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Characteristics of Open Globe Injuries in the United States From 2006 to 2014

Educational Objective
To examine the incidence, common injury mechanisms, and economic burden of open globe injuries in the United States.
1 Credit CME
Key Points

Question  What were the population-based characteristics of open globe injuries in the United States from 2006 to 2014 from the Nationwide Emergency Department Sample?

Findings  This cross-sectional study of 124 989 emergency department visits for open globe injuries found that the incidence of open globe injuries was 4.49 per 100 000 population, accounting for $793 million in total charges. Males and individuals with a low socioeconomic status were at increased risk, and the incidence of open globe injuries associated with falls increased during the study period.

Meanings  These results suggest preventive efforts for open globe injuries should target males, individuals at risk for falls, and those from a low socioeconomic background.


Importance  Open globe injuries can lead to substantial visual morbidity and lifelong sequelae. Interventions to reduce the burden of open globe injuries in the United States require a better understanding of these injuries through well-designed epidemiologic investigations.

Objective  To examine the incidence, common injury mechanisms, and economic burden of open globe injuries in the United States.

Design, Setting, and Participants  This retrospective, cross-sectional study of US nationwide emergency department (ED) data assessed all ED visits of patients with a primary diagnosis of open globe injury in the Nationwide Emergency Department Sample (NEDS) from January 1, 2006, to December 31, 2014. Data analysis was performed from August 29, 2018, to November 11, 2019.

Main Outcomes and Measures  Annual incidence of open globe injuries by age, sex, mechanism of injury, and concomitant diagnosis, as well as median charges associated with open globe injuries and variables associated with hospitalization.

Results  A total of 124 989 ED visits for open globe injuries were assessed, with an incidence of 4.49 per 100 000 population in the United States from 2006 to 2014 (mean [SD] age of study participants, 37.7 [22.5] years; 94 078 [75.3%] male). The incidence was highest in 2006 (5.88 per 100 000 population) and decreased by 0.3% per month between 2006 and 2014 (incidence rate ratio, 0.99; 95% CI, 0.99-0.99; P < .001). Open globe injuries occurred in 37 060 individuals (30.6%) of low socioeconomic status. The most common injury mechanism was being struck by or against an object or person (40 119 of all 124 989 injury mechanisms [32.1%]). Open globe injuries associated with falls increased 6.6% between 2006-2010 and 2011-2015 (95% CI, 1.04-1.08; P < .001) and were the most common injury mechanism in individuals older than 70 years. The total cost associated with open globe injuries was $793 million. The cost of ED visits increased from $865 during 2006-2010 to $1557 during 2011-2015. Inpatient costs similarly increased from $21 527 during 2006-2010 to $30 243 during 2011-2015.

Conclusions and Relevance  The incidence of open globe injuries in the United States decreased from 2006 to 2014. Although the data are from 5 to 13 years ago, these findings appear to provide valuable information for targeting preventive measures toward individuals at highest risk; targeting young men with lower socioeconomic status and individuals 70 years or older at an increased risk of falls may help lower the incidence of open globe injuries.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: November 20, 2019.

Corresponding Author: Fasika A. Woreta, MD, MPH, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21218 (fworeta1@jhmi.edu).

Published Online: January 23, 2020. doi:10.1001/jamaophthalmol.2019.5823

Author Contributions: Mr Canner had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mir, Srikumaran, Friedman, Woreta.

Acquisition, analysis, or interpretation of data: Mir, Canner, Zafar, Friedman, Woreta.

Drafting of the manuscript: Mir, Zafar, Woreta.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Mir, Canner, Zafar.

Administrative, technical, or material support: Mir, Canner.

Supervision: Woreta.

Conflict of Interest Disclosures: Dr Srikumaran reported receiving personal fees from Alcon and grants from the National Institutes of Health outside the submitted work. No other disclosures were reported.

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