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Year : 2023  |  Volume : 11  |  Issue : 2  |  Page : 87-91

Impact of ocular trauma on vision-related quality of life

Drashti Netralaya, Dahod, Gujarat, India

Date of Submission04-Apr-2022
Date of Decision28-Nov-2022
Date of Acceptance25-Dec-2022
Date of Web Publication27-Apr-2023

Correspondence Address:
Mehul Shah
Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod - 389 151, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcor.jcor_56_22

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Introduction: Ocular trauma is a preventable cause of monocular blindness that results in morbidity and sight loss. In this study, we evaluated the impact of ocular trauma on the quality of life. Materials and Methods: In this prospective cohort study, we included all ocular trauma cases presented at Drashti Netralaya enrolled between August 2019 and August 2020. Demographic, clinical, and trauma documentation were done using a pretested online format for all the enrolled cases with specified inclusion and exclusion criteria. The life quality score was recorded using the Indian Version of Visual Function Questionnaire (VFQ). The VFQ scores were recorded before and after treatment. All data were exported into Excel sheets and analyzed with SPSS 22 using descriptive and cross-tabulation. The numerical variables were tested using one-sample t-test. P < 0.05 was considered statistically significant. Results: Our study cohort consisted of 284 patients, of which 211 (68.1%) were adults and 85 (39.9%) were children. Furthermore, 199 (70.1%) were men, and 93 (30%) were women. The mean age of the patients was 29.36 ± 17.38 years. On a comparative study, a significant difference was found between the pretreatment and posttreatment vision as well as VFQ score. Conclusion: Ocular trauma can cause sight loss and morbidity and affect the quality of life. Successful management of ocular trauma can cause a significant difference in the vision as well as quality of life.

Keywords: Ocular trauma, quality of life, Visual Function Questionnaire

How to cite this article:
Shah M, Shah S, Chandana P. Impact of ocular trauma on vision-related quality of life. J Clin Ophthalmol Res 2023;11:87-91

How to cite this URL:
Shah M, Shah S, Chandana P. Impact of ocular trauma on vision-related quality of life. J Clin Ophthalmol Res [serial online] 2023 [cited 2023 Jun 8];11:87-91. Available from: https://www.jcor.in/text.asp?2023/11/2/87/374872

Vision is the most important medium through which we interact with our surrounding environment. Loss of sight is the most feared of all disabilities, especially if suffered acutely as in the case of penetrating eye injuries. Trauma has been labeled as the “neglected epidemic of modern society” by the National Academy of Science and is becoming a leading cause of permanent and yet another avoidable cause of blindness.[1],[2],[3],[4],[5]

Based on the World Health Organization's (WHO) definition of health, quality of life is an integral part of health and well-being. Recently, the WHO has recommended that vision-related quality of life (VRQoL) should form a part of assessments of interventions in eye health. The relationship between impaired vision and VRQoL has been well documented in many developed countries,[3],[4],[5],[6] but a very little information is available in developing countries.[7],[8],[9],[10],[11],[12] Visual acuity (VA) and other clinical measures do not adequately reflect the impact of vision impairment on the patients' lives. Hence, the use of patient-reported outcomes (PROs), such as vision-specific functioning or VRQoL alongside clinical evaluation, has increasingly been recognized as an integral part of the patients' health assessment of medical interventions.[6],[7]

The impact of trauma on the human eye ranges from minute subconjunctival hemorrhage to a lacerated globe[1],[2],[3],[4],[5] and leads to varying degrees of vision loss, depending on the complications, location, and size of the injury. The majority of people who suffer ocular trauma are young individuals.[1],[2],[3],[4],[5] Therefore, injuries leading to loss of vision and visual prognosis are very important for a long life expectancy. Ocular pathology in young patients affects not only VA but also occupational, social, and psychological functions.[8] In the practice of ophthalmology, visual function tests, such as visual field analysis, do not provide information about the psychological consequences of decreased vision and the quality of life.[8],[9]

Earlier studies have used the National Eye Institute-Visual Functioning Questionnaire-25 (VFQ-25)[10],[11],[12] to assess the quality of vision in retinal vein occlusion,[13] diabetic retinopathy,[14] glaucoma,[15],[16] uveitis,[17] and after ocular penetrating injury.[18]

The Indian Vision Function Questionnaire-33 (IND-VFQ33) [Annexure] has been shown to be a very practical and scientifically sound approach to evaluate VRQoL in clinical trials, epidemiological studies, and clinical audit throughout India and possibly South Asia where social, cultural, and lifestyle factors are more similar than different.[19],[20] Hence, in our study, we used this questionnaire to understand the impact of ocular trauma on the quality of life in developing countries such as India.

