|Year : 2021 | Volume
| Issue : 2 | Page : 97-101
Burden of ocular trauma and its effect on vision: A community-based cross-sectional study in the coastal population of South India
Pratima Sahu1, Amit Kumar Mishra2, Bhagwati Wadwekar3, Elfride Farokh Sanjana3, M Manikandan3
1 Department of Ophthalmology, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
2 Department of Ophthalmology, All India Institute of Medical Science, Raipur, Chhattisgarh, India
3 Department of Ophthalmology, Pondicherry Institute of Medical Sciences, Puducherry, India
|Date of Submission||25-Feb-2021|
|Date of Acceptance||19-Jul-2021|
|Date of Web Publication||30-Dec-2021|
Department of Ophthalmology, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Background: The burden of blindness worldwide is 39 million. One of the avoidable causes of blindness is ocular trauma. The ocular trauma could be prevented by preventive measures such as use of goggles and helmets.
Objective: The study was conducted to estimate the burden of ocular trauma and its effect on vision in the coastal area of South India.
Materials and Methods: A community-based descriptive cross-sectional study was conducted in the service area of a tertiary hospital in the coastal area of South India. Ethical approval was obtained from the institute ethics committee. House-to-house visits were done, and relevant information was collected from available and eligible participants. Data were entered in EpiData, and analysis was done in the Statistical Package for the Social Sciences V21.
Results: In this study, 1272 participants were interviewed, among which 882 (69.3%) were female. Most of the participants (27.8%) were in ≤30 years of age. Forty-nine (3.9%) participants had a history of one or more times eye trauma; among them, 38.8% reported that the cause of eye trauma was due to plant branch or thorn. The majority of the participants with a history of eye trauma (91.8%) did not use any safety measures while working such as goggles or spectacles. The vision was affected in 21 (42.9%) participants due to the trauma to the eyes.
Conclusion: The burden of ocular trauma in the current study is lower than that found in other few studies in India. Most of the eye injuries that occurred could have been prevented by the use of preventive measures such as goggles or spectacles.
Keywords: Blindness, ocular trauma, preventive measures, vision
|How to cite this article:|
Sahu P, Mishra AK, Wadwekar B, Sanjana EF, Manikandan M. Burden of ocular trauma and its effect on vision: A community-based cross-sectional study in the coastal population of South India. J Curr Res Sci Med 2021;7:97-101
|How to cite this URL:|
Sahu P, Mishra AK, Wadwekar B, Sanjana EF, Manikandan M. Burden of ocular trauma and its effect on vision: A community-based cross-sectional study in the coastal population of South India. J Curr Res Sci Med [serial online] 2021 [cited 2022 Jan 19];7:97-101. Available from: https://www.jcrsmed.org/text.asp?2021/7/2/97/334448
| Background|| |
The burden of blindness worldwide is 39 million. In 1998, there were an estimated 1.6 million cases of blindness from injuries. Ocular injuries contribute to half a million to this. The National Sample Survey Organization, 1991, recorded the prevalence of trauma-related visual impairment, 3.5% in rural areas and 3.2% in urban areas. A study conducted on the eye diseases in Andhra Pradesh recorded the history of eye injuries in 7.5% of the study participants, resulting in unilateral blindness in 0.6% of eye injured. Ocular trauma may lead to visual impairment and is probably one of the most under-recognized major public health problems facing the nation today. Lack of understanding of this epidemic may hamper the preventive efforts in this direction. There are very few community-based epidemiological studies on ocular trauma in India. Hence, in this study, we studied the prevalence of ocular trauma in the coastal population of South India so that appropriate preventive measures could be recommended to reduce the burden of ocular trauma and the visual impairment caused by it.
| Materials and Methods|| |
A community-based descriptive cross-sectional study was conducted in the coastal areas of Tamil Nadu and Puducherry to find out the burden of ocular trauma and its effect on vision. The ethical approval was obtained from the institute ethics committee of a tertiary medical college hospital, Puducherry. The survey was conducted in the service areas of the rural health center and urban health center, under the department of community medicine of a tertiary medical college hospital at Puducherry, which are located at the coastal areas of Tamil Nadu and Puducherry. We defined ocular trauma as any eye trauma causing discomfort, visible damage, giving rise to any visual symptoms, or needing medical attention. Adults (>18 years) who were permanent residents of the survey areas were included in the study. The sample size was estimated as 1234 using the formula 4pq/d2 at confidence level of 95% (α) and relative precision of 20% (d) anticipating the prevalence of ocular trauma as 7.5% (p).
