Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq

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Hashim" }, { "@type": "Person", "name": "Suzan K. Mohammed‎" }, { "@type": "Person", "name": "Marwan Y. Abdulla" }, { "@type": "Person", "name": "Hayder A Fawzi" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Motorcycle accidents can be particularly hazardous, as riders are exposed to various risk factors, such as high speeds, lack of protective enclosures, and limited safety features. Aim of the study To describe the ocular injuries associated with motorcycled accidents presented to tertiary hospitals and forensic centers in Iraq. Patients and methods The study was conducted in three Teaching hospitals and forensic centers in Baghdad and Al-Qadisiyah in Iraq. Information regarding ocular injuries, recorded and classified according to the International Ocular Trauma Classification, was gathered from motorcycle crash injuries that were presented to the emergency departments of these facilities from June 1, 2019, to June 1, 2023 Results The study involved 335 ophthalmological accidents; the mean age of the patients was 27.84± 9.6 years, most of them were males (96.7%), and there were only 11 females as passengers, 39 (11.6%) had injuries in both eyes. Lesions involving the periorbita, lids, and conjunctiva comprised most of the findings. There were 60.9% of patients with lid lacerations with or without sub-conjunctival bleeding, 22.1% with corneoscleral injury, and 17.9% with commotio retinae. It was the leading cause of decreased visual acuity, with 9% having lens capsule damage with or without iris prolapse and 8.1% having a ruptured capsule, 55.82% of patients had a mild injury, 27.16% had a moderate injury, and 17.01% had a severe injury. Conclusion Eye injury associated with motorcycle accidents mainly affects males in their youth age and has serious outcomes, sometimes ending with blindness. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-183/v2", "name": "Presentations and Incidence of Ocular Injuries Caused by Motorcycle..." } } ] } Home Browse Presentations and Incidence of Ocular Injuries Caused by Motorcycle... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Hashim ZA, Mohammed‎ SK, Abdulla MY and Fawzi HA. Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.12688/f1000research.142871.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] Zainab A. Hashim 1 , Suzan K. Mohammed‎ 2 , Marwan Y. Abdulla 3 , Hayder A Fawzi https://orcid.org/0000-0001-9970-0119 4 Zainab A. Hashim 1 , Suzan K. Mohammed‎ 2 , Marwan Y. Abdulla 3 , Hayder A Fawzi https://orcid.org/0000-0001-9970-0119 4 PUBLISHED 30 Aug 2024 Author details Author details 1 College of ‎medicine, University of Al-Qadisiyah, Diwaniyah, Al-Qādisiyyah Governorate, Iraq 2 College of ‎Medicine‎, Al Iraqia University, Baghdad, Baghdad Governorate, Iraq 3 Opthalmology Department, Al-Noaman ‎Teaching Hospital, Baghdad, Iraq 4 Department of Pharmacy, Al-Mustafa ‎University ‎College, Baghdad, Iraq Zainab A. Hashim Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Suzan K. Mohammed‎ Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Marwan Y. Abdulla Roles: Conceptualization, Investigation, Methodology, Resources, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Hayder A Fawzi Roles: Data Curation, Formal Analysis, Investigation, Resources, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Eye Health gateway. Abstract Background Motorcycle accidents can be particularly hazardous, as riders are exposed to various risk factors, such as high speeds, lack of protective enclosures, and limited safety features. Aim of the study To describe the ocular injuries associated with motorcycled accidents presented to tertiary hospitals and forensic centers in Iraq. Patients and methods The study was conducted in three Teaching hospitals and forensic centers in Baghdad and Al-Qadisiyah in Iraq. Information regarding ocular injuries, recorded and classified according to the International Ocular Trauma Classification, was gathered from motorcycle crash injuries that were presented to the emergency departments of these facilities from June 1, 2019, to June 1, 2023 Results The study involved 335 ophthalmological accidents; the mean age of the patients was 27.84± 9.6 years, most of them were males (96.7%), and there were only 11 females as passengers, 39 (11.6%) had injuries in both eyes. Lesions involving the periorbita, lids, and conjunctiva comprised most of the findings. There were 60.9% of patients with lid lacerations with or without sub-conjunctival bleeding, 22.1% with corneoscleral injury, and 17.9% with commotio retinae. It was the leading cause of decreased visual acuity, with 9% having lens capsule damage with or without iris prolapse and 8.1% having a ruptured capsule, 55.82% of patients had a mild injury, 27.16% had a moderate injury, and 17.01% had a severe injury. Conclusion Eye injury associated with motorcycle accidents mainly affects males in their youth age and has serious outcomes, sometimes ending with blindness. READ ALL READ LESS Keywords Motorcycles, Accidents, Eye Injuries, Visual Acuity Corresponding Author(s) Hayder A Fawzi ( [email protected] ) Close Corresponding author: Hayder A Fawzi Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Hashim ZA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Hashim ZA, Mohammed‎ SK, Abdulla MY and Fawzi HA. Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.12688/f1000research.142871.2 ) First published: 11 Mar 2024, 13 :183 ( https://doi.org/10.12688/f1000research.142871.1 ) Latest published: 30 Aug 2024, 13 :183 ( https://doi.org/10.12688/f1000research.142871.2 ) Revised Amendments from Version 1 Based on the reviewers recommendation, we added the total prevalence of ocular injuries from all monocycle injuries reported, we improved the introduction, methods, results and discussion. and the article now is more comprehensive. Based on the reviewers recommendation, we added the total prevalence of ocular injuries from all monocycle injuries reported, we improved the introduction, methods, results and discussion. and the article now is more comprehensive. See the authors' detailed response to the review by Debapriya Mukhopadhyay See the authors' detailed response to the review by Japheths Ogendi READ REVIEWER RESPONSES Introduction Millions of injuries occur worldwide as a result of road traffic accidents, making them the primary cause of death in adolescents and adults across the world. 