Comparison of Ocular Trauma Indices in Grading Severity of Injury ...

704 AIOC 2010 PROCEEDINGSComparison of Ocular Trauma Indices in Grading Severity ofInjury and Predicting Visual Disability after Open Globe InjuriesOcular trauma has now gained attention as amajor cause of visual morbidity.1Assessment of severity of ocular injury atpresentation using a standardized scoring systemis helpful for unambiguous interpretation andreporting of research results to allow forinternationally valid comparisons.Various ocular trauma scoring systems in usetoday include Trauma Index - TI (1983) by Shuklaet al2 instituted before eye trauma wasunambiguously classified by the InternationalOcular Trauma Classification Group3 in 1997.After the Birmingham Eye Trauma Terminology– BETT 4 (1996) was reported by the ISOT –International Society for Ocular Trauma5 in 1997,the Ocular Trauma Score – OTS (2002) by Kuhn etal6 and the Ocular Trauma Severity Score – OTSS(2001) by Vasu et al7 based on Trauma and InjurySeverity Score (TRISS) 8 and A SeverityCharacterization of Trauma (ASCOT) 9, wereformulated.To the best of our knowledge the accuracy ofthese scoring systems in predicting visualdisability after open globe injuries have neitherbeen established nor compared. The subjectiveand objective quantification of visual disability inopen globe injuries also lacks standardreferences. Moreover, studies involving theexisting scores have been retrospective resultingin lack of standardized terminology, assessmentand reporting of ocular trauma cases. Hence anattempt has been made by us to quantify thevisual disability in open globe injuries using thepublished ocular trauma severity scores.To critically evaluate and compare ocular traumascores in predicting visual function and disabilityafter open globe injuries.Materials and MethodsThis is a prospective study of patients with openglobe injuries conducted in Department ofOphthalmology at St. John’s Medical College andHospital, from June 2005 to June 2007. Patientswith previous ocular surgery/trauma/major eyedisease/difficulty in measuring the visualfunction/new injury during follow-up wereDr. Mayuri Bhargava, Dr. Usha Vasu(Presenting Author: Dr. Mayuri Bhargava)excluded. At presentation, all patients underwenta detailed history and ophthalmic evaluation.Severity of patient’s injury was then gradedaccording to the following Ocular TraumaScoring Indices, used in the study:• Ocular Trauma Score (OTS) – Kuhn et al 6• Ocular Trauma Severity Score (OTSS) – Vasu etal 7 • Trauma Index (TI) – Shukla et al 2• Percentage Disability was calculated for everypatient at the end of 6 months following theinjuries (As per Workman’s Compensation Act,1923, 10 which was subsequently revised in200111 with similar guidelines).At follow-up of six months, after the last surgery,patients were finally evaluated to assess VisualDisability objectively as well as subjectively torelate the effect of his/her visual disability onvarious domains of life like routine activities,psychological and work performance / study.Objectively:• Best Corrected Visual Acuity, • DiplopiaCharting, 12, • Visual Fields 12 by AutomatedHumphrey Perimeter (central 30-2), • %Efficiency (Binocular Vision) for distance = [%efficiency of poorer eye + 3*(% efficiency of bettereye)] / 4 12Subjectively: Representative Questionnaire fromscales used to measure various Domains ofQuality of LifeResultsSixty–four patients were included in the studywith mean age of 28.6 years. Majority of patients(n=45; 70.6%) belonged 11 – 40 age group. Malesaccounted for 90.6% (n=58) of the studypopulation. Visual acuity of

TRAUMA SESSION705Visual acuity recorded at 6 months after the lastsurgery was most commonly between < HM –No PL in 27 patients (42.2%). 30 out of 64 patients(46.8%) had poor binocular vision at 6 monthsfollow-up. At the end of follow – up period, only14 patients (29.1%) had a severe visual disabilityobjectively, while 44 patients (68.8%) had onlymild objective visual disability. Among the 24patients with good binocular vision at 6 months,23 patients (95.8%) had mild objective disability.With respect to subjective disability, 40 patients(62.5%) were only mildly restricted in theirroutine activities, while 29 patients (45.3%), werefound to be moderately psychologically affectedand were anxious, depressed and emotionallydisturbed at the end of 6 months. Well – beingscale with respect to life satisfaction, general well– being and positive attitude was found to beonly mildly affected in most of the patients, 37(57.8 %), at the end of 6 months. Work / studyperformance was found to have suffered mildloss in 23 patients (35.9%), at the end of 6 months.19 out of 24 patients (79.1%) with good binocularvision had mild total subjective disability at 6months.OTS correlation with visual regain at 6 monthswas found to be better for mild and moderateinjuries while that of OTSS showed bettercorrelation for severe injuries. However, acorrelation between TI and various grades ofvisual regain could not be obtained.With respect to correlation of injury severity at1. Parver L. Eye trauma. The neglected disorder. ArchOphthalmol; 104(10):1452–3.2. B. Shukla and Binod Khanna. Trauma Index – asystem of evaluation of ocular damage due totrauma. Indian Journal of Ophthalmology, July 1983,31:439–41.3. Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, BridgesWZ Jr, Capone A Jr, Cardillo JA, de Juan E Jr, KuhnF, Meredith TA, Mieler WF, Olsen TW, RubsamenP, Stout T.”A system for classifying mechanicalinjuries of the eye (globe). The Ocular TraumaClassification Group.” American Journal ofOphthalmology. 1997 Jun;123(6):820-31.4. Kuhn F, Morris R, Witherspoon CD. BirminghamEye Trauma Terminology (BETT): Terminology andclassification of mechanical eye injuries.”Ophthalmology Clinics of North America. 2002 Jun;15(2):139–43.5. Kuhn.F, Morris R, Witherspoon CD, Heimann K,Jeffers JB, Treister G. A standardized classificationof ocular trauma. Ophthalmology. 1996 Feb;103(2):Referencespresentation with objective disability at 6months, in OTS it is better for mild and moderateinjuries while OTSS correlates better formoderate and severe injuries. TI does not reallyrelate the severity of injury at presentation withvisual disability at 6 months well.On correlating injury severity at presentationwith subjective disability at 6 months, OTSshowed statistically significant correlation (P

706 AIOC 2010 PROCEEDINGSDisabilities Act, 1965, 1st June 2001.12. Council on Industrial Health, A.M.A.:Estimation of loss of visual efficiency, Arch. Indust.H. 1955;12:439.13. Schipper J, Landau K, Hornung r. Evaluation ofvisual field defects, motility disorders and diplopiawithin the scope of accident insurance law. KlinMonatsbl Augenheikd. 1993 May; 202(5):382-5.