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The Incidence of Eye Injuries in Canada

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Page 1: The Incidence of Eye Injuries in Canada

The Incidence of Eye Injuries in CanadaKeith David Gordon, PhD

ABSTRACT ● RÉSUMÉ

Objective: To provide information concerning the incidence of eye injuries in Canada.Design: Cross-sectional study.Participants: The study population consisted of all Canadians over the age of 18 years who agreed to participate in a telephone survey.

Study participants were selected via random digit telephone dialing, with a roughly equal per capita geographic representation acrossCanada. Participating in the study were 4974 people, 51.8% of whom were female.

Methods: People agreeing to participate in the survey were asked whether, during the past year, they had had an eye injury that requiredmedical attention. Those who said they had were asked an additional set of questions to ascertain the nature, cause, and locationof the injury.

Results: Of the participants, 104 (2.09%) were found to have had an eye injury that required medical attention during the past year. Thenumber of eye injuries occurring at home and at work was approximately the same (37.5% and 35.5%). Playing sports accounted for8.6% of all injuries. Sharp objects were the primary cause of injury (23.1%), followed by dirt and debris (12.5%), and blunt objects(6.7%). The number of men reporting eye injuries was 3 times that of women. Approximately one quarter of all eye injuries (22.1%)had resulted in taking time off from work or school.

Conclusions: This population-based study indicates that the incidence of eye injuries in Canada is extremely high and argues for apublic prevention campaign that encourages the use of eye protection, both at home and in the workplace.

Objet : Information concernant l’incidence des blessures oculaires au Canada.Nature : Étude transversale.Participants : La population à l’étude comprenait uniquement des Canadiens et Canadiennes de plus de 18 ans qui avaient acceptés

de participer à un sondage téléphonique. Les participants ont été retenus en composant au hasard leurs numéros de téléphone, avecune représentation géographique per capita à peu près égale à travers le pays. En tout, 4 974 personnes, dont 51,8 % de femmes,ont ainsi participé.

Méthodes : Les personnes qui ont accepté de participer se sont d’abord vues demander si elles avaient eu une blessure oculaire quiavait requis des soins médicaux au cours de la dernière année. Celles qui répondirent dans l’affirmative ont dû répondre à plusieursquestions pour confirmer la nature, la cause et l’emplacement de la blessure.

Résultats : Il s’est avéré que 104 participants (2,09 %) avaient eu une blessure oculaire qui avait requis des soins médicaux au coursde l’année précédante. Les nombres de blessures survenues à la maison et au travail étaient approximativement semblables (37,5%et 35,5%). La pratique sportive a compté 8,6 % de toutes les blessures. Les objets tranchants étaient la cause principale de blessure(23,1 %), suivis de la saleté et des débris (12,5 %) et des objets contondants (6,7 %). Les hommes étaient 3 fois plus nombreux queles femmes à signaler une blessure oculaire. Environ le quart de toutes les blessures oculaires (22,1 %) ont entraîné des absencesdu travail ou de l’école.

Conclusions : Cette étude basée sur la population indique qu’au Canada l’incidence des blessures oculaires est extrêmement élevéeet soutient une campagne de prévention publique pour encourager l’utilisation de protecteurs oculaires, à la maison et au travail.

Eye injuries are a major cause of vision loss; an estimated27% of people sustaining serious eye injuries become legallyblind (visual acuity � 20/200) as a final result.1 In spite of theseriousness of the visual outcomes, very little research into theepidemiology and nature of eye injuries has been undertakenrecently in Canada. The Canadian Ophthalmological Societyhas established an eye injury registry to encourage the report-ing of eye injuries, but such registries are limited by the extentto which injuries are reported by ophthalmologists, optome-trists, and the many other physicians that may be treating eyeinjuries.2 A recent study analyzed the nature of eye injuriesreporting to a major Canadian pediatric hospital; however, todate no extensive population-based study of eye injuries hasbeen conducted in Canada.3

Data from comprehensive population-based surveys inthe United States estimated the annual incidence of eyeinjuries requiring treatment in an emergency department,

Canadian National Institute for the Blind, Toronto, Ontario, Canada.

Originally received Jan. 11, 2012. Final revision Feb. 24, 2012. AcceptedMar. 6, 2012Correspondence to Keith D Gordon, PhD, CNIB, 1929 Bayview Avenue,

Toronto, Ontario M4G 3E8; [email protected]

inpatient or outpatient facility, or private physician’s officeat 6.98 per 1000 population, whereas another population-based survey estimated the annual average incidence of eyeinjury to be 3.1 per 1000 population.4,5 Studies conductedin Baltimore, MD, and Melbourne, Australia, estimatedthe cumulative lifetime prevalence of eye injuries requiringmedical attention to be 14.4% and 21.1%, respectively.6,7

A telephone-based population survey in New England re-ported the annual incidence of eye injuries requiring med-ical attention to be 9.75 per 1000 population.8

The wide variation in the incidence and prevalence ofeye injuries reported in these studies results primarily fromthe differences in methodology used and the definitions ofeye injury used in the various studies. These differencesmake it extremely difficult to compare data.