1 Motorcycle-related accidents, in particular, pose a significantly higher risk of injury than other types of road traffic accidents. 2 According to the American Academy of Ophthalmology, 2.5 million eye injuries are reported/occur in the USA annually, with 50,000 individuals experiencing either partial or complete loss of vision. 3 While eye injuries that results in vision loss can occur as a result of motorcycle crashes, only a relatively small proportion of eye injuries are reported in the statistics of motorcycle crashes. 4 A strong emphasis the consistent use of appropriate eye protection by motorcyclists and their passengers whenever they ride their bikes emanates from this recognition. 5 Recent data from the National Highway Traffic Safety Administration of the United States indicates a 10.5% rise in such incidents in 2021 compared to 2020. 6 The problem of motorcycle injuries and fatalities has a greater impact on individuals from lower and middle socioeconomic classes, primarily due to motorcycles being a common mode of transportation in developing countries and to a lesser extent in developed nations. 7 , 8 The lack of strict enforcement of licensing regulations has created opportunities for individuals to obtain licenses without undergoing required eye tests or demonstrating riding proficiency. 9 , 10 Consequently, many motorcycle riders are unfamiliar with the rules and regulations outlined in the Highway Code in Iraq. 11 This has led to a high occurrence of accidents involving motor vehicles and motorcyclists, collisions between motorcyclists and pedestrians, and even among motorcyclists themselves. Intraocular injuries can be categorized into two types: closed globe injuries, which involve partial-thickness wounds in the wall of the eyeball 12 and can be further classified as contusions or lamellar lacerations, 13 and open globe injuries, which involve full-thickness wounds in the eyeball wall, such as ruptures caused by blunt trauma, 12 lacerations, penetrating or perforating injuries, or injuries involving intraocular foreign bodies resulting from sharp forces. 14 Adnexal injuries, on the other hand, pertain to injuries affecting the eyelid and/or conjunctiva. 15 Although ocular trauma imposes a substantial burden on ophthalmic services, constituting 38-52% of all new patients seeking emergency care at hospitals due to accidents. 15 – 17 Enock et al. conducted a study involving 56 eyes with ocular injuries, and it was found that none of the patients were wearing helmets at the time of the injury. 18 Published literature regarding motorcycle-related ocular trauma is sparse in Iraq. Understanding the characteristics of motorcycle-related ocular trauma would be significant in designing appropriate intervention strategies that prioritize the most prevalent nature of ocular trauma. This study assessed and characterized ocular trauma among motorcycle crash injuries that were presented to several University Teaching hospitals and forensic centers located in Baghdad and Al-Qadisiyah from 2019 to 2023. Methods Study design This study presented motorcycle accident injuries patients to the Emergency Department from June 1, 2019, to June 1, 2023. After admission, patients were screened to identify the motorcycle injuries that presented ocular trauma; for those identified to have ocular trauma, written consent was sought and obtained from the patients to participate in the study. Information was obtained from the injured patients, whether they were stable enough or from those who accompanied them for care. Written consent was obtained from the patients if they were over 18 years old or from their caregivers after providing an adequate explanation of the aims and methods of the study. Further information was gathered on the age, sex, laterality, type of ocular injury, ocular findings, lesion severity, and visual acuity. The information regarding ocular injuries was classified and recorded according to the International Ocular Trauma Classification. 19 Previous studies have used this classification and scoring method to classify ocular traumas according to visual acuity, pupillary light response, zone, and type of injury. Study settings According to the World Health Organization (WHO), Iraq’s healthcare system has 2,652 facilities, of which 61 are teaching hospitals. This study was conducted in two governorates (Baghdad, the Iraqi capital, and Al-Qadisiyah), a total of three teaching hospitals: Ibn Al-Haitham Teaching Hospital (in Baghdad), Al-Nauman Teaching Hospital (in Baghdad), and Al-Diwaniyah Teaching Hospital (in Al-Diwaniyah), and the three forensic centers associated with these hospitals. Patients were interviewed initially in the emergency department; if the ocular trauma related to motorcycle injuries were confirmed, the patient would be transferred to the ophthalmology department when the patient was managed and interviewed for the study. Ibn Al-Haitham Teaching Hospital is Iraq’s primary and largest ophthalmology hospital. This hospital only receives patients with ophthalmological conditions. It has a large inpatient capacity (200 beds) and many operating rooms (16 Operating Rooms) for various ophthalmic procedures. Al-Nauman Teaching Hospital is one of the largest teaching hospitals in Baghdad, and it contains various departments, including emergency and ophthalmology departments. Finally, Al-Diwaniyah Teaching Hospital is the largest teaching hospital in the Al-Diwaniyah governorate, with large emergency and ophthalmology departments. Participants Inclusion criteria Patients of all ages and both sexes are presented with ocular injuries during motorcycle accidents. Exclusion criteria Patients who refused to participate in the study. Ethical approval This study was approved by the Research Ethics Committee at Al-Qadisiyah University, College of Medicine. (Approval no.: 25/285, on 22 nd of May 2019). Sample size estimation Sample size estimation was based on the following equation: minimum sample size n = p 1 − p Z 0.95 2 d 2 Where n is the minimum sample