EDITORIAL
Prevention Is Better Than Cure: The Dilemma in the Workplace Lawrence Lee, MBBS, FRANZCO, FRACS
W
ork-related eye injuries represent a significant cost to the community in terms of loss of vision, loss of manpower, work hours, as well as cost of medical and surgical repair. These injuries generally are preventable with protective eyewear. In the Asia-Pacific region, work-related injuries including open and closed globe injuries have been studied, with significant numbers, identifying an important issue in ocular morbidity. In a study by Ho et al1 in 2007, it was found that 189 (38.9%) of 486 subjects treated in emergency departments were work-related eye injuries. These were predominantly male, with common types of eye injuries such as foreign body injuries (31.2%), followed by blunt injuries (20.6%), chemical burn (19.6%), UV light radiation (12.7%), and corneal abrasion (11.6%). This study could not, however, show the industrial distribution of eye injuries in Taiwan. The article, Work-Related Eye Injuries: Important Occupational Health Problem in North Thailand by Chaikitmongkol et al,2 presents important research into the demographics of work-related eye injury in Northern Thailand, particularly looking at the types of injury and the predisposing occupations and activities. This study found 101 eyes of 97 patients with work-related injuries of which they were predominantly men, with a mean age of 39.5 years. Some of 98% did not wear protective eyewear. Looking at the type of injury, open globe injuries (57%) included penetrating eye injury and intraocular foreign bodies and other complicating factors were vitreous hemorrhage, retinal detachment, and endophthalmitis. Closed globe injuries, representing 43%, included eyelid and canalicular lacerations, orbital floor fracture and corneal foreign bodies through to hyphema, as well as traumatic optic neuropathy. Traumatic cataract and hyphema can occur in open and closed injuries. With regard to open globe injuries, the most common presentation was traumatic cataract with disruption of the anterior lens capsule at 28%. Intraocular foreign bodies represented 26%, with associated endophthalmitis and retinal detachment at 19% and 10%, respectively. With closed globe injuries, the most common manifestation was traumatic cataract at 42%, followed by hyphema at 40%. These patients were treated medically; although in comparison, those with open globe injuries required multiple surgical procedures. The mean (SD) follow-up was 4.3 (12.2) months. There was significant reduction in visual acuity with the open globe injuries, which had a much worse visual prognosis. Important data on the occupational hazards found that workers engaged in agriculture work compared with construction work were at a significantly higher risk of an open globe injury and that patients working with nails and grass trimmers were significantly more likely to sustain open globe injuries. Of note, in this study, there were only a small number that sustained chemical injury for which other studies have shown a higher incidence; particularly, a study by Ho et al1 found 19.6% occupational chemical injury versus only 4% in this study. The predominant causative factor for work-related eye injury was lack of protective eyewear, with the reason for not wearing protective eyewear showing that 59% had lack of knowledge of protective eyewear, with 22% having lack of available protective eyewear equipment. Only 18% had available equipment and knowledge but just had not used the protective wear. Alcohol consumption was only 3% and not a significant factor. The predominant cause of open globe injuries was nailing, with motorized grass trimming as the second-highest cause of open globe injuries. For closed globe injuries, metal grinding was the most prominent association, leading to corneal foreign bodies. This study identifies an important preventable ocular health problem in which education and recommendation for usage of protective eyewear are lacking. Governments and public health authorities should be aware of this issue and mandate that industries involved (with particular note in agriculture) should be aware of a need for recommendation of protective eyewear for workers. Although advancements in vitrectomy surgery repair of intraocular injury have been made across the Asia-Pacific region at considerable cost, the cost benefit of simple protective eye wear and public awareness campaigns is paramount in reducing ocular morbidity.3 From the City Eye Centre; Royal Brisbane Hospital; and University of Queensland, Queensland, Australia. Received for publication April 16, 2015; accepted April 16, 2015. Reprints: Lawrence Lee, MBBS, FRANZCO, FRACS, City Eye Centre, Level 10, 135 Wickham Terr, Brisbane, Queensland 4000, Australia. E-mail: eye@ cityeye.com.au. Copyright * 2015 by Asia Pacific Academy of Ophthalmology ISSN: 2162-0989 DOI: 10.1097/APO.0000000000000125
Asia-Pacific Journal of Ophthalmology
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Volume 4, Number 3, May/June 2015
www.apjo.org
Copyright © 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.
