Improving the Treatment of Ocular Trauma

A new initiative led by a Columbia ophthalmologist promises to improve how medical professionals worldwide treat a serious, but undertreated, eye condition. The American Academy of Ophthalmology selected James Auran, MD, professor of ophthalmology at VP&S and chief of ophthalmology at Harlem Hospital, to lead the initiative to develop comprehensive national guidelines, proficiency standards, and continuing education for the management of ocular trauma, which is second only to cataracts as the most common cause of visual impairment. 

As part of the initiative, Dr. Auran is spearheading a new evidence-based, structured ocular trauma curriculum for Columbia ophthalmology residents that will serve as a national model in academic medicine. Today, most ophthalmology residents only learn about ocular trauma on a case-by-case basis.

Plenty of protocols and standards exist for trauma management, says Dr. Auran, but few pertain to the eye. “Ocular trauma has been a smoldering, neglected stepchild,” he says. “It is amazing that standards weren’t developed earlier; eye trauma has been there all the time.”

The idea for the initiative began at Harlem Hospital when Dr. Auran was appointed chief of ophthalmology and looked for ocular trauma protocols to adopt in the hospital. In his search he found that only the military had developed any standards of care for ocular trauma, which is a common battlefield injury. “There are no national standards for civilians,” says Dr. Auran, “and that’s what we are really trying to change.”

The committee leading the initiative is working not only to adapt the military standards to civilian scenarios, but also developing protocols for disaster preparedness and response for use by hospitals and emergency medical teams. 

One important job for the group, which includes members from the military, is to ensure first responders get the same training as medics in the military. “The first responder is vital and really determines what happens in the future,” says Dr. Auran. “If the first responders are trained properly to provide immediate treatment, it can mean saving an eye.”

For ophthalmologists, the standards of care and the continuing education under development will give existing specialists the additional knowledge and experience they need to be able to care for such patients. Eventually, says Dr. Auran, the committee hopes to create a subspecialty in ocular trauma, which he believes will improve care even further. The work has resulted in the founding of a new medical society, the American Society of Ophthalmic Trauma (theasot.org), and Dr. Auran is the society’s first president.