Globe and Adnexal Trauma Terminology Survey

Abstract

ImportanceOcular trauma terminology should be periodically updated to enable comprehensive capturing and monitoring of ocular trauma in clinical and research settings.ObjectiveTo update terminology for globe and adnexal trauma.Design, Setting, and ParticipantsA 2-round modified Delphi survey was conducted from January 1 to July 31, 2021, using an expert panel, including 69 ophthalmologists identified through their membership in ophthalmology (globe and adnexal trauma) societies. Consensus was defined as at least 67% expert agreement. A steering committee developed questions after identifying gaps in the current terminology via a targeted literature review. Round 1 sought consensus on existing and newly proposed terminology, and round 2 focused on unresolved questions from round 1. Experts included ophthalmologists who had managed, on average, 52 globe or adnexal trauma cases throughout their careers and/or published a total of 5 or more globe or adnexal trauma–related peer-reviewed articles.Main Outcomes and MeasuresExpert consensus on ocular and adnexal terms.ResultsA total of 69 experts participated in and completed round 1 of the survey. All 69 participants who completed round 1 were asked to complete round 2, and 58 responses were received. Consensus was reached for 18 of 25 questions (72%) in round 1 and 4 of 7 questions (57%) in round 2. Existing Birmingham Eye Trauma Terminology system terminology achieved consensus of 84% (58 of 69 experts) in round 1 and 97% (56 of 58 experts) in round 2. Experts agreed on the need for further refinement of the definition of zones of injury (55 of 69 [80%]), as the zone affected can have a substantial effect on visual and functional outcomes. There was consensus that the mechanism of injury (52 of 69 [75%]) and status of the lacrimal canaliculi (54 of 69 [78%]), nasolacrimal ducts (48 of 69 [69%]), lens (46 of 58 [80%]), retina (42 of 58 [73%]), and central and paracentral cornea (47 of 58 [81%]) be included in the revised terminology.Conclusions and RelevanceThere was consensus (defined as at least 67% expert agreement) on continued use of the existing Birmingham Eye Trauma Terminology system definitions and that additional terms are required to update the current ocular trauma terminology.

Closed globe and adnexal eye injuries: Epidemiology, clinical and surgical outcomes, and an economic cost analysis

“…LogMAR values of 1.8, 2.3, 2.8 and 3 denoted CF, HM, LP and NLP, respectively 36 . To standardise terminology, all CGI were classified using the Revised Globe and Adnexal Trauma Terminology from the IGATES 26,27 . The zone of injury was defined by the most posterior anatomical aspect affected following the Ocular Trauma Classification Group (Zone I: external, with involvement limited to bulbar conjunctiva, sclera, or cornea.…”

“…36 To standardise terminology, all CGI were classified using the Revised Globe and Adnexal Trauma Terminology from the IGATES. 26,27 The zone of injury was defined by the most posterior anatomical aspect affected following the Ocular Trauma Classification Group (Zone I: external, with involvement limited to bulbar conjunctiva, sclera, or cornea. Zone II: structures in the anterior segment to the posterior lens capsule, including the pars plicata.…”

“…11 However, while open globe injuries have been more comprehensively examined in the literature, [12][13][14][15][16][17][18][19] there remains a paucity of studies investigating the epidemiology and variables predictive of visual and surgical outcomes in adult CGI. 11,[20][21][22][23][24][25] Recently, the Revised Globe and Adnexal Trauma Terminology as part of the International Globe and Adnexal Trauma Epidemiology Study (IGATES) has been published, 26,27 which updates the widely accepted Birmingham Eye Trauma Terminology (BETT). 4 To our knowledge, this revised IGATES classification system has not been studied in a cohort of CGI.…”

Geographical Differences in Ophthalmic Trauma Outcomes and Risk Factors: The International Globe and Adnexal Trauma Epidemiological Eye Study (IGATES)

“…IGATES is an online registry that collects data on ophthalmic trauma with the aim of addressing a broad range of epidemiology and treatment questions relating to ophthalmic trauma using previously validated terminology. 20,21…”

Globe trauma associated with falls at Australian tertiary centres

“…18 Patients' injuries were classified using the Globe and Adnexal Trauma Terminology Survey. 19 Internal globe injuries, lamellar lacerations to the eye, open globe injuries (OGIs) and injuries to the optic nerve were further classified as severe globe injuries, due to the increased risk of vision loss from these injuries. 20,21 Multisystem trauma was defined as injury to two or more areas of the body.…”