The study was conducted in the service area of the peripheral centers of a tertiary medical college in Puducherry; the permanent residents of the service area formed the sampling frame from which the participants were selected by simple random sampling technique. Random houses were selected and house visits were made and all the available participants were interviewed until the sample size was achieved. Before the individual participant's interview, written informed consent was obtained from all the participants. The data were collected using a predesigned, pretested, printed questionnaire. The collected data were entered in EpiData version 3.1 (The EpiData Association, Odense, Denmark), and data analysis was done using IBM Statistical Package for the Social Sciences Statistics for Windows, version 21.0.(developed by IBM Corp, Armonk, New York). The qualitative variables were categorized into different categories as per the responses. The results were presented in proportion and percentages.
| Results|| |
In the current community-based survey, 1272 participants were interviewed, among which 882 (69.3%) participants were female (male:female ratio was 1:2.26). Most (27.8%) of the participants were in ≤30 years of age, followed by 31–40 years of age group (22.1%). One-fifth of the participants were illiterate, half of the participants were a homemaker (two-third of female participants were homemakers), and most of the study participants were in Class IV (30.3%) and Class V (30.9%) socioeconomic class according to the modified BG Prasad Scale [Table 1].
Forty-nine (3.9%) participants had a history of ocular trauma; among them, 21 (42.9%) were male and 28 (57.1%) were female. Most of the participants (24.5%) with a history of ocular trauma belonged to 51–60 years of age group, and most of them were homemakers (48.5%). Four participants had got eye trauma twice and one participant thrice. Two participants had eye trauma on both eyes, 22 had eye trauma in the right eye, and 25 had eye trauma in the left eye, respectively. Most (81.6%) of the participants with a history of eye trauma reported that eye trauma occurred more than 6 months back [Table 2]. About half of the participants with eye trauma reported the cause of eye trauma due to plant branch or thorn which occurred while working in the home garden or workplace followed by the injuries due to thrown or flying objects (24.5%). Half of the participants with a history of eye trauma reported that the eye trauma occurred while working at home followed by at workplace (30.6%). Three participants (6%) reported that eye trauma occurred as a result of the road accident. The majority of the participants (91.8%) did not use any safety equipment such as glasses or spectacles for eye protection during the work or driving [Table 3].
On interviewing about the treatment they had after the eye trauma, the majority (73.5%) of the participants reported that they visited an eye specialist for consultation, followed by seven (14.3%) who visited a general practitioner for eye consultation. Six (12.2%) participants did not visit any doctor. Three-fourth of the participants took medicines such as lubricants and antibiotics for their eye trauma and two participants underwent surgery. Ten (20.4%) participants did not use any medication for their eye trauma. The vision was affected in 21 (42.9%) participants due to the trauma to the eyes [Table 4].
| Discussion|| |
The prevalence of ocular trauma in the current study is 3.9%, similar to the 4% reported by a Nirmalan et al.'s study in the rural population of South India. The prevalence of ocular trauma in their survey was higher than that for glaucoma and diabetic retinopathy. The prevalence of ocular trauma was 7.5% in the rural population of Andhra Pradesh and 4% in the urban population. The present study was carried out in the region of Pondicherry and Tamil Nadu, which were urban and rural areas, respectively. Differences in the prevalence of ocular trauma may be explained by geographical variation, infrastructure, law enforcement, and awareness among the people about such injuries.
We inquired the participants whether they had suffered vision loss because of ocular trauma. It was affected in 42.9% of the participants due to the trauma to the eyes in our study which is a serious concern. The prevalence of blindness in the study by Dandona et al. due to trauma was 0.6% and visual impairment was 0.7% in the urban population. Gothwal et al. evaluated the extent of visual recovery after the multidisciplinary approach of treatment in serious ocular injuries and found poor vision in 39.5% (low vision [<6/18–3/60] in 14.7% and blindness [<3/60 to no perception of light] in 24.8%). Most of the ocular traumas in the present study were unilateral. Both eyes were involved in 4.1% [Table 3] of injuries. Bilateral ocular trauma was reported in 0.4% and 1% in other studies in the rural population of South India., In a study among the urban population by Dandona et al., bilateral involvement was reported in 19.5% of the study participants. The laterality of ocular trauma depends on the causes of ocular trauma, location where the trauma occurred, and whether any eye protection was worn at the time of ocular trauma. These factors might explain the different prevalence of bilaterality in various studies.
