75.0% male) in the study. The average ± SD age (years), SVI, and DCI scores were 44.8 ± 22.7, 0.418 ± 0.207, and 37.9 ± 24.0, respectively. Younger age was associated with higher DCI and lower OTS score (p ≤ 0.002). Non-accidental trauma patients had lower OTS and higher SVI and DCI scores compared to accidental trauma (p < 0.001); firearm-associated ocular injuries (FAOIs) were associated with higher SVI and DCI scores (p < 0.001 and p = 0.040, respectively); domestic violence/assault was associated with worse OTS and higher DCI (p < 001). Falls and sports-related injuries correlated with lower DCI scores (p ≤ 0.031).1
Conclusions
The researchers noted that prompt primary repair, combined with intraocular administration of antibiotics, minimizes endophthalmitis risk and may optimize visual outcome. Optimal timing is based on retrospective studies, with 24 h being the most commonly used arbitrary cut-off, and it is likely that sooner is better.
Moreover, there is no evidence to support eye removal to prevent sympathetic ophthalmia when primary repair is possible, even in the most severely injured eyes.
“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 wrote. “Therefore, lower SES may be considered a risk factor for several distinct mechanisms of OGI.”
