Following the recent Ophthalmology Retina publication of a large-scale analysis providing the clearest picture to date of how patients fare after intraocular foreign body (IOFB) removal by using data taken from the IRIS Registry, The Ophthalmologist reached out to study author Inês Laíns, Massachusetts Eye and Ear, Boston, to discover what insights the multi-institutional research team gained from their study findings.
What inspired such a large-scale analysis of IOFB injuries within the IRIS Registry?
IOFB injuries are ophthalmic emergencies that require prompt intervention and can be visually devastating. Despite their clinical significance, we realized that there were no contemporary, population-level data describing how these patients present or how their visual acuity recovers. Most prior studies were small, single-center case series that were conducted decades ago or were focused on open globe injuries more broadly, rather than on IOFBs specifically. This motivated us to pursue this work using the IRIS Registry – which captures data from approximately 70% of US ophthalmologists – and to characterize IOFB presentation patterns, management, and long-term visual trajectories. We saw this as an opportunity to provide clinicians with real-world benchmarks for counseling, prognostication, and understanding sociodemographic factors influencing outcomes.
Were there any findings that surprised your group?
The most striking finding was the distinct pattern of visual recovery: minimal improvement at one month, followed by a rapid gain at two months and then relative stabilization thereafter. To our knowledge, this pattern had not been reported at scale before. It was also surprising to see that, even after adjusting for clinical and other socioeconomic factors, patients self-identifying as Black or African American had worse mean visual outcomes. This concerning signal likely reflects unmeasured social determinants or inequities in access to care, and merits deeper investigation.
What do you think might explain the shift in median patient age to 55 years?
While a median age of 55 years remains within the working age population, this is one or two decades older than what has been reported in previous series. Several factors may contribute. First, many of the previously published manuscripts originate from low- and middle-income countries (LMICs), where injuries may more commonly affect younger men engaged in high-risk industrial or agricultural work. Second, it’s possible that the US workforce may currently include a larger proportion of older individuals who could be exposed to an IOFB risk later in life. And lastly, this can also represent exposure of older individuals to home-based do-it-yourself (DIY) activities.
Your visual recovery curve shows no significant improvement at one month, followed by these rapid gains at two months. Why do you think this occurs?
I believe this early plateau with no improvement at one month reflects the expected clinical course after IOFB repair. These are usually complex cases, so after surgery there is always a certain degree of post-operative inflammation (i.e. corneal edema, anterior segment, and possibly vitreous cells, etc) that takes a few weeks to improve and can substantially limit visual improvement. In addition, some patients may undergo staged or delayed procedures (such as cataract surgery or secondary vitrectomy), which can contribute to the 1-2 month recovery window. We did not assess the frequency of these additional interventions in this work, but plan to examine it in a future study.
How do you explain the study’s findings of worse visual outcomes among Black or African American patients?
Unfortunately, these findings align with reports of racial and ethnic disparities of open globe injuries and trauma outcomes more broadly in the US. They likely reflect structural and social determinants of health, including differential access to care, barriers related to insurance or transportation not fully captured by median income of geographic variables, or systemic biases within the healthcare system. Of note, this association did not persist in our sensitivity analysis using a median-focused visual acuity model, suggesting that a subgroup with particularly poor outcomes may be driving the mean difference. This reinforces the need for future studies using datasets with more granular clinical and social information.
Do you foresee future predictive tools to assist clinicians in real-time prognostication?
Yes, absolutely. While prognostic scoring systems exist for open-globe injuries, to my knowledge there are none currently validated for IOFB cases. Our findings highlight clear predictors – such as pre-injury and presenting visual acuity or baseline complications – that could be incorporated into risk-prediction models for real-time clinical use. However, such tools should include additional granular data that is not available on the IRIS Registry, such as wound zone (zone I, II or III).
Is there anything else you would like to add?
I would love readers of The Ophthalmologist to take a look at our paper! This study represents the largest and most contemporary analysis of IOFB injuries in the US and provides robust data-driven data on their presentation and visual acuity trajectories. We hope that our findings help clinicians better manage patient expectations, guide clinical decision-making, and ultimately improve care for this high-risk population.
