TY - JOUR
AU - Bass, Cameron R.
AB - ObjectiveTo investigate eye injuries resulting from frontal automobile crashes and to determine the effects of frontal air bags.MethodsThe National Automotive Sampling System database files from January 1, 1993, through December 31, 1999, were examined in a 3-part study that included an investigation of 22 236 individual crashes that occurred in the United States. A new 4-level eye injury severity scale that quantifies injuries based on recovery time, need for surgery, and possible loss of sight was developed.ResultsOf all occupants who were exposed to an air bag deployment, 3% sustained an eye injury. In contrast, 2% of occupants not exposed to an air bag deployment sustained an eye injury. A closer examination of the type of eye injuries showed that there was a statistically significant increase in the risk of corneal abrasions for occupants who were exposed to an air bag compared with those who were not (P= .03). Of occupants exposed to an air bag deployment, 0.5% sustained a corneal abrasion compared with 0.04% of occupants who were not exposed to an air bag.ConclusionsUsing the new injury levels, it was shown that although occupants exposed to an air bag deployment had a higher risk of sustaining minor eye injuries, the air bag appears to have provided a beneficial exchange by reducing the number of severe eye injuries.ALTHOUGH AIR BAGS have reduced the incidence of fatal and severe injuries in automobile collisions, they have been shown to increase the risk of less severe injuries.These associated minor injuries include upper extremity fractures, skin abrasions, and eye injuries. In particular, the medical literature is replete with case studies of air bag–induced eye injuries.In addition to air bag–induced eye injuries, Müller-Jensen and Hollweckfound that broken windshield glass was a serious eye injury mechanism, with 40% of these cases resulting in blindness in at least 1 eye.Most case studies focus on only a few occupants. However, 4 articles in particular include numerous cases of air bag–induced eye injuries.Duma et alpresent an analysis of 25 air bag–induced eye injury cases; they found that the most serious injuries were a result of the occupant being struck by the air bag during deployment. Ghafouri et alfound bilateral injuries in 27% of 43 air bag–induced eye injury cases. Vichnin et alreport 14 cases and note that the most severe injuries were to occupants wearing eyeglasses, all of whom sustained permanent ocular damage. Stein et alprovide a detailed summary of the 97 published case studies that included a wide range of ocular injuries, from corneal abrasions to ruptured globes.There are a paucity of experimental data on air bag–induced eye injuries compared with the number of individual case study publications. Fukagawa et alfound that increased inflator aggressivity contributed to increased endothelial cell damage. The most recent air bag–related study examined the injury potential of high-speed foam particles released during air bag deployment.This study illustrates the compounding risk of eye injuries from not only air bag contact, but also from particles released from the module during deployment.Although previous studies have provided insight into the interaction between an air bag and the eye, the national incidence and relative risk of air bag–induced eye injuries are unknown. The purpose of this article is to determine the overall risk and severity of eye injuries in automobile crashes and to elucidate the effect of frontal air bags on these patterns.METHODSTo eliminate the inaccuracies associated with small case study projections, this study used the National Automotive Sampling System (NASS) database.The 2 primary advantages of using the NASS database are that it includes an analysis of approximately 5000 cases per year and the injuries are coded by trained nurses using the Abbreviated Injury Scale (AIS).The AIS classifies injuries by body region on a 6-point scale ranging from low severity (AIS1) to fatal (AIS6). The AIS values are assigned for each injury sustained and do not include combined