EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
EW NEWS & OPINION 20 October 2014 manager reported a resolution of violence within a year. To help physicians remem- ber the steps to proper screening and treating of an IPV patient, Dr. Shriver presented the acronym RADAR—routinely screen, ask direct questions, document your findings, assess patient safety, and review options and refer. EW References 1. Clark TJ, Renner LM, Sobel RK, Carter KD, Nerad JA, Allen RC, Shriver EM. Intimate Partner Violence: An Underappreciated Etiology of Orbital Floor Fractures. Ophthal Plast Reconstr Surg. 2014 May 14. 2. Max W, Rice DP, Finkelstein E, Bardwell RA, Leadbetter S. The economic toll of intimate partner violence against women in the United States. Violence Vict. 2004 Jun; 19(3):259–72. Editors' note: Dr. Shriver has no fina - cial interests related to her comments. Contact information Shriver: erin-shriver@uiowa.edu by Lauren Lipuma EyeWorld Staff Writer Role of ophthalmologists in helping victims of violence It is also important to assess the patient's safety once he or she leaves the hospital and to ascertain if there are children in the home that may also be at risk. Reporting IPV to the proper authorities is mandatory in certain states, so physicians should be aware of what their state requires. The final thing the physician should do is offer support and refer the patient to the appropriate ancillary service, such as social work or counseling, psychiatry, local shelters, or law enforcement. If a treating physician is unsure of the proper course of action, there are resources available, including the National Domestic Violence Hotline. That number is 800-799-7233. Intervention by physicians has been shown to be effective in resolving violence, Dr. Shriver said— studies have shown that when pa- tients are screened and referred to a patient advocate, they do follow-up, and in one study, 49% of patients who followed up with a case it's happening in our patients," she told the audience at the symposium. "We are seeing these patients in our clinic whether or not we realize it," she said. "We're affected because we're ophthalmologists and these women and men have ocular injuries, but also because it can be very severe." A WHO global study of violence against women released in 2013 found that 40% of murdered women worldwide are killed by a male partner. Nearly half of these victims present to an emergency room with- in 2 years of their deaths. "It's our responsibility because we have an opportunity to redirect this devastat- ing course," Dr. Shriver said. Ask, assess, and refer To get a better understanding of the scope of the problem at her own in- stitution, Dr. Shriver worked with a team of ophthalmologists, including Thomas Clark, MD, to determine the prevalence of IPV at the Univer- sity of Iowa and evaluate physicians' responses to it. Additionally, the team worked with the director of the Minnesota Center Against Violence and Abuse to develop recommenda- tions for identifying and referring future IPV victims. While there are mixed recom- mendations on universal screening of women for IPV, Dr. Shriver rec- ommended that ophthalmologists screen all female patients who have an ocular injury or orbital fracture of unclear etiology. She also recommended screening patients in a private room whenever possible. "I've found it helps thinking through what I'm going to say ahead of time," she said. "I say, 'There's a part of the exam I need to do [that] I can't do in this room. Can I take you next door?' That's my easy route to get them out." Dr. Shriver stressed the need to be persistent when asking patients about the mechanism of their inju- ries and if they would like to speak with a social worker—patients may refuse the first time but may decide to accept help when asked at subse- quent follow-up visits. During a screening, the treating physician should assess if the patient is being physically, emotionally, or sexually abused, Dr. Shriver said. O phthalmologists have a unique opportunity to help the victims of intimate partner violence (IPV) and should not shy away from this responsibility, said Erin Shriver, MD, FACS, assistant professor of ophthalmology and visual sciences, University of Iowa Carver College of Medicine, Iowa City. Speaking at the Women in Ophthalmology (WIO) 2014 Summer Symposium, Dr. Shriver described IPV as an underappreci- ated etiology of ocular and orbital traumas, and emphasized the need for ophthalmologists to take a more active role in recognizing and treating these patients. Eye injuries are involved in 45% of IPV cases, Dr. Shriver explained, so ophthalmologists need to know how to recognize it and how to take action. Ocular injuries can range from orbital fractures and ruptured globes to retinal tears and hyphemas —so physicians from every ophthal- mic specialty have the potential to see IPV patients. After treating a female patient who experienced IPV, Dr. Shriver decided to find out how ophtha - mologists could do more to help women in similar situations. "I was impressed by her inner strength, her resilience, and I was frustrated by my lack of understand- ing and lack of comfort dealing with her situation," she said. A global problem The World Health Organization (WHO) defines IPV as physical, emotional, or psychological abuse inflicted by an intimate partne . While it is more common in wom- en, it does occur in men as well, Dr. Shriver explained, and happens globally across all ethnicities, socio- economic statuses, and relationship types. In the U.S., IPV affects 12 million individuals each year and was estimated to cost $8.3 billion in 2003, the last year that data was available. As pervasive as IPV is, doctors do not discuss it often, and there are some glaring misconceptions regarding it, said Dr. Shriver. "I feel that part of my role is to let us all know that it's out there and Patient who sustained bilateral orbital floor f actures secondary to IPV Coronal CT scan demonstrating bilateral orbital floor f actures Source: Erin Shriver, MD