129
Asia-Pacific Journal of Ophthalmology
Editorial
A study by Lombardi et al4 in 2009 found several factors preventing the usage of protective eyewear. These included lack of comfort/fit, fogging, scratching of the eyewear, young age, and lack of safety training being important factors. These factors can be mitigated by design and government/industrial policy to recommend protective eyewear in all at risk occupations. The article by Chaikitmongkol et al2 represents a timely reminder that in the modern world, simple intervention with protective eyewear can prevent a magnitude of significant ocular morbidity and save significant costs to the community. While it is enlightening to see the growing medical and surgical skill in ophthalmic trauma care across the Asia Pacific region, one must always remember the old adage that ‘‘prevention is better than cure.’’
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Volume 4, Number 3, May/June 2015
REFERENCES 1. Ho CK, Yen YL, Chang CH, et al. Epidemiologic study on work-related eye injuries in Kaohsiung, Taiwan. Kaohsiung J Med Sci. 2007;23:463Y468. 2. Chaikitmongkol V, Leeungurasatien T, Sengupta S. Work-related eye injuries: important occupational health problem in North Thailand. Asia Pac J Ophthalmol. 2014;3. 3. Fong LP, Taouk Y. The role of eye protection in work-related eye injuries. Aust A N Z J Ophthalmol. 1998;23:101Y106. 4. Lombardi DA, Verma SK, Brennan MJ, et al. Factors influencing worker use of personal protective eyewear. Accid Anal Prev. 2009;41:755Y762.
Walking with a friend in the dark is better than walking alone in the light. V Helen Keller
130
www.apjo.org
* 2015 Asia Pacific Academy of Ophthalmology
Copyright © 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.
Prevention Is Better Than Cure: The Dilemma in the Workplace Lawrence Lee, MBBS, FRANZCO, FRACS
W
ork-related eye injuries represent a significant cost to the community in terms of loss of vision, loss of manpower, work hours, as well as cost of medical and surgical repair. These injuries generally are preventable with protective eyewear. In the Asia-Pacific region, work-related injuries including open and closed globe injuries have been studied, with significant numbers, identifying an important issue in ocular morbidity. In a study by Ho et al1 in 2007, it was found that 189 (38.9%) of 486 subjects treated in emergency departments were work-related eye injuries. These were predominantly male, with common types of eye injuries such as foreign body injuries (31.2%), followed by blunt injuries (20.6%), chemical burn (19.6%), UV light radiation (12.7%), and corneal abrasion (11.6%). This study could not, however, show the industrial distribution of eye injuries in Taiwan. The article, Work-Related Eye Injuries: Important Occupational Health Problem in North Thailand by Chaikitmongkol et al,2 presents important research into the demographics of work-related eye injury in Northern Thailand, particularly looking at the types of injury and the predisposing occupations and activities. This study found 101 eyes of 97 patients with work-related injuries of which they were predominantly men, with a mean age of 39.5 years. Some of 98% did not wear protective eyewear. Looking at the type of injury, open globe injuries (57%) included penetrating eye injury and intraocular foreign bodies and other complicating factors were vitreous hemorrhage, retinal detachment, and endophthalmitis. Closed globe injuries, representing 43%, included eyelid and canalicular lacerations, orbital floor fracture and corneal foreign bodies through to hyphema, as well as traumatic optic neuropathy. Traumatic cataract and hyphema can occur in open and closed injuries. With regard to open globe injuries, the most common presentation was traumatic cataract with disruption of the anterior lens capsule at 28%. Intraocular foreign bodies represented 26%, with associated endophthalmitis and retinal detachment at 19% and 10%, respectively. With closed globe injuries, the most common manifestation was traumatic cataract at 42%, followed by hyphema at 40%. These patients were treated medically; although in comparison, those with open globe injuries required multiple surgical procedures. The mean (SD) follow-up was 4.3 (12.2) months. There