| Abstract |
What is known and objective: Eye injuries are a major cause of visual disability worldwide and may present a burden to both quality of life of the sufferers and healthcare services. The aim of the retrospective study was to extract and triangulate information on the demographic, clinical and social features of eye-injured adult patients admitted to the General University Hospital of Heraklion, Crete, the single tertiary referral hospital of the island. Drawing the profile of eye-injured patients may add to future health planning. The aim of the prospective study was to explore the associations between visual outcomes of ocular injury patients with clinical and demographic variables and to evaluate the psychosocial impact of the injury on patients, especially during the period of coronavirus disease 2019 (COVID-19), as restrictive measures of quarantine and commuting led to further access limitation. Identifying factors related to visual outcomes and the psychological impact on the patients, certain protective and managing measures could be initiated, focusing on special geo-epidemiological needs of each region.
Methods: A retrospective study was conducted from 1 January 2015 to 31 December 2019, and data such as socio demographic features and clinical information were collected in a sample of one hundred twenty-eight adult patients. Of those, there was no available information on activity during injury for six patients, thus they were excluded from the analysis. The medical records of patients who presented to the Ophthalmology emergency department were screened and reviewed to fulfill demographic and clinical data for the analysis. In terms of the 18-month prospective study, 30 eye-injured adult patients were included between February 1, 2020 and August 31, 2021. Clinical data were recorded in cooperation with a specialized ophthalmologist who examined each patient at the ophthalmology emergency department until their discharge from the hospital unit. The socio-demographic data were collected via interview by the investigator using certain questionnaires and the Perceived Stress Scale 14 (PSS-14) was used one year after the study end to measure perceived stress. In both studies all participants were adults with eye injuries severe enough to require hospitalization at the ophthalmology clinic. Moreover, visual acuity was labeled as not poor (>0.5/10 or >20/400 on the Snellen scale, <1.3 in LogMAR scale) and poor (<0.5/10 or <20/400 on the Snellen scale, >1.3 on the LogMAR equivalent).
Results and discussion: In the retrospective study, 78(60.9%) had work-related ocular injuries, and 44(34.4%) had non-work related, whilst those with no current formal employment, those who were retired and formally unemployed and manual force workers had the highest rates of work-related injuries. The most common work-related injuries were closed globe, specifically contusions, while ruptures and penetrating wounds were the most frequent on the open globe injuries. Within the univariate analysis, work-related eye injuries were significantly associated with male gender, middle age and the place related to daily work activity. Determinants of poor final visual acuity (VA) were the initial VA, the type of injury (p<0.0001), the distance of the place of residence from the hospital, and the time to hospital admission (p<0.013). In a multivariate analysis, referred patients and those with open globe injuries arrived at hospital after a two-hour interval compared with those who were not referred and those with closed globe injuries (p<0.05). Most patients with work-related eye injuries did not wear protective eye devices (PED) while performing their duties (n=57, 90.5%). Out of the 30 ocular injury patients of the prospective study, 76.7% were men and most of them were self-employed and private or public sector workers (36.7%). Not poor final VA was related to not poor initial VA [odds ratio (OR) 1.714; p=0.006]. No statistical associations were found between visual outcome and demographic or clinical factors, but not poor final VA was associated with improved self-reported psychological condition of the sufferers, as examined by the PSS-14 questionnaire (8.36/10 vs 6.40/10, p=0.011). No patient reported job loss or changed work status following the injury. Not poor initial VA was significant predictor for not poor final visual outcomes (OR 1.714; p=0.006). Finally, patients with not poor final VA expressed higher levels of positive psychology and less fear of injury repetition (64.0 vs 100.0%; p=0.286) and not poor final VA was associated with low PSS-14 scores one year after the study end (77.3 vs 0.0%, p=0.003).
What is new and conclusion: The retrospective study highlighted the need of re-designing services by assisting with early hospital admission and promptly referring patients with severe ocular injuries while managing mild cases from physicians working at a community setting. This can lead to earlier recognition and therefore better visual outcomes of serious cases and appropriate management of mild without burdening large referral centers. In order to increase PED use and compliance, the special geographical, occupational and cultural features of a region should be taken into consideration when designing prevention and protective strategies. A focus on rural areas should be given to inform low-educated, elderly and residents about the risk of not wearing PED, while local settings could provide suitable and well-fitted protective equipment, as a public health measure initiative. The prospective study showed the need of collaboration between ophthalmologists, mental health professionals and primary care teams in order to help patients to cope with the psychological burden sequel to eye trauma. Moreover, it was highlighted that further studies should be conducted throughout Greece, focusing on special geo-epidemiological features to identify factors related to visual outcomes and the psychological impact on the overall health of patients.
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