The Importance of Health Literacy in Addressing Eye Health and Eye Care Disparities.

Disparities in eye health and eye care frequently result from a lack of understanding of ocular diseases and limited use of ophthalmic health services by various populations. The purpose of this article is to describe the principle of health literacy and its central role in enhancing health, and how its absence can result in poorer health outcomes. The article evaluates the current status of health literacy in visual health and disparities that exist among populations. It also explores ways to improve health literacy as a means of reducing disparities in visual health and eye care. Advancing dissemination of health information and enhancing health literacy may help not only to reduce healthcare barriers in the underserved populations but also to lessen visual health disparities.

The Prevalence of Eye Injury in the United States, Estimates from a Meta-Analysis.

Purpose: The burden of vision impairment and blindness is typically focused on the most common causes of these conditions, namely cataract, macular degeneration, glaucoma, and diabetic retinopathy. However, the burden of less common but more preventable causes such as eye injury has not been quantified. The goal of this study is to estimate the prevalence of eye injury and eye injury-associated vision impairment and blindness in the United States.Methods: A systematic review was conducted to identify peer-reviewed population-based studies reporting the prevalence of eye injury. The relevant qualitative and quantitative results were extracted from these studies and the latter pooled using a random-effects model. The model results were then applied to the United States population counts to estimate the number of individuals impacted by eye injury.Results: A total of 20 population-based studies met the inclusion criteria for the study. The pooled prevalences of eye injury and eye injury-associated vision impairment and blindness were 7.5 per 100, 4.4 per 1000 and 5.1 per 1000, respectively. These estimates suggest that an estimated 24 million persons in the United States have ever suffered an eye injury, of whom 1.5 million are visually impaired and 1.7 million and 147,000 are partially blind or totally blind, respectively.Conclusions: Eye injury is an important contributor to the burden of vision impairment and blindness in the United States. Prevention efforts should be enhanced to reduce the incidence of these largely preventable events and as should effective therapies to minimize the visual consequences of those currently affected.

[National studies from the Netherlands and Finland and the impact of regulations on incidences of fireworks-related eye injuries. German version]. / Landesweite Studien aus den Niederlanden und Finnland zur Häufigkeit von Augenverletzungen durch Feuerwerkskörper unter dem Einfluss verschiedener Schutzmaßnahmen.

Fireworks-related eye injuries occur all over the world whenever fireworks are available for the public. The two prospective registers from Finland over 20 years and from the Netherlands over 10 years have tracked the effect of regulations, awareness, and safety campaigns. The incidence of fireworks-related injuries in these two countries has been reduced to about one half during the last 10 years through addressing the number of hours allowed for private fireworks, the use of safety glasses, awareness campaigns, and stricter regulations on fireworks available for purchase. Although the total number of injuries has decreased, the average severity of eye injuries in the Netherlands seems to have increased due to higher content of gunpowder in fireworks. Boys and young men are mainly affected as well as bystanders who account for more than half of fireworks-related eye injuries. More work on safety of fireworks is still needed through regulating private consumer use of fireworks, a challenge that lies ahead for ophthalmologic organizations worldwide, including the European Society of Ophthalmology (SOE), the International Council of Ophthalmology (ICO) and national societies. But every eye saved from severe injury is worth the effort.

Delivered dose changes in COMS plaque-based ocular brachytherapy arising from vitrectomy with silicone oil replacement.

PURPOSE: The purpose of the study was to determine dosimetric effects of performing concurrent I-125 Collaborative Ocular Melanoma Study plaque brachytherapy and vitrectomy with replacement using silicone oil, previously shown to be a means of shielding uninvolved parts of the eye. METHODS AND MATERIALS: Monte Carlo simulations using MCNP6 were performed to compare the dosimetry with all eye materials assigned as water, and for the vitreous (excluding the tumor), composed of polydimethylsiloxane oil for three generic, one large tumor, and two patient geometry scenarios. Dose was scored at the tumor apex, along the sclera, and within a 3D grid encompassing the eye. The assessed patient cases included vitrectomies to treat intraocular pathologies; not to enhance attenuation/shielding. RESULTS: The doses along the sclera and for the entire eye were decreased when the silicone oil replaced the vitreal fluid, with a maximum decrease at the opposite sclera of 63%. Yet, absolute changes in dose to critical structures were often small and likely not clinically significant. The dose at the tumor apex was decreased by 3.1-9.4%. Dose was also decreased at the edges of the tumor because of decreased backscatter at the tumor-oil interface. CONCLUSIONS: Concurrent silicone vitrectomy was found to reduce total radiation dose to the eye. Based on current radiation retinopathy predictive models, the evaluation of the absolute doses revealed only a subset of patients in which a clinically significant difference in outcomes is expected. Furthermore, the presence of the silicone oil decreased dose to the tumor edges, indicating that the tumor could be underdosed if the oil is unaccounted for.