size, p is the prevalence of ocular trauma was 13.5% based on a previous study 20 among patients admitted to the trauma unit. The Z represents the Z-score at 95 % confidence interval, and it equals 1.96, d represents the marginal error 21 to be 0.04. Thus, the minimum sample size was estimated to be approximately 280. Statistical analysis Descriptive statistics were used that included frequency and percentage; GraphPad Prism version 10 was used for the analysis. Results During the four years of the study, 6,243 patients presented with motorcycle injuries in the three Teaching hospitals and their forensic centers. Of those (5.37%), 335 patients were identified to have ocular trauma from the road crash. Table 1 presents the characteristics of motorcycle crash cases with ocular trauma. The ages of those with ocular trauma ranged from 10 to 67 years old, with a mean age of 27.84 ± 9.6 years. Most of them were 324 (96.7%) males, with a male-to-female ratio of 29 to 1, and there were only 11 females as passengers; 39 (11.6%) had injuries in both eyes, as shown in Table 1 . Table 1. Characteristics of enrolled patients. Characteristic N (%) Number of cases 335 Age 50 years 72 (21.5%) Sex Male 324 (96.7%) Female * 11 (3.3%) Eye involved One eye 296 (88.4%) Both eyes 39 (11.6%) * The involvement of females was as passengers. Regarding the type of eye lesions during their presentation, there were 60.9% of patients with lid laceration ± sub-conjunctival hemorrhage, 22.1% with corneoscleral injury, 17.9% with commotio retinae and it was the leading cause of decreased visual acuity, 9% with lens capsule damage ± iris prolapse, and 8.1% with ruptured capsule, as shown in Table 2 . Table 2. The categorization of patients according to type of presenting eye lesion. Presenting lesion * N (%) Lid laceration ± subconjunctival hemorrhage 204 (60.9%) Hyphema 90 (26.9%) Cornea ± scleral wound 74 (22.1%) Commotio retinae 60 (17.9%) Lens capsule damage ± iris prolapse 30 (9.0%) Rupture globe 27 (8.1%) Diplopia (blunt trauma) 17 (5.1%) Blowout fracture 13 (3.9%) * This grouping concentrates on the presenting and most severe injury. After applying the International Ocular Trauma Classification system, 55.82% of patients had a mild injury, 27.16% had a moderate injury and 17.01% had a severe injury, as shown in Table 3 . Table 3. Severity of lesion. Severity No (%) Mild 187 (55.82%) Moderate 91 (27.16%) Severe 57 (17.01%) The visual acuity of the participants ranged from 6/6 to no light perception, 59.1% of patients had visual acuity better than 6/18, 29.0% from 6/18 to 6/60, 8.1% from 6/60 to counting fingers, and 3.9% with no light perception, as shown in Table 4 . Table 4. Visual acuity assessment. Snellen visual acuity N (%) Better than 6/18 198 (59.1%) Between 6/18-6/60 97 (29.0%) 6/60-CF 27 (8.1%) Non-seeing eye 13 (3.9%) Discussion Ocular injuries resulting from motorcycle accidents can range from mild to severe and can have lasting effects on vision; motorcycle accidents often expose riders to various types of impact debris and forces that can directly or indirectly lead to ocular injuries. 4 The finding of this study indicates that of the motorcycle crash injuries that were presented to the health facilities, 335 (5.37%) had ocular injuries. Previous studies reported results that were higher than those reported by the current study; the annual incidence of hospital admission for ocular injuries was 8.1% in the United States, 22 12.6% in Scotland, 23 13.2% in Singapore, 24 and 15.2 in Sweden. 25 The findings on age and sex distribution is in agreement with the results presented in earlier studies, in Larona and Pe-Yan (2012), which reported in their that examined 34 cases of motorcycle ocular injuries and reported a mean of 27.1 years, and 88.2% of their study sample was composed of males. 26 Hsieh et al . (2017) reported that 6,072 were admitted due to motorcycle injuries, 994 (16.4%) of them were ≥ 65 years, and 5078 (83.6%) were aged between 20-64 years; however, females formed 41.9% of the elderly and 42.9% of adults. 27 These findings offer a much higher rate of injury in females; the lower rate of females injured in the current study could be attributed to cultural hindrances posed by society, which limit females as the primary drivers of vehicles. Social/cultural factors play a significant role in the age and sex distribution of motorcycle riders, as in Taiwan it is very common for females to ride bikes, 28 and in another study done by the same author, female riders formed 42.01% of the study sample and were younger, passengers more than riders, used helmets more than males, and had different injury characteristics and lower in-hospital mortality in comparison to males. 28 In the current study, patient injuries included lid lacerations and sub-conjunctival hemorrhage, corneoscleral injury, commotio retinae, lens capsule damage ± iris prolapse, ruptured capsule, and orbital blowout fractures. Soft tissue injuries were the most prevalent probably because of the very limited use of helmets in our country. None of the current studies reported using helmets regularly, Arif et al . (2019) reported that although facial soft tissue injuries occur in helmeted riders, it occurs far more in non-helmeted ones. 29 To the best of our knowledge, no study directly reported open globe injury due to motorcycle injury, rather aggregated road traffic accidents cases, Upaphong et al . (2021) reported that motorcycle injuries constituted 56.3% of patients aged 60 years), and in all patients, hyphema were seen in 55.4%, lens injuries (52.5%), and uveal prolapse (55.4%). 20 In a review done by Kim et al . (2022) it was reported that blowout fractures were the third observed mechanism for orbital fractures, 31 Also other studies reported that motorcycle accidents were the leading cause of orbital/facial fractures. 32 , 33 Direct contact between the eye and a chemical ( e.g., gasoline), or even chemical fumes, can cause burns. 