Ophthalmology Volume 100, Number 9, September 1993

2. Spaeth GL. Instrumentation, sutures, and standardophthalmic procedures. In: Ophthalmic Surgery: Principles& Practice, 2nd ed. Philadelphia: WB Saunders, 1990;71.

Note: Authors elected not to respond.

Ocular Injuries in Motor Vehic1e Crashes

Dear Editor:We read with interest the article by Nanda et al entitled," Penetrating Ocular Injuries Secondary to Motor VehicleAccidents" (Ophthalmology 1993;100:201-7). The mag­nitude of the problem of traffic-related injuries is high­lighted by the fact that since the turn of the century, 2.8million individuals have been killed in traffic accidentsin the United States-more than twice as many as havebeen killed in all U.S. wars since 1775.1 Because the lit­erature on motor vehicle crash (MVC)-related oculartrauma is sparse, the authors are to be commended par­ticularly for reporting on 10 cases of penetrating eye injurycaused by MVCs and for emphasizing the importance ofseat belt legislation. Our experience with MVC-relatedocular trauma reveals data that are somewhat different.

Since 1982, the Eye Injury Registry of Alabama(EIRA), an affiliate of the Un ited States Eye Injury Reg­istry (USEIR) , has been collecting epidemiologic, treat­ment, 6-month outcomes, and rehabilitation informationon both open-globe (penetrating) and closed-globe (non­penetrating) serious ocular trauma (resulting in permanentand significant structural or functional change to the eyeor adnexia).

By December 31, 1989, 150 MVC-related eye injurieswere registered by the EIRA.2 All injuries were sustainedin the state of Alabama, which had no mandatory seatbelt law during this period. Air bags were not availableduring this period. The 150 injuries constituted 8% of thealmost 2000 injuries in the EIRA data base in this 7-yearperiod.

In our study, the mean age of those injured was 29years; 61% of individuals were between 16 and 35 yearsof age, and 73% were male. In a subset of patients, wefound that 22% of those injured wore a seat belt at thetime of impact; approximately half admitted to have notworn it properly.

Bilateral eye injury was much more prevalent amongthose injured during MVCs (7%) than in the total EIRAdata base (3%). The difference was statistically significant(chi-square value: 9.15, P = 0.002; odds ratio: 2.72, 95%confidence interval: 1.4-5.2).

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Posterior segment structures were involved in 71% ofeyes (e.g., optic nerve involvement was documented in13% ofinjuries, compared with 5% in the total EIRA database). Eighty-two percent of eyes required surgery, with29% of eyes undergoing multiple surgeries. Of eyes withat least 3 months of follow-up, 63% had worse than 20/200 initial visual acuity, and 41% remained legally blind.In comparison, 64% of eyes in the total EIRA data basewith at least 3 months of follow-up had worse than 20/200 initial visual acuity , and 36% remained legally blind.Eighteen eyes (12%) required removal, a proportion iden­tical to that in the total EIRA data base.

Fifty-five percent of entries in our series involvedclosed-globe injuries. Other dissimilarities, compared withthe authors' data, include posterior segment involvement(71% versus 30%), final legal blindness (44% versus 10%),bilateral eye injury (7% versus 0%), and enucleation rate(12% versus 0%).

Other than the fact that this series involved both closed­globe and open-globe injuries , including blunt ruptureswhich carry a particularly unfavorable prognosis, it is un­known why we registered more severe injuries than theauthors. Only time will tell whether this larger series ismore representative of all serious MVC eye injuries. Nev­ertheless, the impact of MVC-related eye injuries may beillustrated by the fact that in the subgroup of91 individualsages 16 to 35 years in our study, approximately 2700 yearsof lost eyesight were sustained, based on life expectancytables. Moreover, the MVC is the second most frequentcause of serious bilateral eye injury. The common con­clusion in both series is that effectiveseat belt usage wouldlikely result in a significant reduction ofMVC-related sightloss.

F ERENC K UHN, MDROBERT MORRIS, MDC. DOUGLAS WITHERSPOON, MDSALLY BROWN, RNBirmingham, Alabama

References

I. Division of Injury Control , National Center for Environ­ment al Health and Injury Control. Position Papers fromThe Third National Injury Control Conference. [Washing­ton, DC]: U.S. Dept. of Health and Human Services,1992;77.

2. Kuhn F, Collins P, Morris R, Witherspoon CD. Epide­miology of motor vehicle crash-related serious eye injuries.In: Association for the Advancement of Automotive Med­icine. Proceedings 36th Annual Conference. Des Plaines:The Association, 1992;305-17.