In the present study, we have explored the impact of ocular trauma on the patients' quality of life, which has not been specifically studied.

  Materials and Methods Top

This prospective cohort observational study was conducted after obtaining approval from the hospital's Ethical Committee (DN/2019/23). All patients with ocular trauma who presented to the emergency department between August 2019 and August 2020 and who consented to participate in the study were enrolled.

In this study, patients presenting to Drashti Netralaya, Dahod, who were diagnosed to have ocular trauma were included. All patients were examined completely and treated as per the standard protocols.

The type of ocular trauma was classified according to the Birmingham Eye Trauma Terminology (BETTS), and the Ocular Trauma Score (OTS) was calculated according to standard methodology.[1]

The complete details of ophthalmic examination were documented in the initial report form, including the following: (1) initial best-corrected VA, (2) lid or facial injury and subconjunctival hemorrhage or laceration, (3) presence or absence of corneal/scleral perforation, hyphema, iris injuries, and afferent pupillary defect, and (4) presence or absence of vitreous hemorrhage, retinal detachment or foreign body, endophthalmitis, retinal breaks, choroidal rupture, and/or macular hole.

All patients were followed up as per the standard format and schedule. A complete ophthalmic evaluation and the necessary investigations were performed for each patient. The findings were recorded, and the treatment was administered as clinically indicated. Sociodemographic data and economic data were also collected.

The 33-item IND-VFQ was applied to all patients by the same interviewer pretreatment and on completion of the management.

All data entered into a pretested online format were exported into Excel sheets and analyzed by SPSS 22 using descriptive analysis and cross tabulation. All numerical variables were studied using one-sample t-test, and P < 0.05 was considered statistically significant.

  Results Top

Ours was a single-center, prospective observational study consisting of 284 patients who satisfied the inclusion criteria.

Our study cohort consisted of 211 (68.1%) adults and 85 (39.9%) children. Furthermore, 199 (70.1%) were men, and 93 (30%) were women. Their mean age was 29.36 ± 17.38 years [Table 1].
Table 1: Age and sex distribution

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Closed-globe injuries were seen in 148 (52.6%) patients and open-globe injuries in 136 (47.9%) patients.

When we compared the pre- and post-treatment vision, we found a significant difference (P = 0.000).

We found that OTS, open-closed category, and preoperative vision had a significant impact on the preoperative VFQ [Table 2], [Table 3], [Table 4].
Table 2: Variable affecting quality of life pretreatment

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Table 3: Variable affecting quality of life postoperatively

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Table 4: Ocular trauma score distribution

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OTS, open-closed category, and preoperative vision also had a significant impact on the postoperative VFQ.

When we compared the pre- and postoperative VFQ scores, we found a significant difference in one sample t-test and analysis of variance, with 95% confidence interval.

When we compared the postoperative VFQ scores, a significant difference was found between the open- and closed-globe injuries according to the BETTS.

  Discussion Top

Mechanical eye trauma is one of the main causes that lowers the quality of life and may lead to a decrease in VA and even blindness, logistic loss, treatment expenses, and economic burden.

In our study, eye injuries were detected more frequently in young men, which is similar to many other studies.[1],[2],[3],[4],[5] This may, in part, be explained by boys playing more dangerous games, having a more aggressive lifestyle, or fighting more frequently than the girls. Male predominance (up to 98.9%) has been reported in a recent review by Yalcin Tök et al.[21] Several other studies have also reported a 90% male predominance.[1],[2],[3],[4],[5],[21]

The mean age of the enrolled participants was 29.36, which signifies that the young population is more prone to ocular trauma. Similar results were reported in a study by Yüksel et al.[18]

Patients who lose their vision due to ocular trauma not only suffer vision impairments but also experience deterioration in their social and psychological functioning. Many patients with vision loss cannot continue their employment and need to change their occupation. Similar results were obtained in a study by Karaman et al.[22]

In our study, we also observed that unilateral ocular trauma is more common than binocular trauma as of the 284 patients, only five presented with binocular injury. This finding is similar to many other studies.[5]

As evident from several studies, ocular trauma causes vision loss.[1],[2],[3],[4],[5]