effects from multiple injuries to the same patient. This coding allows for consistent and accurate distinction and identification of eye injuries. Each crash scene is investigated by a group of trained accident investigators who examine and document vehicle damage, occupant injuries, and crash dynamics. This investigation team also examines the vehicle interior to look for signs such as tissue transfer onto interior components that would indicate mechanisms for each recorded injury. All occupants included in the study have given informed consent.The NASS cases are collected from 24 separate field research teams across the United States. Crashes are considered for NASS investigation if they occur on a traffic way, are reported to police, involve a harmful event, and involve at least 1 towed passenger car, light truck, or van. Because it is not practical to investigate every crash in the United States every year, each case investigated for the NASS database is assigned a weighted value, which scales the incidence of the particular crash investigated to a number that represents actual occurrence of similar noninvestigated crashes that occur in the United States each year. The weighting factor for each case is included in the NASS database. This procedure has been used in national injury projection studies to analyze injury severity and crash characteristics for topics such as lower-extremity injury patterns, upper-extremity injury patterns, and restraint effectiveness in motor vehicle crashes.The occupant and injury numbers reported represent the weighted numbers based on the raw cases. Statistical analyses were performed using the SUDAAN statistical software, version 7.0, for weighted survey data (Research Triangle Institute, Research Triangle Park, NC).For this study, NASS cases from January 1, 1993, through December 31, 1999, were selected if they included drivers and front seat occupants only, while excluding ejected occupants and rollovers. In addition, only frontal-impact crashes, defined as having a primary direction of force of 11, 12, or 1 o'clock, were considered. Eye injuries were defined as damage to the periorbital skin, globe, or orbital bones. Occupants with injuries and total injuries to occupants were analyzed for trends in injury incidence, type, and severity. Eye injuries in the NASS database were identified using the current AIS injury codes.The study was divided into 3 parts.PART 1: CRASHES WITH AND WITHOUT AIR BAG DEPLOYMENTFirst, crashes with an air bag deployment were considered. For all occupants who were exposed to an air bag deployment, the number of occupants sustaining an eye injury was compared with the total number who did not sustain an eye injury. Next, an analogous search was performed for crashes in which the air bag did not deploy.PART 2: INJURY SEVERITYA new eye injury grouping method was developed to assess the severity of eye injuries based on both the need for ocular surgery and the potential for loss of sight. The AIS system does not address both these criteria because it only considers the overall threat to life. Eye injuries were divided into 4 new injury groups (Table 1): level 1 includes minor injuries to the skin; level 2, minor injuries to the eye; level 3, more serious eye injuries that may require surgery and present a guarded long-term prognosis; and level 4, the most serious eye injuries that would result in blindness.Table 1. New AIS Severity Levels for Eye Injuries, Classified by Need for Surgery, Expected Recovery Time, and Possible Loss of Sight*AIS Severity LevelAIS No. Injury DescriptionLevel 1: Skin, eyelid, or orbit area soft tissue297099.1Skin NFS297202.1Skin abrasion297402.1Skin laceration297602.1Skin contusion297802.1Skin avulsionLevel 2: Eye, less severe240499.1Eye NFS240416.1Conjunctiva injury240602.1Corneal abrasion240699.1Corneal injury NFS241499.1Uvea injury241699.1Posterior vitreous detachmentLevel 3: Eye, more severe240408.1Tear duct laceration240412.1Choroid rupture240604.1Corneal contusion240604.1Corneal hyphema240606.1Corneal laceration240800.1Iris laceration241000.1Retinal laceration241200.1Scleral