Most of the ocular injuries (46.9%) were reported in 41–60 years of age. The study by Krishnaiah et al. and Dandona et al. shows the maximum occurrence of ocular trauma between 30 and 60 years of age. This age group includes the most productive population. The effect of trauma not only causes ocular morbidity but also affects national productivity as the ocular trauma is more common among the productive age group (30–60 years)., Injuries were more common in females (57.1%) which is contradictory to findings of most other studies.,,, In a study by Dhasmana et al., overall injuries were common in males, but household injuries were common in females. Injuries were more common among illiterate participants in the present study which is consistent with previous studies. In the current study, injuries were found to be more prevalent in homemakers. This is because, in the current study, half of the participants were females and two-thirds of these were homemakers. Injuries among fishermen were 14.3%. Fishing is a substantial occupation of this region, and the fishermen population of Pondicherry is 30,000 according to the 2005 census. Class IV and V socioeconomic class (according to the modified BG Prasad Scale) was more involved in ocular trauma because of their nature of the occupation. Most of the previous studies show higher trauma rates with lower levels of education.,, In the present study, 42.9% of the participants with ocular trauma were illiterate, 41% had school-level education, and 16.3% were graduates. Higher education level is protective for ocular trauma per se.
Only 2% of the participants used protective glasses. The majority of the participants (91.8%) did not use any safety glasses or spectacles for eye protection during the work which lead to an eye trauma. Repeated trauma twice or thrice was noticed in 10.2% of the participants, which is a matter of concern. One participant, a fisherman by occupation, reported the history of eye trauma thrice, whereas few participants with occupation such as daily laborer, unemployed, homemaker, and data entry operator reported a history of eye trauma twice in the recent past. Although there is a paucity of affordable eye care in urban and rural India, the majority of the participants reported that they got a consultation with an eye specialist for their eye trauma. 14.3% visited a general practitioner for eye consultation which could be due to lack of eye care facilities in the region. Six (12.2%) participants considered their eye trauma minor and hence did not visit any doctor.
In the present study, we found that the majority of the participants (91.8%) did not use any safety equipment such as glasses or spectacles for eye protection during the work or driving. Our study may help to spread awareness about the risk of eye trauma involved with routine work and may stimulate community and policymakers to make compulsory use of the safety measures as most injuries are preventable/avoidable.
There are multiple studies of ocular trauma done in a hospital setting, but only a few studies are available in a community-based setting. Reliable and quality data on ocular trauma are completely lacking in our country; as a result, ocular trauma could not be recognized as a public health problem which is an avoidable/preventable cause of ocular morbidity. This is the first community-based survey on ocular trauma from our region, and the study comprises a large number of participants.
Based on the protocol, house-to-house visits were conducted, and data were collected from the available participants. As the field visits were made during working hours, most of the male residents could not be contacted for the survey. The information on eye trauma was recorded based on their memory which could lead to recall bias as minor events/trauma they would have forgotten/difficult to remember, and we did not assess the visual acuity objectively. Hence, the prevalence in our study may be an underestimate of the true situation.
| Conclusion|| |
The current study shows that the burden of ocular trauma in the survey area was lower than the prevalence reported by other studies in various parts of India. It is very important to note that although the burden was low as compared to other studies, the trauma had affected the vision of a greater proportion of study participants which could have been prevented by simple preventive measures such as use of glasses or spectacles.
The authors would like to acknowledge the support and help of the field staff of ARHC, Anaichikuppam and UHC, Pakamudyanpet, and the participants without whom it was not possible to conduct the community-based project on ocular trauma.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998;5:143-69.
National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India. Disability in India. NSS 47th
Round (July-December 1991). Available from: file:///C:/Users/acer/Downloads/IHSN%20Report%20NSS%20Round%2047%20Schedule%2026%20Survey%20of%20disabled%20persons.pdf. [Last accessed on2019 Dec 09].
Krishnaiah S, Nirmalan PK, Shamanna BR, Srinivas M, Rao GN, Thomas R. Ocular trauma in a rural population of southern India: The Andhra Pradesh eye disease study. Ophthalmology 2006;113:1159-64.
Nirmalan PK, Katz J, Tielsch JM, Robin AL, Thulasiraj RD, Krishnadas R, et al.
Ocular trauma in a rural south Indian population: The Aravind comprehensive eye survey. Ophthalmology 2004;111:1778-81.
Dandona L, Dandona R, Srinivas M, John RK, McCarty CA, Rao GN. Ocular trauma in an urban population in southern India: The Andhra Pradesh eye disease study. Clin Exp Ophthalmol 2000;28:350-6.
Gothwal VK, Adolph S, Jalali S, Naduvilath TJ. Demography and prognostic factors of ocular injuries in South India. Aust N Z J Ophthalmol 1999;27:318-25.
Maurya RP, Kundan S, Sen PR. Clinico-epidemiological study of ocular trauma in Indian University students. Pak J Ophthalmol 2013;29:80-8.
Dhasmana R, Bahadur H, Jain K. Profile of ocular trauma in Uttarakhand, A hospital-based study. Indian J Community Health 2012;24:297-303.
[Table 1], [Table 2], [Table 3], [Table 4]