Eyeworld

N SEPTEMBER 2020 | EYEWORLD | 21 Also, research has shown that minority physi- cians tend to serve minority communities and minority communities are relatively under- served," he said. Imam Xierali, PhD, and Marc Nivet, EdD, coauthors with Dr. Wilson on the study pub- lished a few years ago about the makeup of the ophthalmology workforce, wrote to EyeWorld about several benefits of a diverse workforce. Dr. Nivet was chief diversity officer at the As- sociation of American Medical Colleges when they conducted the study. "Studies have found that physicians who are from minority groups underrepresented in continued from page 18 continued on page 22 Ocular trauma from 'less-lethal' weapons medicine (URM) are important for the provi- sion of healthcare for underserved populations and underserved locations," Drs. Xierali and Nivet wrote. "Students from medical schools with more diverse student bodies report feeling more confident managing patients from dif- ferent cultural backgrounds as well as having learned from individuals from different back- grounds. Patients receiving care from physicians of the same race/ethnicity report greater satis- faction with their treatment and greater com- munication with their healthcare professionals." Law enforcement, in some cases amid 2020 Black Lives Matter protests, have turned toward use of rubber bullets, tear gas, and other "less-lethal" crowd control measures, but injuries resulting from these tactics have some calling for their ban. In mid-July, the Washington Post published an article reporting that eight people lost vision in one eye and 12 others were partially blinded after being hit with police projectiles within the first week of protests that began after the death of George Floyd in May. 1 A recent case report of a "less-lethal" weapon injury published in Ophthalmology and Therapy described a patient who presented with no light perception, periorbital ecchymosis, and "devastating globe trauma." 2 The American Academy of Ophthalmology and several other organizations released a statement in early June that read, in part: While classified as non-lethal, [rubber bullets] are not non-blinding. These life-altering eye injuries are a common result of urban warfare, rioting and crowd dispersion. We have seen it around the world, and we now see it in the United States. Following numerous serious injuries in the past two weeks, the American Academy of Ophthalmology calls on domestic law enforcement officials to immediately end the use of rubber bullets to control or disperse crowds of protesters. The Academy asks physicians, public health officials and the public to condemn this practice. Americans have the right to speak and congregate publicly and should be able to exercise that right with- out the fear of blindness. You shouldn't have to choose between your vision and your voice. Over the years, there have been dozens of case reports and papers published on injuries caused by less-lethal weapons, including papers that describe instances of lethal- ity. 3 A paper published in 2003 in the journal Eye described ocular and orbital rubber bullet injuries in 42 consecutive patients in a 3-month period. 4 Lid or skin lacerations were observed in 54% of the patients, 40% had hyphema, 38% ruptured globe, 33% orbital fracture, and 36% retinal dam- age. More than 50% of patients saw less than 6/60. This paper concluded that "rubber bullet" is a misleading term that often refers to projectiles made from a range of different materials. "Orbital fractures are common" with these projec- tiles, the study authors stated. In addition to calling for a ban on rubber bullets, the American Academy of Ophthalmology and the Depart- ment of Ophthalmology at the University of California, San Francisco created a registry of eye injuries occurring from participation in protests. References 1. Kelly M, et al. Partially Blinded by Police. Washington Post. July 14, 2020. Accessed July 19, 2020. 2. Ifantides C, et al. Less-lethal weapons resulting in ophthalmic injuries: A review and recent example of eye trauma. Ophthalmol Ther. 2020;9:1–7. 3. Kobayashi M, Mellen P. Rubber bullet injury: case report with autopsy observation and literature review. Am J Forensic Med Pathol. 2009;30:262–267. 4. Lavy T, Abu Asleh S. Ocular rubber bullet injuries. Eye. 2003;17:821–824.

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