ODs are in a prime position to identify exploited victims.
A panel of experts convened at the recent American Academy of Optometry 2025 annual meeting in Boston to shed light on a worldwide problem, labor and sexual trafficking.
This exploitation extends far wider than realized and is not confined to any particular socioeconomic level or geographic region, according to Deb Getz, ReD, associate clinical professor, Applied Health Science, Indiana University School of Public Health, Bloomington.
Trafficking is defined, according to the Trafficking Victims Protection Act of 2000, as follows: “Severe forms of trafficking in persons” include both sex trafficking and labor trafficking.1 Sex trafficking involves the use of force, fraud, or coercion to compel a person to engage in a commercial sex act, or any commercial sex act involving a minor.1 Labor trafficking, on the other hand, refers to the recruitment or use of labor or services through coercion, fraud, or force across various industries.1
Particular groups that may be impacted disproportionately by sex and labor trafficking are children with a history of abuse or neglect or those who are in the foster care population; homeless/poor individuals; migrant workers or undocumented immigrants; members of minority groups; substance abusers; those in the LGBTQ+ community; and survivors of interpersonal or sexual violence.2,3
The sex trade by itself is pervasive and at least 90% of those workers that Donna Gavin, Esq, reported encountering during her work were controlled by a trafficker. She previously was a lieutenant in the Human Trafficking Unit of the Boston Police Department and currently is a practicing attorney.
Regarding labor trafficking, she pointed out that this practice is grossly underreported, in that only 7% of exploitation cases reported in the US involve labor trafficking.
Another dire statistic is that more than 98% of victims of trafficking are handled by a person close to them, such as parents, other close relatives, family friends, and neighbors.
A challenge with such cases is that they are less “tangible” compared with cases involving drugs or firearms. “Sex trafficking is a more complex crime that can involve young people who are sold in a hotel room five to 10 times a day and they are very unlikely to self-report their situation,” Gavin commented.
In light of that, she explained, the onus falls to, for example, medical professionals who may come into contact with the victims.
Rachel Brackley, OD, FAAO, associate professor at the Pennsylvania College of Optometry at Drexel University, Elkins Park, provided tips on recognizing trafficking in clinical practice.
She emphasized that in many cases health care professionals are the first people to recognize the signs of trafficking.
“It is common for people who are being exploited to seek vision care,” she said and noted that data show that 13% of victims do so.
She described what optometrists and their staff members can be alert to when evaluating patients. It is recommended that clinicians create a safe place in the practice for discussions with patient, and that the individuals are respected and heard, Brackley emphasized.
The vast majority of trafficked cases are people of color. Clinicians may treat victims with infections or improper hygiene associated with eyelash extensions, tattoos, or physical injuries such as black eyes, broken jaws, or brain injuries; in one case, a trafficker threw the victim’s corrective lenses onto a roadway to render her legally blind.
Physical indicators of abuse can include delayed care and inconsistent health records, workplace injuries, suspicious branding or tattoos, bruising in various stages of healing, multiple pregnancies or abortions, respiratory problems, perforated ear drums, or burns.
She detailed the following ocular findings that may be clues to trafficking:
An example of suspicious behavior is an awkward request for contacts or glasses without undergoing an examination.
In addition, the victim may be accompanied by the trafficker who speaks for the victim, watches the examination closely, and tries to rush the examination.
The indications of human trafficking may be characterized by the patient providing little information about themselves, fearfulness, gaps in their medical history and inconsistencies in the medical history, hesitation in response to questions, unawareness of the time and date, depression symptoms, and refusal of care.
It is recommended that clinicians educate themselves and encourage their colleagues to learn about trafficking and becoming aware that trafficking is taking place everywhere.
Optometrists are mandated in every state to report suspected cases of trafficking in both professional and personal settings to the appropriate state agency.
Any injuries should be documented in photographs.
Brackley advised that optometrists develop a plan in their practice to identify and report suspected cases.
If a clinician suspects a possible case of trafficking based on the described characteristics, the following organizations can be contacted:
OVER 18 years of age:
To access general information about exploitation, individuals can use the following link:
If individuals are interested in further discussing this issue, they can contact Getz at dgetz@iu.edu.
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