Ocular trauma caused by intimate partner violence more common in women than men
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Key takeaways:
- Women are more likely than men to experience intimate partner violence-related ocular injuries.
- Home is the most common location for injury.
Intimate partner violence-related ocular injuries are more prevalent among individuals aged 18 to 39 years. The patients are more often women than men, and home is the most common injury location, according to a study.
The study used the National Trauma Data Bank, the largest trauma registry in the U.S., as a source of data. The search focused on patients aged 18 years or older who were hospitalized for intimate partner violence (IPV) ocular injury.
Between 2017 and 2019, 508,976 records of patients with ocular injury were identified, of which 2,598 were associated with IPV. While the age of patients was up to 89 years, 46% of patients were between the ages of 18 and 39 years. There were 1,618 female patients (62.3%) and 980 male patients (37.7%).
Of note, while ocular injuries as a whole were more prevalent in male adults (67.9%), IPV-related ocular injuries were more common in female adults, the study said. Home was the most common location for injury, with greater odds of injury at home for women as compared with men.
The highest prevalence of injuries was reported in white patients. According to the authors, this disparity may be due to underreporting, which is known to be even more acute within ethnic minority communities.
The greatest number of patients were covered by Medicaid, the program for individuals with low income, and women and Black patients were the most likely to present with Medicaid.
“This shows an association between vulnerable populations and financial precarity regarding IPV-related ocular trauma,” the authors wrote.
Alcohol and drug abuse were often associated with IPV eye injuries, with 41.5% of patients testing positive for alcohol and 22.1% testing positive for drugs.
Many of these findings may serve as an area for further research, the authors said.
“Ophthalmologists can play a crucial role in IPV detection and prevention, and this study may help to identify important risk factors of ocular injuries in survivors of IPV,” they wrote.
Perspective
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I was very pleased to read the paper from Alik and colleagues looking into the epidemiology and mechanisms of injury for intimate partner violence-related ocular trauma.
The eyes are involved in 45% of injuries resulting from intimate partner violence (IPV), so it is a topic that we as ophthalmologists need to learn more about and be comfortable discussing with our patients. I applaud the authors on this retrospective cross-sectional analysis of the National Trauma Data Bank as it is the largest study to date looking at IPV and ocular injuries. The summary of the current state of knowledge regarding IPV and ocular injuries is excellent and catches the reader up to where we are in the field at this time. The definitions of IPV and IPV-related ocular injuries are broader than in other studies looking at IPV in ophthalmic trauma patients, and a review of the patient locations after discharge from the emergency department indicates that the patients captured in this study had more severe injuries than in previous studies.
While the percentages will differ depending on the definition of IPV and injuries included, the general trends found in this study are important. Among the findings of the study are that gender (62.3% women), race and ethnicity (52.3% white), and insurance status (32.6% Medicaid) are risk factors for IPV-related ocular injuries. While women made up the majority of the IPV-related ocular injury patients, men constituted more than two-thirds of the overall ocular injury patients. This study highlighted disparities in gender and race and ethnicity with ocular injuries from IPV and the role of social determinants of health. Future studies would benefit from evaluating the racial and ethnic and insurance status breakdown of the general ocular trauma population for comparison with the IPV-related ocular injury patients.
At our Level I trauma center at the University of Iowa, we see a lot of orbital fractures, and this has raised our interest in understanding how often orbital fractures result from IPV and the mechanisms of these injuries in women. Our first study showed that IPV was the third leading documented cause of orbital fracture in adult women after motor vehicle collisions and falls, but 20% of the patients had no documented etiology for the fracture, so rates of IPV could have been even higher.
Once we had a better understanding of the documented mechanisms of injury for orbital fractures and the staggering frequency at which IPV was occurring in our patient population, we set out to identify characteristic injury patterns that we could use to perform targeted screening with patients unaccompanied. We found that both ocular and orbital injuries from IPV typically resulted from significant force. This meant that ocular injuries from IPV were more likely to be severe in nature, such as a ruptured globe and orbital fractures from IPV had a higher percentage of zygomaticomaxillary complex fractures than isolated orbital floor fractures.
Armed with this information, we enhanced the emergency department screening protocols at our institution and developed an educational curriculum regarding IPV injury patterns. Most recently, we reported in JAMA Ophthalmology that these two interventions resulted in improved referral patterns and homegoing safety assessment for adult women with IPV-associated orbital fractures. This highlighted the role for targeted screening for IPV, increasing awareness for IPV injury patterns, and the need for physicians to make appropriate referrals once these patients are identified.
We also have had the pleasure of creating an IPV CME course through the American Academy of Ophthalmology (https://www.aao.org/education/course/intimate-partner-violence) to increase awareness of IPV in the ophthalmic community and improve comfort and confidence with targeted screening.
There is absolutely a need for further studies looking into IPV and ocular and orbital injury patterns. For example, little work has been done looking at men who experience IPV and their ophthalmic injury patterns. Future research may also help in identifying the most effective means for eye care providers to conduct screening and support patients who are experiencing IPV.
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