Globe and Adnexal Trauma Terminology Survey
Authors: Hoskin Annette K. , Fliotsos Michael J. , Rousselot Andrés , Ng Sean Ming Sheng , Justin Grant A. , Blanch Richard , Colyer Marcus H. , Shukla Bhartendu , Natarajan Sundaram , Kuhn Ferenc , Sundar Gangadhara , Woreta Fasika A. , Watson Stephanie L. , Agrawal Rupesh ,   International Globe and Adnexal Trauma Epidemiology Study (IGATES) Ophthalmic Trauma Terminology Consensus Group, Irma Josiah , Mohammad Soleimani , Fernando Arevalo  J. , Md. Rajibul Islam Shah , Shukla Abha , Dhawwahir-Scala Felipe , Dalma-Weiszhausz Jose , Zviornicanin Jasmin , Subramanian Prem S. , Rao Girish , Shukla Bhartendu , Catedral Eva , Moreau Annie , Pradhan Eli , Sen Alok , Pakdel Farzad , perez Daniel , Uwaydat Sami , Lutfi Delfitri , Meireles Angelina , Schrader Wolfgang , Davila Pedro , Rapuano Christopher J. , Shah Ankoor , Park Jungyul , Manaklal Apeksha Kataria , Gao Weiqi , Singh Romi , Cseke István , Khatri Manoj , Jhamnani Rekha , Tambe Rekha , Brundridge Wesley L. , Feng Yun , Grover Ashok , Carricondo Pedro , Mazzoli Robert A. , Hernan Hugo Ocampo Domguez , Awan Amer , Morera Felipe , Das Jayanta Kumar , Yan Hua , Pauly Marian , Singh Shakeen , Legault Gary , Mehta Ruchir , Quiroz-Reyes Miguel A. , Lotfy Nevien , Carricondo Pedro Carlos , Tucker Charles , Fish Gary Edd 
Published: July 2022

Importance

Ocular trauma terminology should be periodically updated to enable comprehensive capturing and monitoring of ocular trauma in clinical and research settings.

Objective

To update terminology for globe and adnexal trauma.

Design, Setting, and Participants

A 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 Measures

Expert consensus on ocular and adnexal terms.

Results

A 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 Relevance

There 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.