The present study was conducted with the goal of obtain-ing comprehensive population-based data concerning the na-

Can J Ophthalmol 2012;47:351–3530008-4182/11/$-see front matter © 2012 Canadian Ophthalmological Society.Published by Elsevier Inc. All rights reserved.dx.doi.org/10.1016/j.jcjo.2012.03.005

CAN J OPHTHALMOL—VOL. 47, NO. 4, AUGUST 2012 351

Page 2: The Incidence of Eye Injuries in Canada

Eye injuries in Canada—Gordon

ture and extent of eye injuries in Canada so as to inform publichealth strategies for the prevention of eye injuries in Canada.

METHODS

The study population consisted of all Canadians over theage of 18 years who agreed to participate in a telephone sur-vey. Study participants were selected via random digit tele-phone dialing, with a roughly equal per capita geographicrepresentation across Canada. The survey was conducted be-tween June and August of 2011. People agreeing to partici-pate in the telephone survey were asked whether they had hadan eye injury that required medical attention during the pastyear. Those who said they had were then asked an additionalset of questions to ascertain the nature, cause, and location ofthe injury. Many people cannot distinguish among ophthal-mologists, optometrists and, in some cases, family practitio-ners, so this description of medical attention was deliberatelykept broad and nonspecific so as to capture the complete spec-trum of attention a patient may have received. A �2 analysiswas used to assess the differences in incidence of injuries inmale and female subjects.

RESULTS

The study included 4974 people, 51.8% (2576) ofwhom were female. Of them, 104, or 2.09% (95% CI,1.73% to 2.53%), were found to have had an eye injurythat required medical attention during the past year. By

Table 1—Number of eye injuries by province

Numbersurveyed

Number ofinjuries inpast year

Percentage ofnumber

surveyed

95% CI

Newfoundland 88 3 3.41 1.17–9.55Nova Scotia 154 3 1.95 0.67–5.57New Brunswick

& PEI 144 2 1.39 0.38–4.92Quebec 1205 20 1.66 1.08–2.55Ontario 1894 33 1.74 1.24–2.43Manitoba 186 2 1.08 0.30–3.84Saskatchewan 159 4 2.52 0.98–6.30Alberta 498 17 3.41 2.14–5.40British Columbia 646 20 3.09 2.02–4.74Total Canada 4974 104 2.09 1.73–2.53

Table 2—Eye injuries by location

Location Number of eyeinjuries in past

year

Percentage ofeye injuries in

past year

95% CI

Home 39 37.5 28.8–47.1Work 37 35.5 27.0–45.1Playing sports 9 8.6 4.6–15.6On the farm 4 3.8 1.5–9.5Traffic accident 3 2.9 1.0–8.1At school 2 1.9 0.5–6.7On vacation/while

traveling 2 1.9 0.5–6.7

All other 8 7.7 4.0–14.5

352 CAN J OPHTHALMOL—VOL. 47, NO. 4, AUGUST 2012

province, the percentage of people experiencing an eye in-jury during the past year ranged from 1.08% in Manitobato 3.41% in Newfoundland and Alberta (Table 1).

The number of eye injuries occurring at home and atwork were approximately the same (Table 2), 37.5% and35.5%, respectively. Playing sports accounted for 8.6% ofall injuries.

Sharp objects were the primary cause of injury (23.1%)followed by dirt and debris (12.5%) and blunt objects(6.7%) (Table 3). The number of men reporting eye inju-ries during the previous year was 3 times that of women.Men incurred 75% of all injuries (3.4% of all males sur-veyed), whereas women incurred 25% of all injuries (1.2%of all females surveyed) (p � 0.0001).

Factory workers incurred 21.2% and office workers19.2% of all injuries; retirees incurred 15.4% (Table 4).

Approximately one quarter of all eye injuries had re-sulted in taking time off from work or school in the previ-ous year (22.1%). This represents 0.46% (95% CI, 0.31%to 0.69%) of all the people surveyed.

DISCUSSION

The incidence of 2.09% for eye injuries requiring med-ical attention during the previous year found in this studyis significantly higher than that found by Glynn et al. in

Table 3—Eye injuries by cause

Object description Number of eyeinjuries in past

year

Percent ofeye injuriesin past year

95% CI

Sharp object/metal/nail 24 23.1 16.0–32.1Dirt/dust/debris 13 12.5 7.5–20.2Blunt object 7 6.7 3.3–13.2Piece of wood/splinter/

tree 6 5.8 2.7–12.0Playing sports/sporting

equipment 5 4.8 2.1–10.8Chemicals 4 3.9 1.5–9.5Fall 3 2.9 1.0–8.1Body part in the eye 3 2.9 1.0–8.1Don’t know/don’t

remember 12 11.5 6.7–19.1All other 27 26.0 18.5–35.1

Table 4—Eye injuries by occupation

Occupation Number of eyeinjuries in past

year

Percent ofeye injuriesin past year

95% CI

Factory worker 22 21.2 14.4–30.0Office worker 20 19.2 12.8–27.8Retired 16 15.4 9.7–23.5Construction/tradesperson 9 8.7 4.6–15.6Student 6 5.8 2.7–12.0Farm worker 6 5.8 2.7–12.0Homemaker 5 4.8 2.1–10.8Unemployed 3 2.9 1.0–8.1Health care worker 2 1.9 0.5–6.7Fireman 1 0.9 0.2–5.2