laceration251200.2 Orbital fracture NFS251202.2 Orbital fracture closed251204.3 Orbital fracture open/displacedLevel 4: Eye, most severe230202.2Optic nerve contusion230204.2 Optic nerve laceration230206.2 Optic nerve avulsion230299.1 Optic nerve injury NFS240402.2 Eye avulsion/enucleation241002.2Retinal detachment241202.2Scleral globe rupture*AIS indicates Abbreviated Injury Scale; NFS, not further specified.PART 3: OCCUPANT AND CRASH CHARACTERISTICSOccupants exposed to an air bag deployment were divided into 2 groups: group 1 included all occupants who received an air bag–induced eye injury and group 2 included all the remaining occupants. The occupants in group 2 could have sustained an eye injury in the crash, but the source would be something other than the air bag. The groups were divided in this way to identify occupant characteristics related to incidence of air bag–induced injury.RESULTSPART 1: CRASHES WITH AND WITHOUT AIR BAG DEPLOYMENTA total of 10 770 828 occupants from 22 236 cases were included in this study for the 7-year period from 1993 through 1999 (Figure 1). Each year, there were more occupants who sustained an eye injury in a crash without an air bag deployment than in a crash with an air bag deployment. As the proportion of air bag–equipped vehicles in the fleet increases, the number of occupants who sustain an eye injury in a crash with air bag deployment has also increased.Figure 1.Occupants with eye injuries in crashes with and without an air bag deployment (1993-1999).For crashes in which the occupant was exposed to an air bag deployment, 60 112 (3%) of 1 946 924 occupants in similar crashes sustained an eye injury (Figure 2). In contrast, for crashes without an air bag deployment, 178 151 (2%) of 8 823 904 occupants sustained an eye injury. This difference was not statistically significant (P= .15).Figure 2.Incidence of eye injury for occupants who were or were not exposed to an air bag deployment (1993-1999).Given that each occupant may have had multiple eye injuries, it is shown that 26% of all eye injuries occurred to occupants exposed to an air bag deployment (Figure 3). If the occupants with an eye injury were exposed to an air bag deployment, the air bag was the source of the eye injury for 88% of the injuries. If an air bag did not deploy, the top 3 sources for eye injury were the windshield (34%), steering wheel (27%), and instrument panel (14%). Regardless of injury source, 76% of occupants who incurred an eye injury were drivers, and 24% were right front seat passengers.Figure 3.Total number and top sources of eye injuries for occupants who were or were not exposed to an air bag deployment (1993-1999).PART 2: INJURY SEVERITYAlthough air bag exposure was shown to increase the incidence of eye injuries, the severity of the resulting eye injuries is more important. Sorting the eye injuries into the 4 newly defined levels, it was shown that eye injuries from crashes without an air bag deployment were distributed as follows: level 1, 85.0% ; level 2, 4.4%; level 3, 10.1%; and level 4, 0.4% (Figure 4). A total of 10.5% of the injuries were more serious, representing the categories of levels 3 and 4 combined. In contrast, the eye injury distribution from crashes with an air bag deployment was level 1, 75.3%; level 2, 17.5%; level 3, 7.2%; and level 4, 0.0%. In crashes with air bag deployments, only 7.2% of injuries were more serious level 3 and 4 injuries. There was a shift in the severity of eye injuries depending on whether the occupants were exposed to an air bag deployment, with the lower-severity injuries occurring to occupants exposed to an air bag deployment.Figure 4.Severity levels of eye injuries sustained in crashes with and without an air bag deployment.When examining the specific injury types, there was a statistically significant increase in risk of corneal abrasions for occupants exposed to an air bag deployment (P= .03). Of the occupants exposed to an air bag deployment, 0.5% sustained a corneal abrasion, compared with 0.04% of occupants not exposed to an air bag deployment.PART 3: OCCUPANT AND CRASH