Disability-Adjusted Life Years Resulting from Ocular Injury among Deployed Service Members, 2001–2020

Objective To quantify the burden of ocular injuries on deployed United States service members by calculating Disability Adjusted Life Years (DALYs). Design Retrospective, observational cohort study Subjects US service members with ocular injuries sustained in combat zones from 2001-2020 Methods Using data from the Defense and Veterans Eye Injury and Vision Registry (DVEIVR), health states and duration of injuries were identified using patient injury, final visual acuity, medication, procedures, and History of Present Illness data. These health states were mapped to disability weights from the Global Burden of Disease (GBD) study. Average duration of injury/illness was calculated until remission or death. For the latter, life expectancy at age of sustaining injury, as identified from United States Life Tables from the National Vital Statistics Reports 2020 was used. Using Defense Manpower Data Center reports capturing number of service members deployed per year, incidence rates were calculated for ocular injury and DALYs. Main outcome measures DALYs of ocular injury Results 17555 patients sustained ocular injury that incurred DALYs. In total, these injuries resulted in 11214 DALYs (average 0.64 DALYs per included patient; 20.6 DALYs per 10000 US service members per year). Severe impairment of distance vision (77.9%) and blindness (10.6%) were the primary contributors of DALYs. While only 9.3% of patients sustained a permanent ocular injury, permanent disability accounted for 99.5% of total DALYs. The average yearly incidence rate of ocular injury was 32.0 cases per 10000 US service members. Foreign body was the most frequent injury type (2754 occurrences) followed by abrasion (2419 occurrences) and multiple injury types (1429 occurrences), while the most DALYs occurred in patients with multiple injury types (2485 DALYs) followed by abrasion (accounting for 725 DALYs), and foreign body (accounting for 461 DALYs.) Conclusion We report higher average DALYs per case ratio among US service members compared to the general population studied by the GBD Study, highlighting the differences in probabilities of permanent injury between the two studies. Our study provides a novel understanding of the impact of ocular injuries on active-duty service members and lays the groundwork for further research and interventions to mitigate their burden. To quantify the burden of ocular injuries on deployed United States service members by calculating Disability Adjusted Life Years (DALYs). Retrospective, observational cohort study US service members with ocular injuries sustained in combat zones from 2001-2020 Using data from the Defense and Veterans Eye Injury and Vision Registry (DVEIVR), health states and duration of injuries were identified using patient injury, final visual acuity, medication, procedures, and History of Present Illness data. These health states were mapped to disability weights from the Global Burden of Disease (GBD) study. Average duration of injury/illness was calculated until remission or death. For the latter, life expectancy at age of sustaining injury, as identified from United States Life Tables from the National Vital Statistics Reports 2020 was used. Using Defense Manpower Data Center reports capturing number of service members deployed per year, incidence rates were calculated for ocular injury and DALYs. DALYs of ocular injury 17555 patients sustained ocular injury that incurred DALYs. In total, these injuries resulted in 11214 DALYs (average 0.64 DALYs per included patient; 20.6 DALYs per 10000 US service members per year). Severe impairment of distance vision (77.9%) and blindness (10.6%) were the primary contributors of DALYs. While only 9.3% of patients sustained a permanent ocular injury, permanent disability accounted for 99.5% of total DALYs. The average yearly incidence rate of ocular injury was 32.0 cases per 10000 US service members. Foreign body was the most frequent injury type (2754 occurrences) followed by abrasion (2419 occurrences) and multiple injury types (1429 occurrences), while the most DALYs occurred in patients with multiple injury types (2485 DALYs) followed by abrasion (accounting for 725 DALYs), and foreign body (accounting for 461 DALYs.) We report higher average DALYs per case ratio among US service members compared to the general population studied by the GBD Study, highlighting the differences in probabilities of permanent injury between the two studies. Our study provides a novel understanding of the impact of ocular injuries on active-duty service members and lays the groundwork for further research and interventions to mitigate their burden.