Epidemiology of blinding trauma in the United States Eye Injury Registry.

PURPOSE: To analyze the epidemiology and clinical characteristics of serious eye injuries leading to legal blindness. METHODS: Analysis of information on 11,320 eyes in the United States Eye Injury Registry (USEIR) database. Legal blindness in this study was defined as visual acuity of worse than 20/200. RESULTS: No less than 27% of eyes with serious injury had < 20/200 final vision, although the rate varied greatly with injury type. Several risk factors were found to statistically significantly increase the chance of eye trauma resulting in blindness: age over 60 years, injury by assault, sustained on street/highway, or occurring during fall or by gunshot. Trauma to the left eye carried a statistically significantly poor prognosis as did two injury types, rupture and perforating. Involvement of the posterior segment was another factor indicating poor outcome; in particular, vitreous hemorrhage, retinal detachment, choroidal rupture, and endophthalmitis were found to increase the risk of blindness. Conversely, young age, contusion and intraocular foreign body injuries, among others, signaled a better than average chance of good outcome. Overall, 60.5% of injured eyes showed visual improvement after treatment. CONCLUSIONS: This large study identified multiple risk factors whose presence significantly increases the chance of the injured eye becoming "legally blind." Continued efforts to improve treatment and develop/implement prevention measures based on risk analysis should reduce the incidence of blinding trauma.

Epidemiology and socioeconomics.

Ophthalmologists should be responsible for a systemic collection of standardized data on the occurrence of eye injuries. Such a database is the key for designing prophylactic measures to successfully prevent ocular trauma. The USEIR model, whether reporting takes place over the Internet [www.USEIRonline.org www.WEIRonline.org (worldwide)] or on paper, has proved to be an efficient epidemiological tool. Use of this model in different countries has allowed making unbiased comparisons between regions or countries, highlighting injury patterns that may be different in different geographical areas, and pinpointing areas where prophylaxis (through legislation and public campaigns) appears most effective. Participation of all ophthalmologists who evaluate/treat patients with serious eye trauma is strongly encouraged.

The Ocular Trauma Score (OTS).

Only based on a standardized terminology of ocular trauma terms, and using a very large number of injuries treated by a wide variety of ophthalmologists, could a reliable method be developed so that the functional outcome of a serious eye injury can be predicted with reasonable certainty. The authors used the databases of the United States and Hungarian Eye Injury Registries and, with a grant from the National Center for Injury Prevention at the Centers for Disease Control and Prevention, designed such a system.