Effectiveness of an educational program on decreasing burns and injuries in Persian festival of fire: A burden of diseases approach.

Chaharshanbeh souri is a historical Persian firework festival which has several health and financial damages for Iranians near celebration of New Year. In this study we tried to find effectiveness of Chaharshanbeh souri educational campaign on decreasing burden of injuries due to fireworks of this day. In this before-after study, an educational campaign was done for 2017 focusing on children and students. Data of a registry which was designed for gathering information of injuries and mortalities of this festival was used to show effectiveness of the program. Disability adjusted life years was calculated and compared before and after intervention. The results of this study showed that mean age of injuries was increased from 27.75 to 32.65 years and DALY decreased significantly after the intervention (P=0.0460) showing that the intervention was effective. Educational programs might be effective to decrease burden of injuries related to Chaharshanbeh souri festival.

Eye Injury Prevention for the Pediatric Population.

Each year an estimated 3.3 to 5.7 million pediatric eye injuries occur worldwide. It is widely reported that 90% of ocular injuries are preventable. Our aim was to identify legislation and policies, education, and mandatory eye protection strategies that have successfully contributed to reducing rates of children's eye injuries. A literature search was conducted using the terms "pediatric" or "children" or "adolescent" and "ocular" or "eye" and "protection" or "injury prevention." Articles were retrieved based on titles and abstracts and assessed in the context of our research question. Strategies identified aimed at reducing ocular trauma fell into 3 broad categories: legislation and policies, education, and personal eye protection. Policies including restrictions on the sale and supply of certain consumer products, mandatory vehicle seatbelts, and laminated windscreens in vehicles have assisted in reducing children's eye injuries. Educational tools aimed at children and their caregivers have been effective in changing attitudes to eye health and safety. Effective pediatric eye injury prevention systems require a multifactorial approach combining legislation, policies, standards, education, and personal eye protection to limit exposure to ocular hazards. A paucity of standardized measurement and lack of funding have limited advances in the field of children's eye injury prevention. Improved eye injury surveillance and research funding along with collaboration with health care providers are important components for strategies to prevent pediatric ocular trauma.

Attenuation assessment of medical protective eyewear: the AVEN experience.

The goal of this paper is to test the attenuation capability of seven models of protective eyewear used in routine clinical practice. Scattered radiation from a standard patient was simulated by using a water tank located over the treatment couch of a GE Innova 3100 x-ray angiography system. Seven protective eyewear models were tested using an anthropomorphic phantom mimicking the first operator. At each test, 4 thermoluminiscent dosimeters were placed on the phantom (respectively in front of the protective eyewear, under the eyewear, on the left earpiece and at chest level) in order to have an eyewear-independent reference. A test session without glasses was also acquired. Each model was tested with standard posterior-anterior (PA) projections and the two most common protective eyewear were tested using LAO90° and LAO45°CRA30° projections. A worst-case scenario was created to be sure of having an upper limit for the assessment of eyewear attenuation in routine clinical practice. In PA projections, the absolute attenuation value ranged between 71% and 81%, while relative attenuation between dose measured at eye lens and that measured at eyewear earpiece ranged from 67% to 85%. The slightly wider range was probably due to scatter radiation variability; anyway, differences are still included in the variable uncertainty of experimental measurements. It is worth noting that #3 eyewear model (the one without lateral protection) allows an attenuation similar to that of #5 eyewear model (with 0.5 mm lead lateral protection) in LAO90° and LAO45°CRA30° projections. Despite the experimental limitations, a description of the radiation properties of protective eyewear concerning radiation attenuation can be useful to rely on protection devices which can be used in routine clinical practice.

AN ASSESSMENT OF THE DOSE REDUCTION OF COMMERCIALLY AVAILABLE LEAD PROTECTIVE GLASSES FOR INTERVENTIONAL RADIOLOGY STAFF.

In light of the proposal from the International Commission on Radiological Protection for a lowered eye dose limit, now adopted by a European Union Council Directive, lead glasses may be required for some staff in interventional radiology to ensure that occupational exposure is as low as reasonably practicable. To investigate the lens protection offered from various models of lead glasses exposed to X-rays coming from a source to the left and below, calibrated radiochromic film was positioned in the lens area of a head phantom. When the source-to-eye angles were large, the dose reduction factors (the ratio of eye dose without protection to dose with protection) to the right lens area were much lower than to the left lens area, particularly with smaller-lensed glasses, due to gaps in protection between the face and the glasses. The results of this study reiterate the importance of employers providing eyewear based on the morphology of, and fit to, individual workers' faces.