34 Sources of radiation, such as bright ultra violet (UV) headlights, can also cause a flash burn. 35 Other drivers may be injured because of their reckless driving and collision with other cars and heavy objects on the side road. 36 Driving under the influence of alcohol can lead to accidents, which not only affects the driver but also the passengers and other people on the road. 37 Limitations of the study Since only two governates out of 18 limit the conclusion, at the same time, it gives us an initial assessment of the seriousness of the ocular injuries, a national study that involves most of the country is necessary. Conclusion In summary, the analysis of eye injuries associated with motorcycle accidents highlights a significant concern primarily affecting young males. The outcomes of these incidents can be particularly severe, at times resulting in permanent blindness. Policymakers, traffic safety authorities, and healthcare professionals must address this issue with targeted interventions and awareness campaigns. By emphasizing the importance of proper protective gear, safe riding practices, and education, we can work towards reducing the occurrence of such injuries and minimizing their life-altering consequences. Furthermore, fostering a culture of responsible riding and enhancing road infrastructure can contribute to safer roads for all, ultimately preventing these devastating eye injuries and their far-reaching impacts on individuals and society as a whole. Data availability Underlying data Zenodo: Ocular Injuries Caused by Motorcycle Accidents [Data set]. https://doi.org/10.5281/zenodo.8370156 . 38 The project contains the following underlying data: - Data sets of Ocular Injuries Caused by Motorcycle Accidents. Extended data Zenodo: Ocular Injuries Caused by Motorcycle Accidents. https://doi.org/10.5281/zenodo.8370208 . 39 The project contains the following underlying data: - STROBE Checklist. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Kortor JN, Yinusa W, Ugbeye ME: Lower limb injuries arising from motorcycle crashes. Niger J Med. 2010; 19 (4): 475–478. PubMed Abstract | Publisher Full Text 2. Meena S, Rakheja V, Sahu S, et al. : Traumatic avulsion of the globe with optic nerve transection: an unusual presentation. BMJ Case Rep. 2020; 13 (10). Publisher Full Text 3. American Academy of Ophthalmology and American Society of Ocular Trauma, United States Eye Injury Registry summary report, 1998–2002. http://www​.aao.org/newsroom​/guide/upload​/Eye-Injuries-BkgrnderLongVersFinal-l​.pdf 4. Kim EJ, Ganga A, Kang C, et al. : Motorcycle-Associated Ocular Injuries: A Narrative Review. Clin Ophthalmol. 2022; 16 : 3457–3479. PubMed Abstract | Publisher Full Text | Free Full Text 5. Ahmad S: Knowledge, attitude and compliance with safety protective devices among commercial motorcyclists in Tudun-Wada Zaria, North-Western Nigeria. Ann Niger Med. 2012; 6 (2): 80. Publisher Full Text 6. National Highway Traffic Safety Administration: Newly Released Estimates Show Traffic Fatalities Reached a 16-Year High in 2021. Washington, DC: United States Department of Transportation; 2022 [cited 2022 May, 5]. Reference Source 7. Bittar CK, Cliquet A, Costa V, et al. : SOCIOECONOMIC IMPACT OF MOTORCYCLE ACCIDENT VICTIMS IN THE EMERGENCY ROOM OF A HOSPITAL (PART 2). 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PubMed Abstract | Publisher Full Text 34. Hurt HH, Ouellet JV, Thom DR: Motorcycle accident cause factors and identification of countermeasures. United States: National Highway Traffic Safety Administration; 1981; vol. 1 . . technical report. 35. Sliney DH: Photoprotection of the eye – UV radiation and sunglasses. J Photochem Photobiol B Biol. 2001; 64 (2): 166–175. PubMed Abstract | Publisher Full Text 36. Lin C-H, Wang C-Y, Shen Y-C, et al. : Clinical characteristics, intraoperative findings, and surgical outcomes of canalicular laceration repair with monocanalicular stent in Asia. J Ophthalmol. 2019; 2019 : 1–6. PubMed Abstract | Publisher Full Text | Free Full Text 37. Lev Ari O, Shaked G, Michael T, et al. : Ocular injuries associated with two-wheeled electric transportation devices and motorcycle accidents. Sci Rep. 2022; 12 (1): 20546. PubMed Abstract | Publisher Full Text | Free Full Text 38. Fawzi HA: Ocular Injuries Caused by Motorcycle Accidents. [Data set]. Zenodo. 2023. Publisher Full Text 39. Fawzi HA: Ocular Injuries Caused by Motorcycle Accidents. Zenodo. 2023. Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 11 Mar 2024 ADD YOUR COMMENT Comment Author details Author details 1 College of ‎medicine, University of Al-Qadisiyah, Diwaniyah, Al-Qādisiyyah Governorate, Iraq 2 College of ‎Medicine‎, Al Iraqia University, Baghdad, Baghdad Governorate, Iraq 3 Opthalmology Department, Al-Noaman ‎Teaching Hospital, Baghdad, Iraq 4 Department of Pharmacy, Al-Mustafa ‎University ‎College, Baghdad, Iraq Zainab A. Hashim Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Suzan K. Mohammed‎ Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Marwan Y. Abdulla Roles: Conceptualization, Investigation, Methodology, Resources, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Hayder A Fawzi Roles: Data Curation, Formal Analysis, Investigation, Resources, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 30 Aug 2024, 13:183 https://doi.org/10.12688/f1000research.142871.2 version 1 Published: 11 Mar 2024, 13:183 https://doi.org/10.12688/f1000research.142871.1 Copyright © 2024 Hashim ZA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Hashim ZA, Mohammed‎ SK, Abdulla MY and Fawzi HA. Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.12688/f1000research.142871.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 30 Aug 2024 Revised Views 0 Cite How to cite this report: Mohammad N. Reviewer Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.170553.r373593 ) The direct URL for this report is: https://f1000research.com/articles/13-183/v2#referee-response-373593 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Apr 2025 Najah Mohammad , University of Baghdad, Baghdad, Iraq Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.170553.r373593 This article deals with the important subject of ocular injury by motorcycles; no previous study estimates the impact of these accidents in Iraq. Additionally, this study reports initial estimates regarding the type of injuries. Since it was carried out in ... Continue reading READ ALL This article deals with the important subject of ocular injury by motorcycles; no previous study estimates the impact of these accidents in Iraq. Additionally, this study reports initial estimates regarding the type of injuries. Since it was carried out in multiple centers, this will provide a broader picture of the current problem in multiple centers. I have several minor questions: 1/ Please calculate the 95% confidence interval of the overall prevalence of ocular injuries. 