CHARACTERISTICSOccupant SexWomen represented 65% of occupants who sustained an air bag–induced eye injury; however, this proportion was not statistically significant (P= .19).Eyeglasses UseOf occupants who sustained an air bag–induced eye injury, 29% were wearing glasses, whereas 25% of occupants who did not receive an air bag–induced eye injury were wearing glasses. However, this variable was not found to be statistically significant in predicting risk of air bag–induced eye injury (P= .81).Contact Lens UseOf occupants who sustained an air bag–induced eye injury, 46% were wearing contact lenses, whereas 11% of occupants who did not receive an air bag–induced eye injury were wearing contact lenses. Contact lens wear was not found to be a statistically significant variable in predicting risk of air bag–induced eye injury (P= .31).Seat Belt UseOf occupants who sustained an air bag–induced eye injury, 75% were wearing a seat belt, compared with 85.6% of occupants who did not receive an air bag–induced eye injury. This study indicated that the occupants who did not sustain an air bag–induced eye injury had a slightly higher rate of seat belt use; however, the difference was not statistically significant (P= .45).Group 1 vs Group 2The 1 946 924 occupants exposed to an air bag deployment were split into 2 groups: group 1 was made up of occupants who sustained an eye injury with an air bag as the source, and group 2 was the remaining set of occupants who were exposed to an air bag deployment but who did not have an air bag–induced eye injury (Table 2). Within a 95% confidence interval, occupant height, age, and crash Δ velocity were not significantly correlated with the risk of incidence of air bag–induced eye injury. However, it was found that lighter occupants were more likely to sustain an air bag–induced eye injury.Table 2. Correlation Between Incidence of Air Bag–Induced Injury and Crash VariablesVariableAir Bag–Induced Injury, Mean (SD)No Air Bag–Induced Injury, Mean (SD)Occupant height, cm171.3 (1.2)171.1 (0.4)Occupant weight, kg64.8 (2.3)72.3 (1.3)Occupant age, y36.3 (7.1)34.1 (0.7)Δ Velocity, km/h18.7 (2.7)21.9 (0.5)COMMENTAlthough more occupants were injured when exposed to an air bag deployment, the air bag did provide a beneficial exchange by decreasing the severity of the associated eye injuries. A closer examination factoring in the type of eye injury showed that there was a statistically significant increase in the risk of corneal abrasions for occupants who were exposed to an air bag deployment (P= .03). Of particular interest to this study is the realization that an increasing proportion of the population will have had corrective vision procedures performed in the years to come. This, combined with the rising proportion of air bag–equipped vehicles in the fleet, warrants further investigation.Although a few studies show that there may be no increased risk of injury associated with eyes that have undergone photorefractive keratectomy, automated lamellar keratoplasty, and laser-assisted in situ keratomileusis, they are in the minority.Far more studies indicate that these types of surgical procedures weaken the cornea and make it significantly more susceptible to injury for years after the procedure.In the present study, an increase in risk from corrective corneal surgery would combine with air bag deployment to shift air bag–induced eye injuries to higher levels of severity. The protective effect of air bags in reducing the more serious injuries may be negated or potentially reversed. One solution is to offer protective eyewear for patients to use while driving their cars.In conclusion, this article presents the most comprehensive eye injury study to date; it investigates 10 770 828 front seat occupants from 22 236 cases for the years 1993 through 1999. An analysis of the cases indicates that 3% of occupants exposed to an air bag deployment sustained an eye injury, compared with 2% of occupants not exposed to an air bag deployment. Moreover, there was a significant increase in the risk of corneal abrasion for occupants exposed to an air bag deployment (P= .03).Establishment of the new eye injury severity levels allowed for a more accurate estimation of eye trauma, thereby introducing a new tool to evaluate the patterns of automobile-related eye injuries. Using the 4 new levels to group eye injury severity, it was found that the overall severity of eye injuries has decreased with exposure to air bag deployment. This was presumably accomplished because the air bag minimizes occupant contact with the windshield and steering wheel, which were the 2 leading sources of serious eye injuries. The current trend of increasing the number of air bags in the fleet as well as the increasing percentage of the population electing for corrective vision surgery is potentially alarming. This vulnerability allows for the current trend of reduction of more severe injuries due to air bag exposure to be reversed, a concern that warrants the continued investigation of air bag design, vision correction procedures, and eyewear protection.HADeeryAPMorrisBNFildesSVNewsteadAirbag technology in Australian passenger cars: preliminary results from real-world crash investigations.Crash Prev Inj Control.1999;1:121-128.RHAsariaAZamanPMSullivanRetinitis sclopetaria associated with airbag inflation.Br J Ophthalmol.1999;83:1094-1095.RSBakerCWFlowerPSinghASmithRCaseyCorneoscleral laceration caused by air bag trauma.Am J Ophthalmol.1996;121:709-711.DCBallCSBouchardOcular morbidity associated with airbag deployment: a report of 7 cases and a review of the literature.Cornea.2001;20:159-163.ARBhavsarTCChenDAGoldsteinCorneoscleral laceration associated with passenger-side airbag inflation.Br J Ophthalmol.1997;81:514-515.KSBiechl-LautenbachBGloorFWalzSevere perforating eye injury caused by an air bag in a traffic skid accident.Klin Monatsbl Augenheilkd.1996;208:196-200.LSBraudeProtective eyewear needed with driver's side air bag [letter]?Arch Ophthalmol.1992;110:1201.LSBraudePassenger side airbag ocular injury while wearing sunglasses [letter].Br J Ophthalmol.1995;79:391.MCacciatoriRWDBellNEHabibBlow-out fracture of the orbit associated with inflation of an airbag: a case report.Br J Oral Maxillofac Surg.1997;35:241-242.JKCampbellAutomobile air bag eye injuries.Nebr Med J.1993;78:306-307.DChialantKFDamjiUltrasound biomicroscopy in diagnosis of a cyclodialysis cleft in a patient with corneal edema and hypotony after an air bag injury.Can J Ophthalmol.2000;35:148-150.DJDalmotasAGermanBEHendrickRMHurleyAirbag deployments: the Canadian experience.J Trauma.1995;38:476-481.PJDriverRCashwellPYeattsAirbag-associated bilateral hyphemas and angle recession.Am J Ophthalmol.1994;118:250-251.JDuboisEStewartOcular injuries from air bag deployment.J Ophthalmic Nurs Technol.1998;17:147-150.KFukagawaKTsubotaCKimuraCorneal endothelial cell loss induced by air bags.Ophthalmology.1993;100:1819-1823.JAGaultMCVichninEAJaegerJBJeffersOcular injuries associated with eyeglass wear and airbag inflation.J Trauma.1995;38:494-497.HSGeggelPBGriggsMIFreemanIrreversible bullous keratopathy after air bag trauma.CLAO J.1996;22:148-150.JFGiguereDSt-VilATurmelAirbags and children: a spectrum of C-spine injuries.J Pediatr Surg.1998;33:811-816.MAGoldbergSValluriJSPeposeAir bag related corneal rupture after radial keratotomy.Am J Ophthalmol.1995;120:800-802.DPHanRetinal detachment caused by air bag injury.Arch Ophthalmol.1993;111:1317-1318.DFHuelkeJLMooreMOstromAir bag injuries and occupant protection.J Trauma.1992;33:894-898.LHuntOcular injuries from driver's air bag.Insight.1995;20:18-19.HJIngrahamHDPerryEDDonnenfeldAir-bag keratitis.N Engl J Med.1991;324:1599-1600.FKuhnRMorrisCDWitherspoonEye injury and the air bag.Curr Opin Ophthalmol.1995;6:38-44.GLLarkinAirbag mediated corneal injury.Am J Emerg Med.1991;9:444-446.WBLeeHSO'HalloranPAPearsonHASenSHReddyAirbags and bilateral eye injury: 5 case reports and a review of the literature.J Emerg Med.2001;20:129-134.HLLemleyJChodoshTCWolfCPBogieTCHawkinsPartial dislocation of laser in situ keratomileusis flap by air bag injury.J Refract Surg.2000;16:373-374.MPLesherDSDurrieMCStilesCorneal edema, hyphema, and angle recession after air bag inflation.Arch