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Eye Injury: Overview

Margaret Harrill

     It can be said that disease occurs in predictable ways, to predictable groups of people and follows more or less a predictable course of events. A common disease that occurs in the eye is age-related macular degeneration (AMD). We know that this disease occurs most often in Caucasian women over the age of 50. We know that there is a combination of genetic and environmental factors that influence who is most vulnerable to this disease. We know that untreated, the natural course of this disease is distinguished by its form, either dry or wet. With the evolution of increasingly more and more sophisticated methods of discovering and understanding, increasingly more and more effective treatments and preventions have been and are being developed for this once inevitably disabling condition.

Can we say the same thing about injury? Can we predict who will have an eye injury and why? Can we say people who have eye injuries will experience a certain type of symptom, which will progress in a specific way and will respond to a distinct treatment? Is there a foundation of historical observation and research on which to base these assumptions? No. Regrettably, we can not offer the same degree of certitude to a victim of ocular trauma today as we can to the AMD sufferer.

It is only within the past 30 years that two elements critical to illuminating the dark unknown of ocular trauma have come to pass. Early in the decade of the 1970’s, Dr. Robert Machemer pioneered the development of vitrectomy, a surgical method of operating inside of the globe through microscopic portals that allow the eye to maintain its shape and integrity during the operation. Prior to the advent of vitrectomy, if someone had a very serious eye injury there was very little that could be done. Many, if not most, of the seriously injured eyes were simply removed. It was not until vitrectomy that surgeons were able to begin to operate within the globe. Only then could surgeons start to sort out damage to the internal structures and find ways to repair them. Empowered with a way to treat injuries, ophthalmologists became interested in improving the results of their work. Little was known about eye trauma and less about the results of ocular trauma surgery. There wasn't’t even a common language or terminology for discussing eye injury among different physicians in different institutions or countries. A decade after Machemer’s advance, a registry for eye injury statistics was formed in Alabama. It was to become the genesis for the United States Eye Injury Registry (USEIR), a project of the Helen Keller Foundation. Thanks to the research of the Registry, many of the gaps in information about eye trauma are beginning to be filled in. Registry research has enabled the creation of a universal terminology for describing injury, the Birmingham Eye Injury Terminology (BETTS). Foundation scientists have also been able, with the Registry data, to develop the Ocular Trauma Score (OTS), a program for prognostic evaluation of injury.

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July 2009

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