2/ Why did you choose this particle type of equation to calculate the sample size, and what is the power of detection? 3/ To better present your data, I recommend adding Figures, not just tables, as part of your results. 4/ Please emphasize the study recommendations (Future perspective). Best regards Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Ophthalmology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Mohammad N. Reviewer Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.170553.r373593 ) The direct URL for this report is: https://f1000research.com/articles/13-183/v2#referee-response-373593 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Mukhopadhyay D. Reviewer Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.170553.r319026 ) The direct URL for this report is: https://f1000research.com/articles/13-183/v2#referee-response-319026 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Sep 2024 Debapriya Mukhopadhyay , Debapriya Mukhopadhyay Vision Research Institute, Kolkata, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.170553.r319026 The study is now a ... Continue reading READ ALL The study is now a good read, Informative & comprehensive. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public Health, Healthcare Strategy, Healthcare Administration, Community Eye Health, Diabetes, Medical imaging, Ophthalmology, Optometry, Medical Investigations & research, Cell biology research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Mukhopadhyay D. Reviewer Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.170553.r319026 ) The direct URL for this report is: https://f1000research.com/articles/13-183/v2#referee-response-319026 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 11 Mar 2024 Views 0 Cite How to cite this report: Mukhopadhyay D. Reviewer Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.156471.r303232 ) The direct URL for this report is: https://f1000research.com/articles/13-183/v1#referee-response-303232 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Jul 2024 Debapriya Mukhopadhyay , Debapriya Mukhopadhyay Vision Research Institute, Kolkata, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.156471.r303232 What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. The meticulous classification of injuries according to the International Ocular Trauma Classification has allowed ... Continue reading READ ALL What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. The meticulous classification of injuries according to the International Ocular Trauma Classification has allowed for a detailed understanding of the types and severities of ocular trauma. The findings highlight the importance of protective gear and safety measures for motorcyclists, as the majority of injuries were to young males, indicating a demographic at high risk. The study's extensive data collection over four years offers a solid foundation for developing strategies to prevent such injuries and improve outcomes for those affected. It's a significant step towards enhancing road safety and healthcare protocols for ocular injuries in Iraq and potentially other regions with similar contexts. The study gap The study presents a significant contribution to understanding the ocular trauma associated with motorcycle accidents in Iraq, highlighting the prevalence of such injuries among young male riders. However, the research reveals gaps that warrant further investigation. The disproportionate representation of male patients could be indicative of cultural or behavioral patterns that influence motorcycle usage and risk exposure, suggesting a need for gender-specific safety interventions. Additionally, the study's focus on tertiary centers in urban areas may not capture the full spectrum of ocular injuries, particularly those treated in rural or non-hospital settings. The classification of injuries, while standardized, does not account for long-term outcomes or the socioeconomic impact on the patients. Future studies could benefit from a longitudinal approach, assessing the recovery trajectory and quality of life post-injury, as well as exploring preventive measures tailored to the local context. Moreover, integrating multidisciplinary perspectives, including ophthalmology, trauma surgery, and public health, could provide a more comprehensive understanding of the factors contributing to these injuries and the strategies needed to mitigate them. Statistical significance is missing in the results. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public Health, Healthcare Strategy, Healthcare Administration, Community Eye Health, Diabetes, Medical imaging, Ophthalmology, Optometry, Medical Investigations & research, Cell biology research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Mukhopadhyay D. Reviewer Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.156471.r303232 ) The direct URL for this report is: https://f1000research.com/articles/13-183/v1#referee-response-303232 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 23 Aug 2024 Hayder A Fawzi , Department of Pharmacy, Al-Mustafa ‎University ‎College, Baghdad, Iraq 23 Aug 2024 Author Response Dear Reviewer, Reviewer Comments - What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. ... Continue reading Dear Reviewer, Reviewer Comments - What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. The meticulous classification of injuries according to the International Ocular Trauma Classification has allowed for a detailed understanding of the types and severities of ocular trauma. The findings highlight the importance of protective gear and safety measures for motorcyclists, as the majority of injuries were to young males, indicating a demographic at high risk. The study's extensive data collection over four years offers a solid foundation for developing strategies to prevent such injuries and improve outcomes for those affected. It's a significant step towards enhancing road safety and healthcare protocols