IGATES Index
Advancing Ocular Trauma Terminology Through International Globe and Adnexal Trauma Epidemiology Study (IGATES)

IGATES Index is designed to address the gaps identified in existing terminology for ophthalmic trauma. These include the absence of agreed-upon terms for adnexal injuries, the need for finer delineation of injury mechanisms and zones, and the inclusion of additional details such as lens status, retinal involvement, and corneal injury extent. By incorporating these refinements, IGATES Index seeks to provide clinicians and researchers with a more nuanced understanding of ophthalmic trauma, thereby facilitating improved communication, management, and prognostication.

The IGATES Index integrates the widely used BETTs (the system for ophthalmic trauma terminology and classification), but also introduce an advanced system designed to simplify the process of adding data points for multiple case analyses. Here's how the IGATES Index maintains the simplicity of its predecessor (BETTs), while incorporating additional specifications for an AI-assisted medical future:

  1. Structured Data Collection: Both BETTs and IGATES index offers a clear and detailed framework for categorizing ophthalmic trauma. By defining specific zones (I, II, III) and types of injuries (sharp, blunt, mixed, IOFB, bite/sting, burn), it provides a comprehensive structure that facilitates the easy entry and retrieval of data.
  2. Enhanced Detail and Precision: The IGATES index classification includes detailed subdivisions within each zone, such as the central 4 mm of the cornea (Zone Ia) and the paracentral and outer areas (Zone Ib and Ic). This granularity allows for precise documentation of injury locations, which is crucial for accurate case analysis and comparison.
  3. Comprehensive Coverage: The IGATES index encompasses various injury mechanisms (e.g., rupture, laceration, perforating injuries) and risk factors (e.g., endophthalmitis, retinal detachment, RAPD). This wide coverage ensures that all relevant aspects of a trauma case are documented, providing a complete dataset for analysis.
  4. User-Friendly Interface: Despite the increased level of detail, the IGATES index remains user-friendly. The structured layout and clear labeling of zones and injury types make it easy for practitioners to quickly and accurately record case information.
  5. Facilitation of AI Integration: The detailed and structured nature of the IGATES index makes it well-suited for integration with AI systems. AI can utilize the precise data points to identify patterns, predict outcomes, and assist in clinical decision-making, enhancing the overall efficiency and effectiveness of medical care.
  6. Future-Proofing: By incorporating detailed specifications and facilitating the collection of granular data, the IGATES index positions itself as a future-proof tool. It not only addresses current clinical needs but also anticipates the growing role of AI in medical analysis and treatment planning.

In summary, the BETTS classification embedded in the IGATES Index enhances the ease of adding data points for multiple case analyses while maintaining the simplicity of the original system. It achieves this by providing a detailed, structured, and user-friendly framework that supports the integration of advanced AI technologies, thereby ensuring its relevance and utility in future medical practices.

Patient Details

Gender
Age
Injured Eye
VA
Duration from injury to presentation
Date of Trauma
Time of Trauma

Mechanism of Trauma(if known)

Low mass projectile at high speed, fall onto or struck with sharp object
Sharp
High mass projectile at low speed, fall onto or struck with blunt object
Blunt
Very high energy injury eg. caused by a blast, glass bottle exploding, causing a mix of injuries typically associated with a sharp and blunt trauma.
Mixed
Intraocular Foreign Body, retained foreign object causing entrance lacerations.
IOFB
Bite or Sting
Bite
Chemical or Thermal
Burn

Open / Closed Globe(if applicable)

CGI: the eyewall does not have a full thickness wound
There is no evident wound
Contusion
The eye wall has a partial thickness wound
Lamellar Laceration
OGI: the eye wall has a full thickness wound
Full thickness wound of the eyewall by blunt object
Rupture
Full thickness wound of the eyewall by sharp object
Laceration / Single Penetration
2 full thickness lacerations (entry + exit)
Perforating

Severity Indicators

Severe Adnexal Injury
Lens Injury
Endophthalmitis
RD
RAPD

Trauma Zone

Zone I:
Cornea and corneoscleral limbus
a. Central 4 mm
b. Paracentral between a and c
c. Outer 3 mm (including limbus)
Zone 1
Zone 1a
Zone 1b
Zone 1c
Zone II:
Outside the limbus to 5 mm
posterior to the limbus
Zone 2
Zone IIIa:
5 to 8mm posterior to the rectus muscle insertion

Zone IIIb:
more than 8mm posterior to the limbus
Zone 3a
Zone 3b

Additional Remarks


Results

Mechanism
Globe
Severity
Zone

References
  1. Kuhn F, Morris R, Witherspoon CD, Mester V. The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol. Feb 2004;27(2):206-10.
  2. Kuhn F, Morris R. A quarter of a century of the Birmingham Eye Trauma Terminology (BETT) system. Graefes Arch Clin Exp Ophthalmol. Oct 2021;259(10):2867-2868. doi:10.1007/s00417-021-05407-6
  3. Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized classification of ophthalmic trauma. Graefes Arch Clin Exp Ophthalmol. Jun 1996;234(6):399-403.
  4. Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The Ophthalmic Trauma Score (OTS). Ophthalmol Clin North Am. Jun 2002;15(2):163-5, vi.
  5. Hoskin AK, Fliotsos MJ, Rousselot A, Ng SMS, Justin GA, Blanch R, Colyer MH, Shukla B, Natarajan S, Kuhn F, Sundar G, Woreta FA, Watson SL, Agrawal R; International Globe and Adnexal Trauma Epidemiology Study (IGATES) Ophthalmic Trauma Terminology Consensus Group. Globe and Adnexal Trauma Terminology Survey. JAMA Ophthalmol. 2022 Aug 1;140(8):819-826. doi: 10.1001/jamaophthalmol.2022.2594. PMID: 35862061; PMCID: PMC9305602