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1 In the true sense of the word, "blindness" means NLP, although terms such as "legal blindness" - applied for legal, rather than medical, purposes - are still used in everyday practice.

• An increased risk of further injury [14]19

19 The risk of sustaining another injury (e.g., falling down the stairs) is greater if the person's vision is poor, especially if this occurred only recently; a vicious circle can also ensue since the eye can be reinjured during a fall.

• An impaired quality of life20

• Occasionally permanent physical disfigurement

To minimize the effects of these challenges, rehabilitation must aim at both maximizing the eye's remaining potential (low vision specialist21) and additional experts [20] such as psychologists, vocational advisers, occupational therapists, nurses, educators, mobility therapists, social workers. The ophthalmologist should be the initiator for the entire process and remain available for advice and leadership.22 A file on such patients should be kept so that if a new therapeutic option becomes available, the patient can be contacted.23

20 e.g., a diabetic patient may become unable to accurately draw and inject insulin without somebody's help

21 e.g., to develop and utilize to the maximum the function of a new macula; to use movement, rather than binocular parallax for stereopsis

22 Throughout the entire treatment/rehabilitation process, the ophthalmologist must emphasize the positives, not the negatives, to the patient. Focusing on what can be achieved, rather than on what was lost, improves patient attitude, cooperation, and outcome.

23 The author is forever indebted to Donald C. Fletcher, MD, San Francisco, Calif., for his invaluable contributions. Tables 1.7.5 and 1.7.6 are based on his previous works.

collect information on your eye injury cases, utilizing the standardized system (www.useironline.org, www.weironline.org)

think of prevention, whether this concerns an individual case or a major societal risk factor consider initiating proper rehabilitation as soon as it becomes clear that vision cannot be restored in the injured eye

think that collection of epidemiological and clinical information on all your patients with serious eye injury is a waste of time: this is the basis for prevention and the improvement on current treatment approaches downplay the possibility of visual rehabilitation if an injured patient has poor vision; with proper techniques, the eye's functional capability can be increased substantially

Summary

Collecting epidemiological data on the occurrence of eye injuries allows identification of trends and societal risk factors. This information can then serve as the basis for designing and implementing preventive measures. Continuing data collection is necessary for the evaluation of the efficacy of the preventive measure. If the eye's functional capability remains seriously depressed despite all reasonable treatment efforts, the eye and person must be rehabilitated to utilize to the maximum the eye's remaining capabilities and help the person cope with the situation.

References

[1] Altangerel U, Spaeth G, Steinmann W (2006) Assessment of function related to vision (AFREV). Ophthal Epidemiol 13: 67-80

[2] Baker S, Braver E, Chen L, Pantula J, Massie D (1998) Motor vehicle occupant deaths among Hispanic and Black children and teenagers. Arch Pediatr Adoles Med 152: 1209-1212

[3] Belkin M, Treister G, Dotan S (1984) Eye injuries and ocular protection in the Lebanon War, 1982. Isr J Med Sci 20: 333-338

[4] Berger L, Kalishman S, Rivara F (1985) Injuries from fireworks. Pediatrics 75: 877-882

[5] Bledsoe G, Li G, Levy F (2005) Injury risk in professional boxing. South Med J 98: 994-998

[6] Blomdahl S, Norell S (1984) Perforating eye injury in the Stockholm population: an epidemiological study. Acta Ophthalmol 62: 378-390

[7] Brillant GE (1988) The epidemiology of blindness in Nepal. Report of the 1981 Nepal Blindness Survey. The SEVA Foundation, San Rafael

[8] Briner A (1976) Penetrating eye injuries associated with motor vehicle accidents. Med J Aust 1: 912-914

[9] Burnstine MA, Elner VM (1996) Golf-related ocular injuries. Am J Ophthalmol 121: 437-438

[10] Byhr E (1994) Perforating eye injuries in a western part of Sweden. Acta Ophthalmol 72: 91-97

[11] Casson R, Walker J, Newland H (2002) Four-year review of open eye injuries at the Royal Adelaide Hospital. Clin Exp Ophthalmol

[12] Catalano R, Maus M (2004) Economic antecedents of temporal variation in the incidence of ocular trauma. Ophthalmol Epidemiol 11: 279-289

[13] Cole MD, Clearkin L, Dabbs T, Smerdon D (1987) The seat belt law and after. Br J Ophthalmol 71: 436-440

[14] Coleman A, Stone K, Ewing S, Nevitt M, Cummings S, Cauley J, Ensrud K, Harris E, Hochberg M, Mangione C (2004) Higher risk of multiple falls among elderly women who lose visual acuity. Ophthalmology 111: 857-862

[15] Dana M, Tielsch J, Enger C, et al. (1990) Visual impairment in a rural Appalachian community. J Am Med Assoc 264: 2400-2405

[16] Danis R, Hu K, Nell M (2000) Acceptability of baseball face guards and reduction of oculofacial injury in receptive youth league players. Inj Prev 6: 232-234

[17] Desai P, MacEwen C, Baines P, Minassian D (1966) Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome. Br J Ophthalmol 80: 592-596

[18] Desai P, MacEwen C, Baines P, Minassian D (1996) Epidemiology and implications of ocular trauma admitted to hospital in Scotland. J Epidemiol Community Health 50: 436-441

[19] Easterbrook M (1988) Ocular injuries in racquet sports. Int Ophthalmol Clin 28:

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