for ocular injuries in Iraq and potentially other regions with similar contexts. The study gap 1/ The study presents a significant contribution to understanding the ocular trauma associated with motorcycle accidents in Iraq, highlighting the prevalence of such injuries among young male riders. However, the research reveals gaps that warrant further investigation. The disproportionate representation of male patients could be indicative of cultural or behavioral patterns that influence motorcycle usage and risk exposure, suggesting a need for gender-specific safety interventions. Author response We agree with the reviewer the high prevalence of ocular injuries in males is attributed to couturier factors, such as males representing the majority of the drivers in our country, and which will lead to a higher proportion of males inflicted with ocular injuries. Reviewer Comments - 2/ Additionally, the study's focus on tertiary centers in urban areas may not capture the full spectrum of ocular injuries, particularly those treated in rural or non-hospital settings. Author response We chose the largest hospitals in the country since other locations have low presentation of such access. We agree with the reviewer that there is a strong need to examine ocular injury in non-tertiary hospitals and other health care facilities. However, this is beyond the scope of the current study. Reviewer Comments - 3/ The classification of injuries, while standardized, does not account for long-term outcomes or the socioeconomic impact on the patients. Future studies could benefit from a longitudinal approach, assessing the recovery trajectory and quality of life post-injury, as well as exploring preventive measures tailored to the local context. Moreover, integrating multidisciplinary perspectives, including ophthalmology, trauma surgery, and public health, could provide a more comprehensive understanding of the factors contributing to these injuries and the strategies needed to mitigate them. Author response We agree with the reviewer that this work should be the basis of further studies in this direction. Reviewer Comments - 4/ Statistical significance is missing in the results. Author response This is a descriptive study; there is no comparison between the different groups, so no statistical analysis applies to the current work. Best regards Dear Reviewer, Reviewer Comments - What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. The meticulous classification of injuries according to the International Ocular Trauma Classification has allowed for a detailed understanding of the types and severities of ocular trauma. The findings highlight the importance of protective gear and safety measures for motorcyclists, as the majority of injuries were to young males, indicating a demographic at high risk. The study's extensive data collection over four years offers a solid foundation for developing strategies to prevent such injuries and improve outcomes for those affected. It's a significant step towards enhancing road safety and healthcare protocols for ocular injuries in Iraq and potentially other regions with similar contexts. The study gap 1/ The study presents a significant contribution to understanding the ocular trauma associated with motorcycle accidents in Iraq, highlighting the prevalence of such injuries among young male riders. However, the research reveals gaps that warrant further investigation. The disproportionate representation of male patients could be indicative of cultural or behavioral patterns that influence motorcycle usage and risk exposure, suggesting a need for gender-specific safety interventions. Author response We agree with the reviewer the high prevalence of ocular injuries in males is attributed to couturier factors, such as males representing the majority of the drivers in our country, and which will lead to a higher proportion of males inflicted with ocular injuries. Reviewer Comments - 2/ Additionally, the study's focus on tertiary centers in urban areas may not capture the full spectrum of ocular injuries, particularly those treated in rural or non-hospital settings. Author response We chose the largest hospitals in the country since other locations have low presentation of such access. We agree with the reviewer that there is a strong need to examine ocular injury in non-tertiary hospitals and other health care facilities. However, this is beyond the scope of the current study. Reviewer Comments - 3/ The classification of injuries, while standardized, does not account for long-term outcomes or the socioeconomic impact on the patients. Future studies could benefit from a longitudinal approach, assessing the recovery trajectory and quality of life post-injury, as well as exploring preventive measures tailored to the local context. Moreover, integrating multidisciplinary perspectives, including ophthalmology, trauma surgery, and public health, could provide a more comprehensive understanding of the factors contributing to these injuries and the strategies needed to mitigate them. Author response We agree with the reviewer that this work should be the basis of further studies in this direction. Reviewer Comments - 4/ Statistical significance is missing in the results. Author response This is a descriptive study; there is no comparison between the different groups, so no statistical analysis applies to the current work. Best regards Competing Interests: None Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 23 Aug 2024 Hayder A Fawzi , Department of Pharmacy, Al-Mustafa ‎University ‎College, Baghdad, Iraq 23 Aug 2024 Author Response Dear Reviewer, Reviewer Comments - What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. ... Continue reading Dear Reviewer, Reviewer Comments - What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. The meticulous classification of injuries according to the International Ocular Trauma Classification has allowed for a detailed understanding of the types and severities of ocular trauma. The findings highlight the importance of protective gear and safety measures for motorcyclists, as the majority of injuries were to young males, indicating a demographic at high risk. The study's extensive data collection over four years offers a solid foundation for