Protest Deterrence Strategies in 2020 Led to Eye Loss, Blindness, and Death

NEW YORK, USA – SEPTEMBER 5: A protester is seen after badly affected by tears gas as Rochester police use heavily tears gas to disperse protestors during Daniel Prude protest in Rochester, New York, United States on September 5, 2020. Daniel Prude, an unarmed black man who died after being arrested and being placed a “spit hood” over his head by Rochester police. (Photo by Tayfun Coskun/Anadolu Agency via Getty Images)
A study shows the effects of kinetic impact projectiles as deterrence strategies on ocular and systemic health.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of the American Academy of Ophthalmology, held in New Orleans from November 12 to 15, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the ophthalmology experts at the AAO. Check back for more from the AAO 2021 Meeting.


History will almost certainly characterize the events of 2020 — a debilitating global pandemic, political and economic strife, and civil unrest — as traumatic for many. But for many who put their bodies on the front lines to make their voices heard, that trauma manifested physically in clashes with both law enforcement and militia groups who employed the use of kinetic impact projectiles. In a study presented at the American Academy of Ophthalmology 2021 meeting in New Orleans, held November 12-15, researchers identified the groups affected by these devices, the specific ocular and adnexal traumas endured, and the effects of the injuries.

In a large, multicenter, retrospective, case series from 20 institutions across the country, researchers gathered a sampling of protest-related ocular and adnexal injuries. The investigators performed a dynamic mathematical modeling of protest-related databases and rigorous decision analysis. The study took into account outcomes regarding visual acuity (VA), rate of retinal detachment (RD), instances of injuries so severe that enucleation was required, and death. 

The researchers found relevant records of 72 eyes of 67 patients (mean age 37.2 years, range: 9-87). The most common cause of injury, 43.3%, came from direct rubber bullet impact, or other kinetic impact projectile trauma. The patients who endured these injuries were also the most severely impacted, with significantly worse presenting and final VA (P <.001), higher rates of RD (P <.001) and enucleation (P =.005) than other patients, according to the investigators. The study found 28 deaths associated with these injuries. 

The violence affected all groups within the radius of the protests, but especially protestors themselves, who shouldered 73.1% of the injury burden. The remainder of the patients included 15.1% bystanders, 7.5% law enforcement personnel, and 3% journalists. Patients were 49.3% White, 31.3% Black, 16.4% Latino, and 3% Asian. 

“Deterrence strategies led to greater violence,” the team, led by presenting author Nicole Koulisis, MD, of University of California’s Roski Eye Institute, reported. “[kinetic impact projectiles] fired during protests carry a high risk of blindness and loss of the eye.” 

The presenters advocated for avoiding the use of kinetic impact projectiles at protests.

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Koulisis N, Satija C, Hou JH, et al. Ocular trauma and death during the protests and riots of 2020: decision analysis informed by data and dynamic mathematical modeling. Paper presented at: The American Academy of Ophthalmology 2021 Annual Meeting; November 12-15; New Orleans. Abstract PA047.