Ophthalmol.1993;111:1320-1322.GTLuederAir bag–associated ocular trauma in children.Ophthalmology.2000;107:1472-1475.EEMancheRAGoldbergBJMondinoAir bag related ocular injuries.Ophthalmic Surg Lasers.1997;28:246-250.MLMcDermottDHShinBAHughesSValeAnterior segment trauma and air bags [letter].Arch Ophthalmol.1995;113:1567-1568.AMichaeli-CohenMNeufeldMLazarOGeyerRHaddadHKashtanBilateral corneal contusion and angle recession caused by an airbag.Br J Ophthalmol.1996;80:487.KEMishlerHyphema caused by air bag [letter].Arch Ophthalmol.1991;109:1635.LMMoliaEStrohAirbag injury during low impact collision.Br J Ophthalmol.1996;80:487-488.ALMorrisonDChuteSRadentzMGolleJCTroncosoJESmialekAir bag–associated injury to a child in the front passenger seat.Am J Forensic Med Pathol.1998;19:218-222.RANordenHDPerryEDDonnenfeldCMontoyaAir bag–induced corneal flap folds after laser in situ keratomileusis.Am J Ophthalmol.2000;130:234-235.HSO'HalloranKDraudJLStevensPrimary enucleation as a consequence of airbag injury.J Trauma.1998;44:1090.CJOnwuzuruigboGJFuldaDLarnedDHailstoneTraumatic blindness after airbag deployment: bilateral lenticular dislocation.J Trauma.1996;40:314-316.SRimmerJDShulerSevere ocular trauma from a driver side air bag [letter].Arch Ophthalmol.1991;109:774.MRosenblattBFreilichDKirschAir bags: trade-offs.N Engl J Med.1991;325:1518-1519.MRosenblattBFreilichDKirschAir bag–associated ocular injury [letter].Arch Ophthalmol.1993;111:1318.JMRuiz-MorenoAir bag–associated retinal tear.Eur J Ophthalmol.1998;8:52-53.SMSastryRACopelandHMezghebeSMSiramRetinal hemorrhage secondary airbag-related ocular trauma.J Trauma.1995;38:582.IUScottGRJohnWJStarkAirbag-associated ocular injury [letter].Arch Ophthalmol.1993;111:25.IUScottDSGreenfieldRKParrishAirbag-associated injury producing cyclodialysis cleft and ocular hypotony.Ophthalmic Surg Lasers.1996;27:955-957.GKShahRPenneMGGrandPurtscher's retinopathy secondary to airbag injury.Retina.2001;21:68-69.HWSingerPotential air bag–related eye injuries require special ER attention.J Ophthalmic Nurs Technol.1998;17:21-22.AJSmallyABinzerSDolinDVianoAlkaline chemical keratitis: eye injury from airbags.Ann Emerg Med.1992;21:1400-1402.WSSmockGRNicholsAirbag module cover injuries.J Trauma.1995;38:489-493.JDSteinEAJaegerJBJeffersAir bags and ocular injuries.Trans Am Ophthalmol Soc.1999;97:59-82.RSteinmannA 40-year-old woman with an air bag–mediated injury.J Emerg Nurs.1992;18:308-310.MFStrancEye injury resulting from the deployment of an airbag [letter].Br J Plast Surg.1999;52:418.BSwanson-BiearmanRMrvosBSDeanEPKrenzelokAir bags: lifesaving with toxic potential.Am J Emerg Med.1993;11:38-39.VYTottenMHFani-SalekKChandramohanHyphema associated with air bag deployment in a pediatric trauma patient.Am J Emerg Med.1998;16:102-103.YTsudaHWakiyamaTAmemiyaOcular injury caused by an air bag for a driver wearing eyeglasses.Jpn J Ophthalmol.1999;43:239-240.MCVichninEAJaegerJAGaultJBJeffersOcular injuries related to air bag inflation.Ophthalmic Surg Lasers.1995;26:542-548.DPWalterMRJamesAn unusual mechanism of airbag injury.Injury.1996;27:523-524.FHWalzMMackayBGloorAirbag deployment and eye perforation by a tobacco pipe.J Trauma.1995;38:498-501.SAWeinmanAutomobile air bag-mediated injury: a case presentation.J Emerg Nurs.1995;21:84-85.MMWhitacreWAPilchardSMKanAir bag injury producing retinal dialysis and detachment [letter].Arch Ophthalmol.1993;111:1320.JEWhiteKMcClaffertyRBOrtonACTokareqiczESNowakOcular alkali burn associated with automobile air-bag activation.CMAJ.1995;153:933-934.NAZabriskieIPHwangJFRamseyASCrandallAnterior lens capsule rupture caused by air bag trauma.Am J Ophthalmol.1997;123:832-833.JWZacovicTDMcGuirkKJKnoopBilateral hyphemas as a result of air bag deployment [letter].Am J Emerg Med.1997;15:323-324.KMüller-JensenWHollweckSerious eye injuries produced by windshield damage: an actual problem in ophthalmology.In: Stapp Car Crash Conference Proceedings. Warrendale, Pa: Society of Automotive Engineers; 1970.SMDumaTAKressDJPortaAir bag induced eye injuries: a report of 25 cases.J Trauma.1996;41:114-119.AGhafouriSKBurgessZKHrdlickaBMZagelbaumAir