Many studies have reported that ocular morbidity and sight loss can pose a health burden.[5]

Visual impairment can affect the quality of life. Many authors have reported similar findings.[1],[2],[3],[4],[5]

The questionnaire designed by the National Institutes of Health is effective in determining the quality of life.[10],[11],[12] Thevi et al. reported that the language of the questionnaire has a significant impact on the result.[23] The present study used the Indian version of the quality of life questionnaire, which has been proven to be effective in many studies.[19],[20]

Vision loss can cause psychological distress.[22],[24] Ocular trauma can also cause mental distress and affect the quality of life.[18]

The quality of life being affected by sight loss attributed to various eye conditions has been reported by several authors. Mills and Wren et al. recorded how the quality of life is affected in case of glaucoma.[14],[15],[16]

Sahin et al. and Patel et al. investigated the quality of life score in macular pathologies, such as central serous retinopathy and geographic atrophy.[25],[26]

Poetic scrutinized the quality of life using this questionnaire following retinal detachment surgery.[12]

Morris explored the quality of life after interventions for cataract.[11] Amiri et al. examined the quality of life following a corneal transplant.[27] Marian et al. documented the quality of life in case of diabetic retinopathy.[14] Kondo assessed the quality of life following the surgical removal of the eye.[28]

Fiona et al. studied the quality of life in case of homonymous hemianopia.[29]

We could not find any study in the literature evaluating the impact of overall ocular trauma on the quality of life. Several authors reported that the quality of life was affected in case of penetrating injuries. The present study reported a significant difference in quality of life between open- and closed-globe injuries using the BETTS.[1] We could not find any study that has reported such findings.

  Conclusion Top

Ocular trauma can impact the quality of life, but appropriate interventions can improve it, which was determined by the Indian version of the VFQ, which is very useful in determining the quality of life under Indian conditions.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Yüksel H, Türkcü FM, Ahin M, Cinar Y, Cingü AK, Ozkurt Z, et al. Vision-related quality of life in patients after ocular penetrating injuries. Arq Bras Oftalmol 2014;77:95-8.  Back to cited text no. 18
Gupta SK, Viswanath K, Thulasiraj RD, Murthy GV, Lamping DL, Smith SC, et al. The development of the Indian vision function questionnaire: Field testing and psychometric evaluation. Br J Ophthalmol 2005;89:621-7.  Back to cited text no. 19
Murthy GV, Gupta SK, Thulasiraj RD, Viswanath K, Donoghue EM, Fletcher AE. The development of the Indian vision function questionnaire: Questionnaire content. Br J Ophthalmol 2005;89:498-503.  Back to cited text no. 20
Yalcin Tök O, Tok L, Eraslan E, Ozkaya D, Ornek F, Bardak Y. Prognostic factors influencing final visual acuity in open globe injuries. J Trauma 2011;71:1794-800.  Back to cited text no. 21
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Thevi T, Abas AL, Stephanie Yen Li C. Comparison between the English and Bahasa Malaysia language versions of the Visual functioning questionnaire (VFQ-25) for use in patients with cataracts. BMC Ophthalmol 2021;21:348.  Back to cited text no. 23
Ye J, Lou L, Jin K, Xu Y, Ye X, Moss T, et al. Vision-Related quality of life and appearance concerns are associated with anxiety and depression after eye enucleation: A cross-sectional study. PLoS One 2015;10:e0136460.  Back to cited text no. 24
Sahin A, Bez Y, Kaya MC, Türkcü FM, Sahin M, Yüksel H. Psychological distress and poor quality of life in patients with central serous chorioretinopathy. Semin Ophthalmol 2014;29:73-6.  Back to cited text no. 25
Patel PJ, Ziemssen F, Ng E, Muthutantri A, Silverman D, Tschosik EA, et al. Burden of illness in geographic atrophy: A study of vision-related quality of life and health care resource use. Clin Ophthalmol 2020;14:15-28.  Back to cited text no. 26
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  [Full text]  
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Rowe FJ, Hepworth LR, Conroy EJ, Rainford NE, Bedson E, Drummond A, et al. Visual Function Questionnaire as an outcome measure for homonymous hemianopia: subscales and supplementary questions, analysis from the VISION trial. Eye (Lond) 2019;33:1485-93.  Back to cited text no. 29


  [Table 1], [Table 2], [Table 3], [Table 4]


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