From chemical burns to puncture wounds, most eye injuries can be prevented with the right safety eyewear. RHIANNON BOWMAN reviews current eye injury trends and the role of optometrists and employers to minimise the risks.
Preventable eye injuries land thousands of Australians in the optometrist’s chair or hospital emergency department every year, with a number of cases resulting in permanent damage and significant vision loss.
Eye injuries can happen anytime, anywhere, but some trends are evident. An Australian white paper on eye protection and the importance of protecting vision found eye injuries in the workplace are most likely to happen on a Friday.
At home, most preventable eye injuries happen during DIY projects, car repairs or gardening and are caused by chemical burns, penetrating eye injuries and small particles.
Now evidence has started to emerge that DIY and home-based injuries are reaching new heights, potentially as a result of the COVID-19 lockdown. This is being attributed to isolation rules, seeing people spend more time on home-based activities – without adequate eye protection.
Trends in eye injuries
It is undisputed in the literature that ocular trauma represents a serious public health problem and is a leading cause of visual impairment. Furthermore, it is widely quoted that 90% of injuries are preventable.
Data from Optometry Australia’s 2020 Vision Index found that 21% of Australians had acquired an eye injury from a DIY project at home but only 12% always wear eye protection for these projects.
Despite the risk of injury at home, 60% of all eye injuries in Australia occur in the workplace, according to a white paper published in May this year by Essilor-owned PSG Eyewear, Australia’s largest supplier of certified prescription safety glasses.
Leading eye injury expert, Ms Annette Hoskin, who authored the white paper, says that advances in eye protection design as well as improved work health and safety regulations have helped reduce work-related eye injuries.
However, with thousands of people admitted to hospital each year as a result of workplace accidents, Australia is still far from solving this problem.
Hoskin is a Research Fellow from Save Sight Institute (University of Sydney) and Lions Eye Institute (University of Western Australia). She is also Essilor’s global standardisation manager, and Optometry Australia’s representative on Standards Australia’s committees for eye protection, spectacles and sunglasses.
“Males are over-represented in the literature in terms of the number of injuries,” she says.
“In the population over the age of 65, when falls are more prevalent, we are seeing more woman with eye injuries as a result of falls. It’s becoming more of a trend.”
Hoskin notes that, anecdotally, there has been a spike in eye-related accidents during COVID-19, many of them related to DIY projects at home.
“Generally speaking, people are not aware of the dangers they may face at home. They don’t know they should be protecting their eyes,” she says.
“In the workplace, there are several visual cue’s and reminders to wear protective eyewear, such as posters and signs, but these don’t exist in the home.”
To help counter the number of eye injuries that result from DIY projects at home, Hoskin wants retail outlets to position safety eyewear directly alongside their range of tools.
“I’ve been looking at how we can get hardware stores to place eye protection beside power tools at the point-of-sale,” she says. “We need to prompt people, ‘If you buy a drill, do you have eye protection to wear with that?’ when they make their purchase.
“It’s not hard to have the right type of eye protection. But general eyewear – like regular spectacles or sunglasses – does not offer adequate protection.”
She says the severity of an eye injury can be worse if a person has an accident while wearing regular spectacles because the lens can shatter and glass fractures can penetrate the eye.
A study in Italy was one of the first to investigate whether the COVID-19 social distancing measures were having a significant impact on the risk of ocular trauma.
It analysed data on patients presenting to an ophthalmological emergency department at a hospital in Bologna, Italy, from 10 March to 10 April 2020, compared with the same period of the previous year.
In a letter to the editor published in May in The Royal College of Ophthalmologists journal Eye, author Marco Pellegrini notes that the study found the number of patients presenting to the emergency department with eye injuries fell by more than half during COVID-19.
According to Pellegrini, there were 354 eye injuries in the 2019 study period compared to 112 in the 2020 study period. During quarantine in Italy, the proportion of children and adolescents with eye injuries decreased (from 14.7 to 8%), while the proportion of males increased (from 66.7 to 75%).
Based on the hospital’s emergency department data, the percentage of eye injuries from falls and sports injuries had the highest decrease. Meanwhile, injuries during home activities and injuries with plants had the highest increase – from 12.4 to 17% and from 8.5 to 10.7%, respectively.
Anecdotal evidence suggests similar trends have emerged in Australia during COVID-19.
Sydney-based ophthalmologist Dr Tim Roberts, medical director of Vision Eye Institute and a consultant at Royal North Shore Hospital, says there was a distinct change in eye-related injury patterns during the peak of the COVID-19 lockdown.
“Typically, ophthalmic emergencies at Royal North Shore Hospital result from car accidents, alcohol-related incidents, and falls,” he says.
“But during COVID-19, we saw fewer of these types of emergencies, and an increase in DIY and home-based accidents. For example, a yoga mishap with a theraband resulted in a bleed in the eye for one patient.