developing strategies to prevent such injuries and improve outcomes for those affected. It's a significant step towards enhancing road safety and healthcare protocols for ocular injuries in Iraq and potentially other regions with similar contexts. The study gap 1/ The study presents a significant contribution to understanding the ocular trauma associated with motorcycle accidents in Iraq, highlighting the prevalence of such injuries among young male riders. However, the research reveals gaps that warrant further investigation. The disproportionate representation of male patients could be indicative of cultural or behavioral patterns that influence motorcycle usage and risk exposure, suggesting a need for gender-specific safety interventions. Author response We agree with the reviewer the high prevalence of ocular injuries in males is attributed to couturier factors, such as males representing the majority of the drivers in our country, and which will lead to a higher proportion of males inflicted with ocular injuries. Reviewer Comments - 2/ Additionally, the study's focus on tertiary centers in urban areas may not capture the full spectrum of ocular injuries, particularly those treated in rural or non-hospital settings. Author response We chose the largest hospitals in the country since other locations have low presentation of such access. We agree with the reviewer that there is a strong need to examine ocular injury in non-tertiary hospitals and other health care facilities. However, this is beyond the scope of the current study. Reviewer Comments - 3/ The classification of injuries, while standardized, does not account for long-term outcomes or the socioeconomic impact on the patients. Future studies could benefit from a longitudinal approach, assessing the recovery trajectory and quality of life post-injury, as well as exploring preventive measures tailored to the local context. Moreover, integrating multidisciplinary perspectives, including ophthalmology, trauma surgery, and public health, could provide a more comprehensive understanding of the factors contributing to these injuries and the strategies needed to mitigate them. Author response We agree with the reviewer that this work should be the basis of further studies in this direction. Reviewer Comments - 4/ Statistical significance is missing in the results. Author response This is a descriptive study; there is no comparison between the different groups, so no statistical analysis applies to the current work. Best regards Dear Reviewer, Reviewer Comments - What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. The meticulous classification of injuries according to the International Ocular Trauma Classification has allowed for a detailed understanding of the types and severities of ocular trauma. The findings highlight the importance of protective gear and safety measures for motorcyclists, as the majority of injuries were to young males, indicating a demographic at high risk. The study's extensive data collection over four years offers a solid foundation for developing strategies to prevent such injuries and improve outcomes for those affected. It's a significant step towards enhancing road safety and healthcare protocols for ocular injuries in Iraq and potentially other regions with similar contexts. The study gap 1/ The study presents a significant contribution to understanding the ocular trauma associated with motorcycle accidents in Iraq, highlighting the prevalence of such injuries among young male riders. However, the research reveals gaps that warrant further investigation. The disproportionate representation of male patients could be indicative of cultural or behavioral patterns that influence motorcycle usage and risk exposure, suggesting a need for gender-specific safety interventions. Author response We agree with the reviewer the high prevalence of ocular injuries in males is attributed to couturier factors, such as males representing the majority of the drivers in our country, and which will lead to a higher proportion of males inflicted with ocular injuries. Reviewer Comments - 2/ Additionally, the study's focus on tertiary centers in urban areas may not capture the full spectrum of ocular injuries, particularly those treated in rural or non-hospital settings. Author response We chose the largest hospitals in the country since other locations have low presentation of such access. We agree with the reviewer that there is a strong need to examine ocular injury in non-tertiary hospitals and other health care facilities. However, this is beyond the scope of the current study. Reviewer Comments - 3/ The classification of injuries, while standardized, does not account for long-term outcomes or the socioeconomic impact on the patients. Future studies could benefit from a longitudinal approach, assessing the recovery trajectory and quality of life post-injury, as well as exploring preventive measures tailored to the local context. Moreover, integrating multidisciplinary perspectives, including ophthalmology, trauma surgery, and public health, could provide a more comprehensive understanding of the factors contributing to these injuries and the strategies needed to mitigate them. Author response We agree with the reviewer that this work should be the basis of further studies in this direction. Reviewer Comments - 4/ Statistical significance is missing in the results. Author response This is a descriptive study; there is no comparison between the different groups, so no statistical analysis applies to the current work. Best regards Competing Interests: None Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ogendi J. Reviewer Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.156471.r267248 ) The direct URL for this report is: https://f1000research.com/articles/13-183/v1#referee-response-267248 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 May 2024 Japheths Ogendi , Maseno University, Maseno, Kisumu County, Kenya Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.156471.r267248 I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs to be revised and additional information added to it to make it complete. For example, ... Continue reading READ ALL I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs to be revised