Published on September 16, 2024

While training as an eye surgeon in Bosnia and Herzegovina over a decade ago, Dr. Nina Jovanovic witnessed firsthand how eye injuries, including those caused by war in the former Yugoslavia, impacted people’s vision and independence. Eye injury was a largely unexplored field at the time: Her country lacked data and a broader understanding of how eye injuries happened and who was at risk for them.

Jovanovic has since become Bosnia and Herzegovina’s leading eye researcher. She established Bosnia and Herzegovina’s first eye trauma registry, which collects data about eye injuries seen at Canton Hospital of Zenica, one of the largest trauma hospitals in the country. Jovanovic established and led the oculoplastic surgery section in the hospital’s Department of Ophthalmology until 2 years ago, when she moved to Zagreb, Croatia to work for Eye Institute Knezovic.

Her latest research, published in the official journal of the Medica Association of Zenica-Doboj Canton, investigated changes in academic success and social inclusion before and after a traumatic eye injury. She found that academic success in the few years after the injury may be more impacted but saw no association between social inclusion and eye trauma. The study included pediatric patients admitted to the Canton Hospital of Zenica from 2011-2017.

“Our research did not show a significant statistical difference in academic success between the point in time before and after the eye injury, but there was a trend toward worsening academic performance as time passed over the years,” Jovanovic said.  “This is very important data that may help create post-injury event interventions like trauma-informed educational systems that support children with traumatic experiences.”

Jovanovic was a fellow in the NIH-funded University of Iowa International Trauma and Injury Prevention Training Program and received her Master of Public Health (MPH) at the University of Iowa College of Public Health in 2017. In 2021, she received the UI International Impact Award for her eye injury research and advocacy.

“Thanks to Dr. Corrine Peek Asa [former director of the UI IPRC], my MPH advisor, and the IPRC team of amazing researchers and epidemiologists, we have conducted several large studies in this field in Bosnia and Herzegovina, including adulthood, childhood, and occupational eye injuries,” she said. “Our ultimate goal was to build a database that may serve for interventions, policies, and behavioral changes, leading toward better prevention and control of injury rates and, in the end, visual impairment caused by ocular trauma.”

Here, Jovanovic talks about her research in Bosnia and Herzegovina, highlighting the factors that put children at risk for eye injuries, the role parents can play in prevention, and the impact these injuries have on children’s quality of life, social inclusion, and academic performance.

Q: What puts children at risk for eye injuries?

A: Based on the research we conducted in Bosnia and Herzegovina, in collaboration with the University of Iowa Injury Prevention Research Center, engaging in unusual and unfamiliar activities poses the most significant risk for eye injury in kids, especially during the summer months. Some examples we found include wearing the mother’s shoes, stumbling and falling, helping the father to whitewash the house, (a common practice in my country) or any activity that the child was engaged in for the first time and rarely did again.          

What also puts children at risk for an eye injury is not being supervised by an adult while doing chores around and in the house, such as chopping wood or helping to whitewash the walls. Similar to past research, our study showed that boys are at greater risk for eye injuries compared to girls, with the most at-risk age increasing from 6 until 18 years old.

The most common sources of injury were sharp or blunt wooden objects and metal objects, chopped wood, falls on hard surfaces, and biological material.  Family poverty and parent’s lower level of education can be a reason for more complications following an eye injury and severe vision loss due to inappropriate preventive measures and difficult accessing appropriate treatment facilities.

Q: How can parents and caregivers help reduce the risk of children injuring their eye(s)?

A: In our survey, parents and caregivers reported that the most frequent activities leading up to eye trauma included mowing the lawn, playing in the garage with heavy tools, improvising bottle cup opening (using a cigarette lighter), being injured by an object during construction work in the house, playing with the kitchen supplies, and falling downstairs the stairs while sleepy and without supervision.

These risk factors indicate that an adult’s alert and vigorous supervision could prevent most injuries. In addition, prevention measures could focus on minimizing access to potentially harmful tools. Research shows that proper rest of the child, quality sleep, and daytime naps can reduce all injuries, including eye-related ones.

Q: How can eye injuries affect the quality of life of children?

A: Sustaining an eye injury in childhood is a traumatic event that affects children and their families. One of the great challenges in treating pediatric eye injuries is that sometimes a child fails to report the injury and hides it initially from parents due to feeling afraid or ashamed. Thus, a few days may pass until a healthcare professional is able to treat the child. In such cases, an eye infection may occur, and the injury becomes more severe due to inflammation, ischemia or necrosis. 

If an injury causes visual impairment during and after recovery, kids may miss school, have less ability to engage in social activities, do homework, read, and may become isolated from their peers. A traumatic experience can generally cause decreased concentration, memory problems, and impaired organizational abilities that negatively affect school performance and later academic success. Eye trauma at such a young age can put children at risk for mental health problems that may also negatively affect academic performance. These consequences are magnified several times if the eye trauma is severe enough to cause blindness or eye loss.

Q: How do eye injuries affect children’s academic performance?

A: One of the main factors that can contribute to lesser academic success in injured school kids is missed school days due to prolonged hospital or out-of-hospital treatment.

Secondly, when kids must wear a patch over one eye during recovery in and out of school, they have decreased peripheral visual field and poor depth perception. This negatively affects their academic performance and social activities and sets them behind their peers. Younger kids who must wear a patch over one eye or have an aesthetically unpleasing eyeball may experience social stigma and bullying from their peers.

Other resources:

Nina Jovanovic: UI IPRC alumni story (video)

Eye injury and demographic parameters associated with poor visual outcome (research publication)

The Risk and Protective Factors for Pediatric Eye Injuries: A Case-Crossover Study

Prevalence and risk factors associated with work-related eye injuries in Bosnia and Herzegovina (research publication)

American Academy of Ophthalmology: Children’s Eye Injuries: Prevention and Care