“Registrars also reported seeing fewer contact-lens incidents, as people were not wearing contact lenses while they were at home in isolation. It is a complete change in the pattern of society.”
Sydney ophthalmologist and RANZCO Fellow Professor Stephanie Watson agrees more accidents are resulting from DIY activities at home since the COVID outbreak.
She recently consulted a 45-year-old man who was painting his ceiling without protective eye wear. “He held the roller brush above his head and paint dripped into his left eye,” she says.
“I also have a 72-year-old patient who tripped over and ruptured her right eye just before the COVID-19 lockdown. She lost her intraocular lens and iris and had a haemorrhage into the vitreous. I repaired her eye but post-operatively she developed raised intraocular pressure that did not respond to topical therapy.
“At the time she required urgent management for her pressure, people her age were being advised to stay at home as much as possible due to COVID-19 and access to surgical facilities were limited.”
The patient’s pressure came under control, the haemorrhage cleared and Watson is now planning sutured intraocular lens surgery to restore her vision.
Preventing eye injuries
To prevent ocular injuries, Watson believes work needs to be done in three key areas: education, protection and policy.
“Prevention begins with education – informing the public of the risk of injury. Next there is the need for people to wear protective eye wear – this is often overlooked when ‘working at home’. Policy can have a huge impact; for example, changes in legislation dramatically reduced injuries from fireworks,” she says.
Last month a national eye health awareness campaign, JulEye, supported by a RANZCO-led charity, aimed to raise public awareness about simple measures to prevent common household eye injuries.
According to Optometry Australia (OA), eye injuries and resulting vision loss represent a major burden to society, with the direct cost of eye injuries in Australia estimated to be more than $155 million per year.
To assist optometrists in their role as primary healthcare providers in preventing eye injuries in the workplace, OA has produced an updated occupational optometry and safety eyewear guide, outlining changes to safety standards and prescribing safety eyewear.
Ms Annette Hoskin was the lead author of the 2020 Occupational Optometry Guide review and update. It includes information on preventing occupational eye injuries, vision assessments, eye protection products, Australian vision and eye-protection standards and screening protocols. It also advises about eye safety consultations and how to conduct workplace screenings.
When it comes to preventing workplace eye injuries, the task is twofold; optometrists and employers both have a role to play. Hoskin says there is much more to eye safety than just telling employees to wear safety glasses.
“Optometrists can help differentiate their skills and ensure adequate fit and comfort by individually fitting employees with the appropriate eye protection,” Hoskin says.
When choosing the best eye protection, it is important to understand and differentiate between low, medium and high-impact hazards, the employee’s needs, and their environment.
Common eye hazards in the workplace include high-speed small objects, low-speed large objects, and dust and airborne particles. Chemicals, thermal energy and radiation can also be hazardous.
At home, chemical burns from gardening or cleaning products, and penetrating eye injuries – often caused by using a lawnmower, power trimmer or edger in the garden – are most common.
Because a number of safety eyewear options exist, depending on the hazards and the environment, Hoskin recommends optometrists should be familiar with Australian Standards AS/NZS 1336 (Recommended practices for occupational eye protection), AS/NZS 1337 (Occupational eye protectors), and AS/NZS 1337.6 (Prescription eye protectors).
Employers should also be familiar with Australian Work Health and Safety Regulations, which states that it is an employer’s duty to provide suitable protective clothing and equipment to employees, including eyewear.
The penalty for non-compliance can be steep for an employer – up to $3 million for an offence committed by a corporate body resulting in serious injury, according to PSG’s white paper. For an employee, the injury can be incapacitating if they suffer permanent vision loss.
For example, in 2016 a company in New South Wales Hunter region was fined $240,000 after a teenage work experience student suffered permanent eye injury after welding for up to five hours. The teen was not told of the need to use welding eye protection and suffered thermal retinal burns, otherwise known as ‘flash burns’, to both eyes as a result, leaving him with a 75% bilateral visual incapacity.
This incident, and many more, highlight the severe consequences of workplace injuries and the importance of safety eyewear to prevent injury and permanent vision loss.
According to the Australian Bureau of Statistics, more than two million Australians work in construction, mining and manufacturing industries, and the market for eye protection in Australia is currently estimated to be worth half a billion dollars annually.
Kevin Hackett Optometrist in Geraldton, a central hub for the midwest mining region in Western Australia, has a toe in that market. While the practice does not provide workplace screenings, it does provide safety eyewear for mining companies including Rio Tinto, Downer and Iluka.
Ms Carol Martin, a lab technician and optical assistant, has been part of the team for more than 27 years. She says the practice gets a gauge on what type of eye protection a patient may need during their consultation.
