The Birmingham Eye Trauma Terminology : Suggestions For Re-Inforcement

Presenting Author: Dr. Anand A. Tibdewal, Co-Authors: Dr. Mehul Shah, Dr. Shreya Shah, Dr. Kashyap Patel

1. The Birmingham Eye Trauma Terminology : Suggestions for Re-inforcement Token no: 0304 Presenting author: Dr. Anand A. Tibdewal Co-authors: Dr. Mehul Shah Dr. Shreya Shah Dr. Kashyap Patel There is no financial interest of any of the authors behind conducting this study and no financial assistance was provided by any institute or organization & there are no competing interests.

2. Introduction Ocular trauma is common, preventable yet the most under-recognized major health problem today. Blindness due to injury is a social and economical burden for every individual. Optimizing visual outcome in ocular injury requires prompt diagnosis and treatment. 1,2, 3 With the introduction of the Birmingham Eye Trauma Terminology System ( BETTS), the documentation of ocular trauma has been standardized. 4 In practice, BETT only concerns mechanical eyeball injury. As a result, eye lid, orbital and ocular adnexa injury cannot be classified by BETT, although part of orbital and ocular adnexa injuries associated with globe injury can be categorized into globe injury by BETT, this classification is still incomplete and misses some information. BETT was proposed 12 year before so it needs some additional information regarding eye lid, orbital and ocular adnexal injuries. 5,6

3. Aims & objectives To implement modification in Birmingham Eye Trauma Terminology System classification for ocular trauma. C lassification of Mechanical Ocular Injuries according to BETT

4. Study Design: Prospective And Retrospective Cohort Study. All patients with ocular trauma in either eye, diagnosed and managed between January 2002 to December 2015 at Drashti Netralaya , Dahod were included in the study, and patients consenting to participate were included. Inclusion Criteria: All patients coming to Drashti Netralaya with ocular trauma.   Exclusion Criteria: Severe trauma to other body parts. Patient with ocular trauma, already treated for the same in any other hospital . Sample size: 4721 Materials & methods

5. Examination Protocol: For each patient enrolled, we obtained a detailed history, socioeconomic data, details of the injury, and information on the eye treatment and surgery performed to manage past ocular trauma. Data for both the initial and follow-up reports were collected using the online BETTS format of the International Society of Ocular Trauma. Details of the surgery were collected using an online form. Visual Acuity on presentation of both eyes , A nterior Segment examination by Slit Lamp Biomicroscopy , Posterior Segment examination by Indirect Ophthalmoscope and if media was not clear, then a B-scan was performed to evaluate the posterior segment . The surgical technique was selected according to the morphology and the condition of tissues other than the lens. In all patients undergoing corneal wound repair, the traumatic cataract was managed in a second procedure . The duration of medical treatment depended on the degree of inflammation in the anterior and posterior segments of the operated eye . Data was exported from electronic medical record system, collected in excel sheets and analyzed.

6. Observation & results Age Incidence Gender Distributuion

7. Activity at Injury Object Causing Injury Ocular Structures Involvement

8. OTS POINTS AND FINAL VISUAL OUTCOME ( P < 0.01 ) OTS 1 OTS 2

9. OTS 3 OTS 4 OTS 5

10. NEW PROPOSED CLASSIFICATION

11. Discussion Ocular trauma is believed to be one of the significant cause of visual impairment. It can cause a wide variety of damage to the ocular tissues . Trauma generally occurs in the younger age group and in males who are commonly involved in outdoor activities. It is comparatively rare in old age and in females. Most of the people sustain injuries during work, which in a rural setup includes agricultural activity most commonly . Trauma can cause a variety of damage to the ocular tissues. This damage can involve both the anterior and posterior segment. The damage can be relatively mild or can be very severe, leading to loss of vision. In mild cases, medical management is sufficient whereas in severe cases, early surgical intervention such as paracentesis, globe repair and vitrectomy is required to restore some useful vision . conclusion Standardized international classification of mechanical eyeball injury proposed by BETT considering incomplete, we propose a new classification of mechanical eye injuries. This classification nearly includes all mechanical eye injuries to makes epidemiological study and clinical records easier.

12. References Wong TY, Klein BE, Klein R. The prevalence and 5-year incidence of ocular trauma. The Beaver Dam Eye Study. Ophthalmology. 2000; 107:2196-202. Negrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiology. 1998;5:143-69. Alfaro DV 3rd, Jablon EP, Rodriguez Fontal M, Villalba SJ, Morris RE, Grossman M, Roig-Melo E. Fishing-related ocular trauma. Am J Ophthalmol . 2005 Mar;139(3):488-92. Kuhn F, Morris R, Witherspoon CD, Mester V, The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol . 2004;27:206-10. Rofail M, Lee GA, O’Rourke P: Prognostic indicators for open globe injury. Clin Experiment Ophthalmol 2006;34:783–786. Rahman I, Maino A, Devadason D: Open glob injuries: Factors predictive of poor outcome. Eye 2006;20:1336-1341.