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GUEST EDITORIALmerican Optometric Association Eye Safety Project Team:regory W. Good, O.D., Ph.D., Jeffrey L. Weaver, O.D., Steven A. Hitzeman, O.D.,

ol. George L. Adams, III, O.D., and William L. Lapple, O.D.

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or the first time in its short his-tory, the Healthy People Initia-tive1 has included vision objec-

ives to help reach its goal for creatinghealthier American public. Some of

he vision objectives are general inature:

1. Increase proportion of personswho have a dilated eye examina-tion at appropriate intervals.

2. Increase the proportion of pre-school children ages 5 yearsand under who receive visionscreening.

Several are related to specific dis-ase entities:

1. Reduce impairment from dia-betic retinopathy.

2. Reduce impairment from glau-coma.

It is easy for practicing optometristso understand their roles in helpingmericans meet these particular objec-

ives. That is what we do every day inractice.There are 2 objectives that deal with

ye safety, with the goal of reducingreventable eye injuries at work andome:

1. Reduce occupational eye injury.2. Increase the use of appropriate

personal protective eyewear inrecreational activities and haz-ardous situations around thehome.

For these objectives, the practicingptometrist’s role is less obvious andertainly is complimented with a com-itment by the entire office staff.The most recent estimates show

hat, on average, 2,000 occupationalye injuries requiring medical treat-ent occur every workday.2 (This fig-

re was partially determined using data p

529-1839/06/$ -see front matter © 2006 American Ooi:10.1016/j.optm.2006.03.003

rom the National Electronic Injuryurveillance System [NEISS], whichonitors injuries and illnesses treated

n emergency rooms. Because the ma-ority of most injuries in the Unitedtates are treated in non-emergencyoom medical facilities, the originalEISS estimate was increased by ap-roximately 2.5 times to arrive at the,000 eye injuries per day figure.3)ithin industry, the majority of eye

njuries occur to workers not wearingny eye protection. The Bureau of La-or Statistics found that in 60% ofccupational eye injuries, eye protec-ion was not worn.4 Additionally, forases in which an injury occurred inpite of wearing eye protection, mostnjuries occurred when the wrong typef protector was used or was improp-rly adjusted. When safety equipments fit and used properly, it is estimatedhat more than 90% of eye injuries cane lessened in severity or preventedntirely.5

The number of eye injuries each yearssociated with sporting activities is alsotaggering. Estimates from the NEISSrogram indicate that more than 40,000ye injuries occur and are evaluatedithin emergency rooms each year from

porting activities.6 Because these esti-ates are only from emergency rooms, it

s logical to assume that the 40,000 num-er underestimates the actual total bypproximately 2.5 times as was de-cribed above. Therefore, a better yearlystimate for sports-related eye injuriesay be 100,000. Similar eye injury

umbers are found associated with lawnnd garden products. Clearly, the num-er of eye injuries each year is puttingision at risk for a large number of our

atients. 1

ptometric Association. All rights reserved.

s optometry doingnough?

ith eye injury numbers like these it isasy to see why it is so important forptometry to be involved in helping pre-ent eye injuries whether at home or atork. As the primary eye care profes-

ion, optometry should be participatingt all levels to help maximize eye safety.

To help determine how optometry isurrently participating in industrial eyeafety, AOA’s Eye Safety Projecteam sent a short survey dealing with

ssues surrounding safety glasses toearly 1,000 companies in Ohio. Aomplete list of all “companies” regis-ered in Ohio was obtained from theureau of Workers’ Compensation.very sixth company that had “manu-

acturing” or “construction” in its offi-ial State of Ohio name was sent a

Gregory W. Good, O.D., Ph.D.

3-question survey. One hundred

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202 Guest Editorial

wenty-five of the surveys (of 914 sur-eys sent), were completed and re-urned. The results present an interest-ng view of eye safety from theompany’s perspective. The results arehown in Table 1.

That only 34% of the respondingompanies provide prescription eye-lasses at no cost to workers may beurprising to many readers. This mayeem exceptionally low to those of usho believe it is an OSHA require-ent for companies to provide pre-

cription devices to all workers. This isot the case, of course. Providinglano safety devices that fit over streetlasses is sufficient to comply withSHA requirements. Therefore, inany cases, if workers want to wear

rescription safety glasses, there is aood chance that they must purchasehe glasses themselves. Many compa-

Table 1 Vision Survey of Industry

Does your company provide PRESCRIPTIO(Separate from glasses provided thro

When a worker requires PRESCRIPTION sathe safety glasses?

