Epidemiology of blinding trauma in the United States Eye Injury Registry

Purpose: To analyze the epidemiology and clinical characteristics of serious eye injuries leading to legal blindness. Methods: Analysis of information on 11,320 eyes in the United States Eye Injury Registry (USEIR) database. Legal blindness in this study was defined as visual acuity of worse than 20/200. Results: No less than 27% of eyes with serious injury had <20/200 final vision, although the rate varied greatly with injury type. Several risk factors were found to statistically significantly increase the chance of eye trauma resulting in blindness: age over 60 years, injury by assault, sustained on street/highway, or occurring during fall or by gunshot. Trauma to the left eye carried a statistically significantly poor prognosis as did two injury types, rupture and perforating. Involvement of the posterior segment was another factor indicating poor outcome; in particular, vitreous hemorrhage, retinal detachment, choroidal rupture, and endophthalmitis were found to increase the risk of blindness. Conversely, young age, contusion and intraocular foreign body injuries, among others, signaled a better than average chance of good outcome. Overall, 60.5% of injured eyes showed visual improvement after treatment. Conclusions: This large study identified multiple risk factors whose presence significantly increases the chance of the injured eye becoming "legally blind." Continued efforts to improve treatment and develop/ implement prevention measures based on risk analysis should reduce the incidence of blinding trauma.