This nationwide population-based study of ocular trauma revealed significantly decreasing trends in the incidence of hyphema and BOF, but no significant trends in the OGI incidence from 2011 to 2020. By age, the incidence of BOF and IOFB increased significantly in those aged > 60 years, but not in younger subjects. Those aged < 20 years manifested the greatest decrease in the incidence of most ocular traumas in 2020 compared to 2019.
Of the various ocular traumas, hyphema evidenced the greatest decrease from 2011 to 2020.14 Hyphema is the most common ocular trauma and exhibits a male and pediatric predominance,15,16 occurring principally in those aged 5–14 years during participation in sport.17 We found that, although the prevalence was highest of all ocular traumas, the incidence decline was the fastest. This may reflect recent safety and preventive measures. Previous studies found that BOFs caused by assaults, traffic accidents, and sport peaked in those aged 20 to 40 years,17-19 as did we. BOF surgery gradually and significantly has decreased by 29.70% over the 10 years. However, the overall incidence of PCCS and IOFB did not change significantly over the decade. OGIs can cause permanent visual disturbance and any of endophthalmitis, traumatic cataracts, glaucoma, retinal detachment, and corneal opacity.20-22 Prevention of such injury is obviously most desirable.
Uniquely, we found that the incidence of the more serious ocular traumas, including BOF and IOFB, increased significantly in the older population. That of BOF has increased by 35.46% and that of IOFB by 58.95%. As life expectancy increases and physiological aging slows, older adults are socially active or working.23 Although physiological functioning is better than in the past, some physical deterioration and reaction delay are inevitable. We infer that the increased ocular trauma rates are associated with increased social participation. As older adults are particularly prone to occupational accidents, workplace safety requires more attention.24,25
Covid-19 most affected the incidence of hyphema; in 2020, this was 27.02% less than in 2019. In contrast, the incidence of IOFB removal in 2020 was 1.75% greater than in 2019. In those aged < 20 years, the hyphema incidence fell 54.33%, the BOF incidence 25.37%, and the IOFB removal incidence 47.93%. Therefore, in the Covid-19 era, this age group exhibited the greatest declines in ocular traumas, perhaps reflecting school closures and reduced outdoor activities because of social distancing.
Our work had certain limitations. First, we could not identify the causes of trauma. Second, we inferred the incidence of BOF and OGI based on the numbers of surgeries. Thus, the incidence may have been underestimated.
In conclusion, in this nationwide population-based study of about 50 million Koreans supported by the NHI system, we explored the incidence and yearly trends of four major types of ocular trauma from 2011 to 2020. The incidence of closed globe injuries decreased, but that of OGI did not. In addition, older adults have become more prone to serious ocular traumas. Given the school closures and social distancing in the era of Covid-19, ocular trauma in those aged < 20 years decreased markedly.