Advances in Ophthalmology

Ocular trauma is second only to cataracts as the most common cause of visual impairment, but eye injuries are often undertreated. A new initiative led by a Columbia ophthalmologist promises to improve how medical professionals care for these serious conditions. James D. Auran, MD, Professor of Ophthalmology at Columbia University Vagelos College of Physicians and Surgeons and Chief of Ophthalmology at Harlem Hospital, cofounded and served as the first President (and now the Executive Vice President) of the American Society of Ophthalmic Trauma (ASOT). Dr. Auran and the ASOT are leading efforts to develop comprehensive national guidelines, proficiency standards, and continuing education for the management of ocular trauma.

Dr. James Auran

As part of the program, 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 learn about ocular trauma on a case-by-case basis.

Protocols and standards exist for trauma management, notes 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.”

Dr. Auran conceived the idea for the initiative when he sought to adopt ocular trauma protocols at Harlem Hospital. In his search he found that only the military had developed any standards of care for ocular trauma, a common battlefield injury. “There were no national standards for civilians and that’s what we are trying to change.”

A committee has been established to lead the initiative and is working not only to adapt the military standards to civilian scenarios but is also developing protocols for disaster preparedness and response for use by hospitals and emergency medical teams. One important goal for the group, which includes members from the military, is to ensure that first responders receive the same training as military medics. “If the first responders are trained properly to provide immediate treatment, it can mean saving an eye,” says Dr. Auran.

The standards of care and continuing education under development will give ophthalmologists the additional knowledge and experience they need to be able to care for patients with ocular trauma. According to Dr. Auran, the committee hopes to create a subspecialty in ocular trauma, which he believes will improve care even further. Their work thus far has led to the founding of the American Society of Ophthalmic Trauma, for which Dr. Auran served as the society’s first president.

(Adapted from “Improving the Treatment of Ocular Trauma,” Columbia Medicine magazine. Spring 2021)