Specific Eye Doctor/Optical Shop thatWorker required to bring prescription f

Where do workers choose, and get measuEyeglass dispensary ON-SITE within coEye Doctor/Optical Shop has signed agWorker’s private eye doctor completesOther

Where do workers have safety glasses adEyeglass dispensary ON-SITE within coEye Doctor/Optical Shop has signed agWorker is responsible to have this servOther

Who determines what specific safety devIndividual workerSupervisor of individual workerCompany safety personnelAll workers just wear safety glasses

During the past year, have any employee

Does your company require pre-employm

Do you have an eye doctor/vision consulin your company?

Does your company have a WRITTEN poli

Are there jobs within your plant for whicworking with chemicals and/or weld

Note: The above numbers apply only to tho* Numbers without “%” are raw numbers. N

ies provide vision care plans that al- c

ow workers to obtain safety glasses asperiodic insurance benefit. This,

owever, would “use up” the benefitsor that year and not allow coverageor dress eyewear.

The survey also shows that for theajority of cases, workers are responsi-

le for obtaining adjustments to eyewearn their own. Although this is not unex-ected, it does illustrate that optometricffices can be involved with eye safetycross a variety of avenues. Determininghe safety glass prescription, orderingafety glasses, or adjusting safety spec-acles are all opportunities for optometryffice personnel to discuss eye safetyssues with patients at times other thanuring comprehensive evaluations.

ye safety discussions

hat can we and our office staffs do to

ety glasses at no charge to employees?a Vision Insurance Plan)glasses, how does the employee obtain th

igned agreement to provide servicesprivate eye doctoror, prescription safety frames?yent to provide servicesr form provided by company

d when they get out of adjustment?yent to provide servicesrovided privately

re required for different jobs in plant?

eived a safety briefing concerning the eye

ision screenings of applicants?

that has given advice on vision requireme

garding contact lens wear within your plan

wearing of contact lenses is NOT allowedperations.)

mpanies that said that safety eyewear was requl questions had the same number of total respo

onvince patients to wear personal pro- w

ective equipment when it is appropri-te? How can we modify behavior? Toest change health-related behavior forur own good, the Health Benefit Modelas first proposed in the 1950s.7,8 Thisodel explains how individuals must be

pproached on 4 different levels to insti-ute long-term change. The model holdshether we are discussing smoking ces-

ation, seat belt use, or the wearing ofafety glasses. Our discussions with pa-ients should address the 4 levels dis-ussed below.

erceived susceptibility

or individuals to make a conscious deci-ion to routinely wear eye safety protec-ors, they must accept the fact that they areusceptible to eye injury. Individuals mustelieve there is a real threat to their visionnd eye health. Educating patients and

YES 34.4%NO 65.6%

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27.4%62.6%

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vision? YES 52NO 41YES 8NO 86

or certain jobs YES 6NO 86YES 8NO 84

s involved YES 10NO 79

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Guest Editorial 203

ies that occur in the United States eachear is a start; however, individuals need toelieve it can happen to them and not justto the other guy.” Personal knowledge ofn incident is often necessary before indi-iduals realize that they are at risk. Havingn example of an injury sustained byomeone they know, someone within theirompany, or someone in their hometownan be very useful. Testimonials by celeb-ities or sports figures can help individualsee that “yes, it can happen to me!”

erceived severity

elieving that the consequences of anye injury can be severe is required be-ore a change in behavior will be accept-ble. Patients and workers must under-tand the overall importance of vision tour everyday lives and that vision loss isossible from injury. Showing slides ofnjured eyes helps drive home this point.ndividuals often don’t understand howragile the eyes can be. A small scar tohe skin can have no consequences,hereas the same small scar to the cor-ea can “steal” vision needed for read-ng, driving, or working.

erceived benefit

ndividuals must believe that eye pro-ection does work. No one will wearafety glasses if it is generally believedhat they serve no protective benefit.ndividuals must have confidence thatafety glasses can protect the eyesrom injury. A demonstration of theoughness of a polycarbonate lens canelp drive home this point.