“When our patients are being tested, we ask them about their occupation and hobbies. That then enables us to offer safety eyewear if we feel that would benefit them for their eye safety needs and requirements,” Martin says.
The practice also dispenses safety eyewear for patients doing DIY projects at home but not all who should wear safety eyewear do so.
“There are too many people who don’t take their eye safety seriously enough to buy or use safety eyewear for their DIY projects and a lot of people don’t feel they need safety eyewear, even when they do work in areas where debris is flying around,” she says.
“We explain what can happen when or if your eye is damaged and the advantage of safety eyewear protection.”
“We have seen the occasional circumstance where a patient has had fine metal fragments in their eye and as a result the patient has been referred to the hospital for the fragments to be removed.”
Incorporating safety eyewear into practice
Mr Adam Rowe owns Specs 2-4-1 Karratha, in Western Australia’s Pilbara region, home to the ‘giants’ of the mining and natural resources industry, including Rio Tinto, BHP and Fortescue.
Rowe says these companies comply to strict personal protective equipment (PPE) guidelines, including safety eyewear, and every employee must adhere to these guidelines to work on these sites.
Along with supplying safety eyewear to Karratha-based and fly-in fly-out employees, Rowe says Specs 2-4-1 also makes regular visits to inland towns.
“We go to Tom Price, Paraburdoo, Pannawonica, and all Rio Tinto mine sites offering full optometry services to the people who live and work in these towns, and we have been doing so for over 10 years,” he says.
“We not only offer safety eyewear to the Rio Tinto employees, whose safety glasses are supplied by [Essilor-owned] PSG Eyewear, but take along a huge range of optical, sunglass and kids frames for them to look at and purchase while we are there,” he says.
“We also liaise with the child health nurses in these towns who refer children with potential vision problems for us to test and correct with prescription glasses.”
Rowe says Specs 2-4-1 has been operating in the Pilbara for the past 18 years and over that time he has seen the safety eyewear industry change dramatically.
“In my early years in optics, I remember when safety glasses did not even need to be certified or even compulsory – we would simply use polycarbonate or even grind CR39 to a minimum thickness at any point of the lens to two millimetres and that would be suitable,” he says.
“Nowadays safety in general, on all work sites, is priority one. We introduced a large range of certified prescription safety glasses from four different certified suppliers over the last 10 years due to the huge rise in demand from employees requiring prescription eye protectors against low and medium impact, meeting AS/NZS 1337.6.2012 standards.”
Rowe says safety on work sites is paramount: “The safety industry itself is big business – safety eyewear is the same.
“Safety eyewear for our practice, been located in Karratha, is constant and we do large numbers of prescription safety glasses every month which is financially rewarding for the practice,” he says.
In Rowe’s experience, selling a pair of safety glasses often converts into a purchase for new personal eyewear while the patient is in the practice.
“While safety eyewear ranges have become a lot larger and better looking over the years, people still like to purchase a nice pair of sunglasses or glasses for while they are not at work,” he says.
“I personally believe that the safety eyewear industry is well-catered for these days. The ranges available are large, stylish, comfortable and as mentioned earlier, we have multiple certified suppliers to choose from so we find it really easy these days to find the right frame for all the different size faces out there.”
To successfully incorporate safety eyewear into general practice, Rowe believes experience is the key.
“I believe having experience in all aspects of dispensing is very important and supplying the patient the best possible frame to suit their prescription and head. No one wants to wear bad fitting frames on a 12-hour shift,” he says.
Specs 2-4-1’s experienced optometrist Mr Nick Defteros conducts all patient eye exams, both in-store and inland.
“The only specialised equipment we use, rather than standard optometry consulting room set-up, is how we do eye testing when we go to inland towns Tom Price, Paraburdoo and Pannawonica. We obviously can’t take our optometry chair with us, but we do take a phoropter and connect it to a portable phoropter stand which works perfectly, allowing Nick to offer a comprehensive standard eye test in these remote locations,” Rowe says.
Dispensing safety eyewear is very similar to dispensing normal spectacles, with one exception, he says.
“The patient’s prescription is the most important thing to consider before looking at frames but one major way dispensing safety eyewear is different is that there are a lot of wrap around frames to choose from in the safety ranges.
“Wrap around frames and progressive lenses or certain prescriptions usually don’t mix too well, that’s why I sell more of certain supplier’s frames than others.
“Some suppliers make their plastic safety frames appear to be wrap around, but they are actually flatter than they look and have been designed this way to accommodate progressive lenses better. Other safety eyewear suppliers have just brought out 8-Base curved frames which limits what prescriptions and lens designs we can put in them.”
Again, Rowe emphasises that experience is key.
“Experience and all the things I have learned over the years in optics has helped the selling of safety eyewear become successful and the growth of the safety eyewear industry overall has also helped grow my practice,” he says.