380 of 2295 (17%)

97 of 1147 (8%)

9 of 84 (11%)

11 of 205 (5%)

Risk reduction




• Seat belt laws reduced the number of eye injuries by 47-65% [8, 13]8 and facial fractures by 9 percentage points [68] in the U.S., where 82% of drivers buckle up.9 The effect of legislation is shown by the fact that the rate is significantly higher in states with primary, rather than secondary, law.10

• Air bags reduce the risk of sustaining an eye injury during a crash by 2.5 times [40].

• Although air bags may themselves be a source of ocular trauma, this risk is minimal, especially when compared with the risk of death in the crash [41, 63].

• Air bags are supposed to supplement, not substitute, seat belt use (Table 1.7.3).

• The increase in the number of air bags per vehicle and the decrease of air bag deployment force are expected to further reduce the injury risk.

• In the USEIR, the rate of MVC-related serious eye injuries decreased from 12% in 1995 to 8% in 2005.

8 Seat belts saved an estimated 12,000 lives in the U.S. in 2001; two-thirds of those killed did not wear them (


10 A primary seat belt law allows police to stop a vehicle when an unbelted driver/passenger is seen; a secondary seat belt law means that another infraction must also have occurred. Sports-related Ocular Trauma11

• Ice hockey is a prototype success story. Among Canadian youth players, 283 eye injuries were seen in the 1974-1975 season; after face visors were mandated, the number of eye injuries dropped by 68%, and not a single eye was injured if the player wore full-face protection [62].

• Baseball is a major source (Fig. 1.7.5) in the U.S. In one study, a 28% reduction was achieved with a protective device [16].

• Racquetball and squash. The proportion of these games among all sport-related injury cases was reduced from 73% in 1982 to 38% in 1987 as proper protective devices^ were introduced [19].

• Paintball, an increasingly popular sport, represents a very significant risk of causing permanent visual loss/3 Proper eye protection is very efficient in preventing it-if the device is actually worn [44].

• Golf is not a common cause of eye injury, but if either the club or, more often, the ball does cause injury, it is very serious, resulting in a 40% enucleation rate [9, 28, 55, 76]. War-related Trauma

Although the rate of eye injuries among all war-related trauma has steadily increased since the mid-19th century (1.76% in the Crimean War [1854-1856], 6.8% in the Lebanon War [1982], 16% in Iraq [2004]) [3, 47], not a single eye injury occurred among Israeli Defense Forces soldiers wearing proper goggles (Fig. 1.7.9).

11 In 2000, over 42,000 persons were injured in the U.S. during sports; 72% of these persons were younger 25 years (Sports and recreational injuries, U.S. Consumer Product Safety Commission, 2000). In general, females had a twice as high risk as males to sustain a sports injury.

13 Its rate among all injuries in the USEIR was 0.5% in 2000, increasing to 1.8% in 2005.

Fig. 1.7.9 Eye protection is effective only if it is actually worn. This photo shows a soldier from the Israeli Defense Forces, who was issued a proper goggle to protect him from eye injury; he obviously is not reducing his risk of ocular trauma (Courtesy of M. Belkin, Tel Aviv, Israel) Fireworks-related Ocular Trauma

In the USEIR database, 4% of cases are caused by fireworks, and 80% of these result from bottle rockets [42]. States that prohibit private fireworks14 have a 50-fold reduction in the rate of injuries as compared to states without such regulation [4]. Fireworks can result in very severe injury (see Fig. 2.12.1). Hammering

In the USEIR database, 4% of all serious trauma are sustained while hammering; in the HEIR, 9% [38]. This statistically significant difference is most probably due to increased public awareness in the U.S., emphasizing the danger of this activity and the benefits of protective devices [29].

14 Public displays are still allowed. Protective Eyewear

The ideal device15 is:

• Tailored to a specific purpose (i.e., different designs are necessary for soccer and for racquetball)

• Resistant against major impact (made of 3- or even 4-mm polycarbonate) as well as against scratching

• Held by a proper frame that does not break or let go

• Offering frontal as well as side protection without interfering with the field of view

• Designed to prevent fogging

• Readily available (e.g., prominently displayed at the checkout counter in home-improvement stores)

• Affordable

A Controversial

The answer as to whether a regular prescription glass contributes to the injury risk since it can shatter [33] or offers at least some protection [49], is not straightforward. The finding that only 27,152 people were estimated to be treated at the ER in the U.S. due to such injury in a 2-year period^, and that only 3.8% of these persons had to be admitted [69], appears to support the protective theory.

1.7.4 Rehabilitation

If complete restoration of the injured eye's visual functions cannot be achieved, rehabilitation becomes necessary so that the person can utilize his remaining vision to the fullest extent possible. If vision cannot be im

15 The SG-1 (Wiley X Eyewar, Livermore, Calif.), a versatile, multifunctional, antibal-listic eyewear issued for personnel in the U.S. military, satisfies most criteria listed here.

16 An estimated 96 million people in the U.S. wear prescription glasses.

proved, the person needs rehabilitation (e.g., vocational training, psychological support; see below).

O Pearl

Therapy and some form of rehabilitation ideally occur simultaneously; use of the OTS allows the ophthalmologist to make a reasonable prediction regarding the long-term visual prognosis of the injured eye(s), and initiate rehabilitation early. This rehabilitation ranges from the ophthalmologist encouraging positive patient attitude to "building" and utilizing a new fovea [20].

Impairment of vision is typically measured in distance visual acuity (Table 1.7.4), even if reading ability better reflects the impairment's impact on quality of life [64]. While acuity remains the most readily measured function and is the basis for classification (Table 1.7.5), other tests measure reading speed [57] or assess function related to vision (AFREV) by incorporating visual field loss as well as the ability to perform everyday tasks [1]. While society has an official "translation" for calculating what degree of vision loss corresponds to what degree of impairment to the whole person (Table 1.7.6), this certainly varies with individual needs.

If an eye injury is vision-threatening, the person faces several short-and long-term challenges:

• Significant initial anxiety

• Psychological adaptation to a new, unfavorable reality17

• Loss of, or major changes in, career opportunities

• The potential of severe financial loss"

• The need to accept an altered lifestyle

17 With a chronic problem such as glaucoma or age-related macular degeneration, the person has a much longer period of time to prepare himself for life with visual impairment; this is significantly less difficult than facing the implications of an acute ("out of the blue") visual loss.

18 Cost of treatment itself and/or the loss of a well-paying job.

Table 1.7.4 Visual acuity and the corresponding central vision loss in percentage

Visual acuity

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