[Protective glasses. Personal eye protection for professional use]. / Schutzbrille. Persönlicher Augenschutz für den beruflichen Einsatz.

Several activities in the occupational environment or in leisure time implicate an increased risk of eye injuries. Many injuries could be prevented by wearing adequate eye protection devices; however, the selection of appropriate eye protection devices requires considerations of different attributes in order to achieve a maximum of protection efficiency. This article provides an overview on the three basic types of eye protection device, introduces the classification regarding optical and protective properties and gives some additional advice on the selection of protective eyewear beyond the current standard regulations.

Impact of visors on eye and orbital injuries in the National Hockey League.

OBJECTIVE: Eye and orbital injuries are a significant risk to professional hockey league players and have resulted in career-ending injuries. The goal of this study was to determine the incidence, value lost, mechanism, and effect of visors on eye and orbital injuries over the last 10 National Hockey League (NHL) seasons: 2002-2003 to 2012-2013. DESIGN: Retrospective case-control study. PARTICIPANTS: Participants were 8741 NHL players who had played at least 1 game during the last 10 seasons. METHODS: Using The Sports Network (TSN), ProSportsTransactions, and the Sporting News Hockey Register, NHL players were searched to identify eye and orbital injuries. The mechanism of injury was obtained from media reports and direct observation from online videos. The number of players wearing visors each year was obtained from The Hockey News annual visor survey. RESULTS: A total of 149 eye or orbital injuries over the last 10 seasons resulted in an overall incidence of 2.48 per 10 000 athlete exposures. A total of 1120 missed games led to a lost financial value of more than $33 million. Visor use among players grew from 32% in 2002-2003 to 73% in 2012-2013, and there was a significantly increased risk for having an eye or orbital injury when a visor was not worn (OR 4.23, 95% CI 2.84-6.30). Most injuries were a result of being hit by a deflected or direct puck (37%) followed by being struck by a high stick (28%). Players who did not wear a visor were found to be involved in more fights, hits, and penalty minutes (p < 0.001). CONCLUSIONS: Eye and orbital injuries are mostly accidental in nature and represent a significant risk and cost to the NHL and its players. Eye and orbital injuries are significantly more likely in players who do not wear visors.

Increasing compliance with protective eyewear to reduce ocular injuries in stone-quarry workers in Tamil Nadu, India: a pragmatic, cluster randomised trial of a single education session versus an enhanced education package delivered over six months.

OBJECTIVE: To evaluate the efficacy of standard education versus enhanced education in increasing compliance with protective eyewear to prevent ocular injuries in stone-quarry workers. DESIGN: Pragmatic, allocation concealed, participant and outcome assessor blinded, cluster randomised trial. SETTING: Six stone-quarries around Vellore, Tamil Nadu, South India. PARTICIPANTS: 204 consenting adult stone quarry workers. INTERVENTIONS: Protective eyewear plus enhanced education (one education session, plus 11 sessions of group education, individual discussions, and educational plays over six months) versus protective eyewear plus standard education (one education session and 5 follow up visits). OUTCOMES: The primary outcomes were observer-rated compliance with protective eyewear and reduction in incidence of ocular injuries (slit-lamp examination by an observer blinded to allocation status) at three and six months. Analysis was by intention to treat. RESULTS: Quarries and participants were similar at enrolment. All quarries; 92/103 (90%) of workers in three quarries given enhanced intervention, and 91/101 workers (89%) in three quarries given standard education, completed six months follow up. Compared to standard education, enhanced education significantly increased compliance with protective eyewear by 16% (95% CI 3-28%) at three months (OR 2.1; 95% CI 1.2-3.8); and by 25% (95% CI 11-35%) at six months (OR 2.7; 95% CI 1.5-4.8). Protective eyewear and enhanced education reduced the incidence of eye injuries at three months by 16% (95% CI 7-24%); and standard education by 13% (95% CI 4-22%), compared to the three months before interventions. The cumulative reduction over baseline in eye injuries at the six months was greater with enhanced education (12% decrease; 95% CI 3-21%) than with standard education (7% decrease; 95% CI 17% decrease to 3% increase). However, this incidence did not differ significantly between intervention arms at three months (OR 0.7% 95% CI 0.3-2.1); and at six months (OR 0.8; 95% CI 0.4-1.5). CONCLUSION: Provision of appropriate protective eyewear reduces the incidence of eye injuries in stone-quarry workers. Periodic educational and motivational sessions with individuals and groups facilitates sustained use of protective eyewear.