All other 14 13.5 8.2–21.3
Page 3: The Incidence of Eye Injuries in Canada

Eye injuries in Canada—Gordon

New England in 1985, using a similar methodology.8 Pos-sible reasons for this are, first, the fact that the currentstudy included more men than did the Glynn et al. study.The current study sample consisted of 48% men, whereasthe Glynn et al. study sample only had 42% men. Bothstudies showed that men were more likely to have experi-enced an eye injury. The greater number of men in thecurrent study, therefore, might be expected to account forsome of the difference. Second, because the survey ques-tion defined an eye injury as an injury requiring medicalattention, one might expect a greater number of people inCanada to have gone for medical attention than in theUnited States because of the universal accessibility ofhealth care in Canada. Further differences may be ex-plained by differences in location and the fact that theGlynn et al. study was conducted in New England in 1985.Urbanization and machinery development for both homeand industrial use have increased since then and may ac-count for the greater number of injury-causing accidents.

The results of this study are also higher than the an-nual incidence reported in the population-based studyby McGwin et al. mentioned above (6.93 per 1000).4

This difference can be accounted for by the fact that opto-metric care is excluded from the previous study, whereas allforms of care are included in the current study.

The finding that the annual incidence of eye injury inmen was 3 times that for women was compared with sim-ilar ratios of injuries in total. The Canadian CommunityHealth Survey for 2010 reported the 12-month incidenceof all injuries in men in the age group of 20 years and olderto be 1.35 times that for women in the same age group.9

More research is needed to determine the reason for thisdifference.

This study has certain limitations. The ability of an in-dividual to recall the exact nature of an eye injury whenasked on the telephone may be limited, particularly if theinjury was not a major one. Because of the limited timeavailable in a telephone survey, it was not possible to askmore detailed questions about the cause of the injury andwhat type of eye protection had been used. Further study isnecessary in this regard.

The finding that 2.09% of people surveyed had had aneye injury during the previous year, when projected acrossthe total Canadian population, would mean that 721 000people had had an eye injury requiring medical attentionduring the past year. This study showed that 0.46% of all

people surveyed had lost time from school or work in the

past year because of an eye injury. When this number isprojected across the Canadian population between the agesof 20 and 64 years, it means that 99 700 people in Canadalost time from work last year due to an eye injury.10

These findings have significant implications for publichealth prevention in Canada. If only a small percentage ofeye injury accidents could be prevented, a significantamount of suffering to individuals could be avoided. Itwould also result in financial savings to the health caresystem and the economy.

CONCLUSION

This study shows that eye injuries represent a significantsource of morbidity in Canada. The associated costs tosociety, both personal and financial, are extremely high.Prevention of eye injuries can provide significant financialsavings to the health care system and the economy and can,at the same time, reduce the significant social and personalcosts that may ensue as a result of vision loss.

Disclosure: The author has no proprietary or commercial interest inany materials discussed in this article.

REFERENCES

1. Kuhn F, Morris R, Witherspoon CD, Mann L. Epidemiology of blind-ing trauma in the United States eye injury registry. Ophthalmol Epide-miol. 2006;13:209-16.

2. Canadian Ophthalmological Society 2007. Eye injury registry. Availableat: www.eyesite.ca/english/press/eye-injury-registry.html. Accessed Jan-uary 6, 2012.

3. Podbielski DW, Surkont M, Tehrani NN, Ratnapalan S. Pediatric eyeinjuries in a Canadian emergency department. Can J Ophthalmol. 2009;44:519-22.

4. McGwin G, Xie A, Owsley C. Rate of eye injury in the United States.Arch Ophthalmol. 2005;123:970-6.

5. Wong TY, Klein BEK, Klein R. The prevalence and 5-year incidence ofocular trauma: The Beaver Dam Eye Study. Ophthalmology. 2000;107:2196-202.

6. Katz J, Tielsch JM. Lifetime prevalence of ocular injuries from the Bal-timore eye survey. Arch Ophthalmol. 1993;111:1564-8.

7. McCarty CA, Fu CLH, Taylor HR. Epidemiology of ocular trauma inAustralia. Ophthalmology. 1999;106:1847-52.

8. Glynn RJ, Seddon JM, Berlin BM. The incidence of eye injuries in NewEngland adults. Arch Ophthalmol. 1988;106:785-9.

9. Statistics Canada. Injuries in Canada: Insights from the Canadian Com-munity Health Survey. Available at: www.statcan.gc.ca/pub/82-624-x/2011001/article/11506-eng.htm#a4. Accessed January 9, 2012.

10. Statistics Canada. Population by sex and age group. Available at:www.40.statcan.gc.ca/l01/cst01/demo10a-eng.htm. Accessed January

6, 2012.

CAN J OPHTHALMOL—VOL. 47, NO. 4, AUGUST 2012 353