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BLOG: Are we blind to the importance of trauma?
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One of the most gratifying surgical cases I remember from my fellowship training was an 8-year-old boy named Vartan, who came to the ER at UCLA with a perforating corneal wound. It seems his classmate had thrown a pencil across the aisle at him (boys do this because it’s fun), and the business end of the pencil found its way directly into the center of his cornea, causing a perfectly centered, horizontal 2.7-mm entry wound and a “dent” in the anterior lens cortex but an intact capsule. (In retrospect, I wish I’d met the boy who threw the pencil. If he could consistently repeat this trick of creating a perfect 2.7-mm corneal wound by throwing a pencil from 3 feet, he might make a fine cataract surgeon, although a limbal approach might be more astigmatically neutral.)
I was a veteran of treating ocular trauma from my residency at Henry Ford Hospital in Detroit, so I knew it was important not to promise Vartan’s somber parents too much. I told them our first goal would be to save his eye, and secondly we would do our best to restore vision. Two 10-0 nylon sutures placed carefully under general anesthetic closed the wound, and like 80% of patients with penetrating ocular trauma, Vartan did not develop endophthalmitis. In fact, he healed remarkably free of inflammation, and weeks after suture removal he regained 20/20 uncorrected acuity, despite a fine, central scar and persistent lens irregularity. After my fellowship, Vartan’s parents continued to bring him to me for care, although I now practiced nearly 2 hours away in Orange County. In their eyes, I could do no wrong.
But of course Vartan was extremely lucky among the unlucky 2.4 million Americans who have significant eye injuries each year. He didn’t escape the pencil, but he did escape most of the bad sequelae. About half of trauma patients’ lives are permanently limited by much lesser injuries no matter who provides care.
Although Vartan’s accident happened nearly 20 years ago, the statistics and the tools for treating ocular trauma have changed very little. That’s partly because we can’t entirely stop man’s inhumanity to man, and it may be partly because we haven’t tried hard enough.
To be sure, our eye care societies have promoted public education about eye protection. How much more, though, would we impact public health if we approached professional and amateur sports clubs, labor unions and large manufacturers? How about the insurance companies that underwrite their coverage to show the number of eyes that could be saved (and saved cost) if protective eye wear were used consistently? How about holding an employer partly responsible for the cost of care if an employee loses an eye while not wearing “required” eye protection? Do you suppose “required” will take on a new meaning at that place of work? And what impact will that have on do-it-yourselfers who follow the example of professionals? Surely, the impact of such initiatives will easily justify the cost and effort they would create.
That old grandma’s expression: “Oh, it’s always fun ’til someone loses an eye!” What it really means is, “You may soon really regret what you’re doing!” Maybe that’s advice we as eye care providers should more strongly take — and give — in the interest of a more healthy public.
Disclosure: Hovanesian reports no relevant financial disclosures.