bag related ocular trauma.Am J Emerg Med.1997;15:389-392.SMDumaJRCrandallEye injuries from airbags with seamless module covers.J Trauma.2000;48:786-789.National Highway Traffic Safety AdministrationNational Automotive Sampling System: Crashworthiness Data System, 1993-1999 [database on CD-ROM].Washington, DC: Dept of Transportation; 1999. HS report 808985.Association for the Advancement of Automotive MedicineThe Abbreviated Injury Scale, 1998 Revision.Barrington, Ill: Association for the Advancement of Automative Medicine; 1998.TAtkinsonPAtkinsonKnee injuries in motor vehicle collisions: a study of the National Accident Sampling System database for the years 1979-1995.Accid Anal Prev.2000;32:779-786.CMFarmerERBraverELMitterTwo-vehicle side impact crashes: the relationship of vehicle and crash characteristics to injury severity.Accid Anal Prev.1997;29:399-406.TRMillerNMPindusJBDouglassMedically related motor vehicle injury costs by body region and severity.J Trauma.1993;34:270-275.DAReiffGMcGwinLWRueSplenic injury in side impact motor vehicle collisions: effect of occupant restraints.J Trauma.2001;51:340-345.MSegui-GomezDriver air bag effectiveness by severity of the crash.Am J Public Health.2000;90:1575-1581.DCVianoCCCulverLEvansMFrickRScottInvolvement of older drivers in multivehicle side-impact crashes.Accid Anal Prev.1990;22:177-188.YBurnsteinDKlapperPSHershExperimental globe rupture after excimer laser photorefractive keratectomy.Arch Ophthalmol.1995;113:1056-1059.MCamposMLeePJMcDonnellOcular integrity after refractive surgery: effects of photorefractive keratectomy, phototherapeutic keratectomy, and radial keratotomy.Ophthalmic Surg.1992;23:598-602.JCCasebeerDRShapiroSPhillipsSevere ocular trauma without corneal rupture after radial keratotomy: case reports.J Refract Corneal Surg.1994;10:31-33.MEJohn JrTESchmittTraumatic hyphema after radial keratotomy.Ann Ophthalmol.1983;15:930-932.LWPeacockSGSladeJMartizAChuangRWYeeOcular integrity after refractive procedures.Ophthalmology.1997;104:1079-1083.NPAlviEKDonohueKCurnynJSugarRupture of radial keratotomy sites after presumed blunt trauma.Ophthalmic Surg Lasers.1995;26:574-575.PSBinderGOWaringPNArrowsmithCWangHistopathology of traumatic corneal rupture after radial keratotomy.Arch Ophthalmol.1988;106:1584-1590.NAChaudhryWESmiddyDisplacement of corneal cap during vitrectomy in a post-LASIK eye.Retina.1998;18:554-555.BJGlasgowHHBrownDHAizussBJMondinoRYFoosTraumatic dehiscence of incisions seven years after radial keratotomy.Am J Ophthalmol.1988;106:703-707.ATLeungSKRaoDSLamTraumatic partial unfolding of laser in situ keratomileusis flap with severe epithelial ingrowth.J Cataract Refract Surg.2000;26:135-139.TDLindquistComplications of corneal refractive surgery.Int Ophthalmol Clin.1992;32:97-114.PJMcDonnellJSLeanDJSchanzlinGlobe rupture from blunt trauma after hexagonal keratotomy.Am J Ophthalmol.1987;103:241-242.ESPearlsteinPJAgapitosHLCantrillEJHollandPWilliamsRLLindstromRuptured globe after radial keratotomy.Am J Ophthalmol.1988;106:755-756.ERRashidGOWaringComplications of refractive keratotomy.In: Waring GO, ed. Refractive Keratotomy for Myopia and Astigmatism. St Louis, Mo: Mosby–Year Book Inc; 1992:863-936.PFVingerWFMielerJHOestreicherMEasterbrookRuptured globes following radial and hexagonal keratotomy surgery.Arch Ophthalmol.1996;114:129-134.GDZhaboedovGSBondarevaTraumatic rupture of the eyeball after radial keratotomy [in Russian].Vestn Oftalmol.1990;106:64-65.Submitted for publication March 6, 2002; final revision received June 10, 2002; accepted June 13, 2002.Correspondence and reprints: Stefan M. Duma, PhD, Virginia Polytechnic Institute and State University, Impact Biomechanics Laboratory, 114 Randolph Hall, Blacksburg, VA 24061 (e-mail: duma@vt.edu).
TI - The Effect of Frontal Air Bags on Eye Injury Patterns in Automobile Crashes
JO - JAMA Ophthalmology
DO - 10.1001/archopht.120.11.1517
DA - 2002-11-01
UR - https://www.deepdyve.com/lp/american-medical-association/the-effect-of-frontal-air-bags-on-eye-injury-patterns-in-automobile-llBeZPnNJ6
SP - 1517
EP - 1522
VL - 120
IS - 11
DP - DeepDyve
ER -