erceived barriers

arriers to the general wearing of safetylasses include cosmesis concerns, com-ort, and interference with clear vision.ndividuals not accustomed to wearingpectacles will eventually adapt to dis-omfort behind the ears or subtle visualistortions; however, cosmetic concernsill continue to impede compliance with

afety spectacle wear regardless of the

ime frame. p

Representatives of workers shoulde involved in choosing safety eye-ear styles that are most acceptable.here are hundreds of styles available

oday from which to choose. The styleshat are most appropriate will dependn many factors including the age andex of the workers. A style that looksood is more likely to be worn when its needed for protection.

For recreational and home safety,ptometrists should stock a wide rangef safety eyewear that is appropriateor the types of hazards that may bencountered. Different styles are re-uired for basketball than for footballr lacrosse. The American Society foresting and Materials (ASTM Section5.07, www.astm.org) has developedtandards for eye protective devices forpecific sports to ensure that the deviceill protect against the foreseeableazards for different sports.

hat can I do?

t is important that eye safety issues areiscussed with patients at each andvery patient visit. Whether discussingye hazards at work, at school, at play,r around the home, there are numer-us issues that can be addressed.Be a role model for your neighbor-

ood. Wear eye protection when work-ng in the yard or during athletic endeav-rs. Make safety devices available toour patients and try to make eye safetyart of everyday life. This is the methodpproached by the U.S. Army in theirombat Eye Protection program.9

Train as you will fight” is the motto.afety glasses are now issued to all sol-iers deploying to southwest Asia andill soon be issued to all basic training

oldiers throughout the Army. Combatye protection will become part of theniform and will be in place when theyre needed. The U.S. Army has hadremendous recent success in convincingommanders and soldiers throughout theanks of the benefits of routinely wearingrotective eyewear.

Help make the wearing of protectiveyewear a habit. Only then can wensure that the protection will be in

lace when it is needed! g

ummaryptometry can be the “go to” professionhen questions concerning eye safety

nd eye injury prevention are raised.elp your patients recognize the hazards

hey face and help convince them thathey are at risk. This can be done on anndividual patient basis or with generaliscussions at safety talks at a local in-ustry or school. Have your office per-onnel bring up safety issues with everyatient. It is our responsibility as THErimary Eye Care Profession to helpnsure that preventable eye injuries don’tccur. Do the right thing. Help Healthyeople 2010 reach its eye safety goals.ou can make the difference.

eferences. Office of Disease Prevention and Health Pro-

motion, U.S. Department of Health and Hu-man Services. Healthy People 2010. http://www.healthypeople.gov/. Last accessedMarch 1, 2006.

. National Institute for Occupational Safety andHealth. Eye safety. http://www.cdc.gov/niosh/topics/eye/. Last accessed March 1, 2006.

. Nonfatal occupational injuries and illnessestreated in hospital emergency departments–United States, 1998. MMWR April 27, 2001;50(16):313-7. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5016a3.htm.

. U.S. Department of Labor. Accidents In-volving Eye Injuries. Report 597. Washing-ton, DC, Bureau of Labor Statistics, 1980.

. Prevent Blindness America, 2005. PreventBlindness America fact sheets. http://www.preventblindness.org/resources/factsheets/Preventing_Workplace_Injuries_MK33.PDF.Last accessed March 1, 2006.

. Prevent Blindness America, 2005. PreventBlindness America Fact Sheets. http://www.preventblindness.org/resources/fact_sheets.html#sports. Last accessed March 30, 2006.

. Rosenstock IM. Historical origins of thehealth belief model. Health Education Mono-graphs 1974;2(4):470-3.

. Becker MH. The health belief model andpersonal health behavior. Health EducationMonographs 1974;2(4):324-469.

. Bye-bye BCGs: The plan to dump those uglyglasses. U.S. Army Times: June 13, 2005, p.14. Army Times Publishing Company.

orresponding author:

regory W. Good, O.D., Ph.D., Thehio State University, College of Op-

ometry, 338 West 10th Avenue, Co-umbus, OH 43221

ood.3@osu.edu

204 Guest Editorial