Epidemiology of lifetime work-related eye injuries in the U.S. population associated with one or more lost days of work.

PURPOSE: Eye injuries are one of the most common types of work-related injuries. This study examined the lifetime prevalence rate of eye injuries at work and associated factors in the general population of the United States. METHODS: The data from the 2002 National Health Interview Survey (NHIS) were analyzed for individuals aged 18 years or older (n = 28,913). Lifetime prevalence rates of work-related eye injuries were determined by different factors, calculated as the percentage of the weighted number of people who reported to have an eye injury at work divided by the weighted total number of people in the corresponding category. RESULTS: The overall lifetime prevalence rate of work-related eye injuries was 4.4%. The lifetime age-specific prevalence rates of work-related eye injuries ranged from 2%, 3.8%, 4.9%, 6.0%, 5.4%, 4.0%, and 3.1% for ages 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, and 75+ years, respectively, with the highest rate in the age of 45-54 years. Men had a more than four-times higher rate of eye injury at work than women. Workers with less than a high-school education, non-Hispanic whites, self-employed, and in the midwest region were more likely to experience eye injuries (all p-values < 0.001). Occupations of precision production, transportation, or farming, and industries of mining or construction also increased the risk of eye injuries at work. CONCLUSION: Findings of the current study underscore the need of education and prevention program on eye protection at workplaces, targeting male workers, especially those who have a low education level and are self-employed.

Prevention of work related eye injuries: long term assessment of the effectiveness of a multicomponent intervention among metal workers.

BACKGROUND: Systematic assessments of the effectiveness of interventions to prevent work related eye injuries are needed. AIM: To investigate the long term effectiveness of a multicomponent prevention campaign. METHODS: The campaign (conducted in collaboration with the local Employers' Association and Trade Unions) targeted all 237 metal-ware factories in the district of Imola, Italy. Based on preliminary inspections, the main intervention included distribution to all factories of specific educational brochures and broadcasting/publication of television/radio programmes and local newspaper articles containing expert advice on the subject. This was followed by a four year "post-intervention reinforcement" period of unannounced official inspections. Main outcome measures analysed were eye injury rates (versus non-eye injury rates) among metal workers during "pre-intervention" (1988-90), "peri-intervention" (1991-92), "post-intervention reinforcement" (1993-96), "late post-intervention" (1997-2000), and "very late post-intervention" (2001-03) periods with respect to two comparison sectors (construction and wood/ceramics). RESULTS: A Poisson regression in which the eye injury rates were modelled for each sector, period, and interaction, adjusting for non-eye injury rates, was chosen. The periods did not by themselves determine an overall reduction in eye injuries. The period/sector interaction terms were related to significant reductions for the metal sector when crossed with the "post-intervention reinforcement" (IRR = 0.77, 95% CI 0.61 to 0.97; % decline = 23.4), the "late post-intervention" (IRR = 0.63, 95% CI 0.50 to 0.79; % decline = 37.4), and the "very late post-intervention" (IRR = 0.58, 95% CI 0.43 to 0.77; % decline = 42.4) periods, suggesting a sustained reduction in eye injury risk following the main intervention. CONCLUSION: Results suggest that a carefully coordinated, extensive, multicomponent intervention can lead to lasting reductions in the burden of eye injuries.

Cost of treating preventable minor ocular injuries in Rijeka, Croatia.

AIM: To determine the cost of medical services for the treatment of preventable minor ocular injuries in Rijeka, Croatia. METHODS: We analyzed data on 3,755 outpatients (3,363 men and 392 women) treated for eye injuries at the Department of Ophthalmology, Rijeka University Hospital, from April 2002 to March 2003. Median age of patients was 37 years (range, 26-47 years). Data were collected with a questionnaire designed for the study, which included sociodemographic data, type of injury, time and place of injury, and preventability. We carried out cost analysis of the procedures and determined the length of hospital stay. RESULTS: Out of 5,143 emergencies, minor eye injuries comprised 3,755 cases (73%). Minor injuries were potentially preventable in 90% of cases, as they resulted from nonuse or misuse of obligatory protection devices. Total one-year cost of preventable eye injuries was 135,529.55 Euros. CONCLUSION: Preventable minor eye injuries in Rijeka, Croatia, cause a serious medical and economic burden. Stricter adherence to the use of protection devices should be promoted.