was significant reduction in visual acuity with the open globe injuries, which had a much worse visual prognosis. Important data on the occupational hazards found that workers engaged in agriculture work compared with construction work were at a significantly higher risk of an open globe injury and that patients working with nails and grass trimmers were significantly more likely to sustain open globe injuries. Of note, in this study, there were only a small number that sustained chemical injury for which other studies have shown a higher incidence; particularly, a study by Ho et al1 found 19.6% occupational chemical injury versus only 4% in this study. The predominant causative factor for work-related eye injury was lack of protective eyewear, with the reason for not wearing protective eyewear showing that 59% had lack of knowledge of protective eyewear, with 22% having lack of available protective eyewear equipment. Only 18% had available equipment and knowledge but just had not used the protective wear. Alcohol consumption was only 3% and not a significant factor. The predominant cause of open globe injuries was nailing, with motorized grass trimming as the second-highest cause of open globe injuries. For closed globe injuries, metal grinding was the most prominent association, leading to corneal foreign bodies. This study identifies an important preventable ocular health problem in which education and recommendation for usage of protective eyewear are lacking. Governments and public health authorities should be aware of this issue and mandate that industries involved (with particular note in agriculture) should be aware of a need for recommendation of protective eyewear for workers. Although advancements in vitrectomy surgery repair of intraocular injury have been made across the Asia-Pacific region at considerable cost, the cost benefit of simple protective eye wear and public awareness campaigns is paramount in reducing ocular morbidity.3 From the City Eye Centre; Royal Brisbane Hospital; and University of Queensland, Queensland, Australia. Received for publication April 16, 2015; accepted April 16, 2015. Reprints: Lawrence Lee, MBBS, FRANZCO, FRACS, City Eye Centre, Level 10, 135 Wickham Terr, Brisbane, Queensland 4000, Australia. E-mail: eye@ cityeye.com.au. Copyright * 2015 by Asia Pacific Academy of Ophthalmology ISSN: 2162-0989 DOI: 10.1097/APO.0000000000000125
Asia-Pacific Journal of Ophthalmology
&
Volume 4, Number 3, May/June 2015
www.apjo.org
Copyright © 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.
129
Asia-Pacific Journal of Ophthalmology
Editorial
A study by Lombardi et al4 in 2009 found several factors preventing the usage of protective eyewear. These included lack of comfort/fit, fogging, scratching of the eyewear, young age, and lack of safety training being important factors. These factors can be mitigated by design and government/industrial policy to recommend protective eyewear in all at risk occupations. The article by Chaikitmongkol et al2 represents a timely reminder that in the modern world, simple intervention with protective eyewear can prevent a magnitude of significant ocular morbidity and save significant costs to the community. While it is enlightening to see the growing medical and surgical skill in ophthalmic trauma care across the Asia Pacific region, one must always remember the old adage that ‘‘prevention is better than cure.’’
&
Volume 4, Number 3, May/June 2015
REFERENCES 1. Ho CK, Yen YL, Chang CH, et al. Epidemiologic study on work-related eye injuries in Kaohsiung, Taiwan. Kaohsiung J Med Sci. 2007;23:463Y468. 2. Chaikitmongkol V, Leeungurasatien T, Sengupta S. Work-related eye injuries: important occupational health problem in North Thailand. Asia Pac J Ophthalmol. 2014;3. 3. Fong LP, Taouk Y. The role of eye protection in work-related eye injuries. Aust A N Z J Ophthalmol. 1998;23:101Y106. 4. Lombardi DA, Verma SK, Brennan MJ, et al. Factors influencing worker use of personal protective eyewear. Accid Anal Prev. 2009;41:755Y762.
Walking with a friend in the dark is better than walking alone in the light. V Helen Keller
130
www.apjo.org
* 2015 Asia Pacific Academy of Ophthalmology
Copyright © 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.