and additional information added to it to make it complete. For example, the background of the study needs to be revised to improve on its readability. I have provided details in track changes which can be viewed in the file linked here . The Section on Methods needs to be reexamined. For example, the authors should make it clear to readers, who may not be familiar with the study settings, sufficient geographical to introduce the study sites. Many readers may not be familiar with Iraq or the teaching hospitals and forensic centers. Equally important is to add the reasons why the teaching hospitals and forensic centers were chosen. (I have included an example of a study that has shown how to do this in a reference indicated in track changes). It should also be made clear where exactly the study participants were gotten, were they Emergency Departments? The authors should consider revising the findings and present them according to conventions of reporting scientific findings. The findings reported in this study started presenting ages and sex. It would be important for the readers to know the denominator, the total number of participants then proceed to present the distribution different categories . The authors should strive to improve the discussion section by focusing the discussion on how the major findings of the study relates with other findings in previous studies. This has not been adequately achieved. The public health implication of the study findings and the implication of the findings to practice and policy should be addressed where possible. Consider also revising the study limitations and draw three or four from study design, settings or data collection instruments. The work is a good effort but it can still be improved. I have also taken an effort to be more clear by adding proposed suggestions in track changes. If this is required Ill provide it. I think it has captured lots of details as well. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Hashim Z, Mohammed‎ S, Abdulla M, Fawzi H: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq. F1000Research . 2024; 13 . Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: My areas of research are in Epidemiology with emphasis on Epidemiology of NCDs and road traffic injuries. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ogendi J. Reviewer Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.156471.r267248 ) The direct URL for this report is: https://f1000research.com/articles/13-183/v1#referee-response-267248 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 30 Aug 2024 Hayder A Fawzi , Department of Pharmacy, Al-Mustafa ‎University ‎College, Baghdad, Iraq 30 Aug 2024 Author Response Dear Reviewer, Reviewer Comments - I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs ... Continue reading Dear Reviewer, Reviewer Comments - I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs to be revised and additional information added to it to make it complete. For example, the background of the study needs to be revised to improve on its readability. I have provided details in track changes which can be viewed in the file linked Reviewer Notes from Tracked file - 1/ The reference needs to be counterchecked. The authors talk of the American Academy of Ophthalmology that has an annual occurrence of 2.5 million eye injuries. However, the references appear to be from other sources, not the academy. Kindly countercheck and update appropriately. Author response Reference 3 was counterchecked, and it was inappropriately placed; below is the correct reference: American Academy of Ophthalmology and American Society of Ocular Trauma, United States Eye Injury Registry summary report, 1998–2002. Available at: http://www​.aao.org/newsroom​/guide/upload​/Eye-Injuries-BkgrnderLongVersFinal-l​.pdf Reviewer Notes from Tracked file - 2/ Also consider revising the sentence. Do the authors mean , for example, or could consider this kind of wordings: “ According to the America Academy of Ophthalmology, a total of 2.5 million eye injuries are reported/occur in USA annually, with 50,000 individuals experiencing either partial or complete loss of vision” (American Academy of Ophthalmology Report, 20..) Author response We agree with the reviewer; the entire sentence lacks clarity; as such, we rephrase it to the following: According to the American Academy of Ophthalmology, 2.5 million eye injuries are reported/occur in the USA annually, with 50,000 individuals experiencing either partial or complete loss of vision. Reviewer Notes fromTracked file - 3/Regarding the number of previous studies on motorcycle accidents in Iraq, Author response This is the first study to examine motorcycle ocular injury in Iraq; as such, no previous study can be reported. We used estimated facts from developing countries to reflect the numbers. Reviewer Comments - 4/ The Section on Methods needs to be reexamined. For example, the authors should make it clear to readers, who may not be familiar with the study settings, sufficient geographical to introduce the study sites. Many readers may not be familiar with Iraq or the teaching hospitals and forensic centers. Equally important is to add the reasons why the teaching hospitals and forensic centers were chosen. (I have included an example of a study that has shown how to do this in a reference indicated in track changes). Author response We agree with the review suggestion; we included more details regarding the requested information as mentioned below: 2.1 Study design This study presented motorcycle accident injuries patients to the Emergency Department from June 1, 2019, to June 1, 2023. After admission, patients were screened to identify the motorcycle injuries that presented ocular trauma; for those identified to have ocular trauma, written consent was sought and obtained from the patients to participate in the study. Information was obtained from the injured patients, whether they were stable enough or from those who accompanied them for care. Written consent was obtained from the patients if they were over 18 years old or from their caregivers after providing an adequate explanation of the aims and methods of the study. Further information was gathered on the age, sex, laterality, type of ocular injury, ocular findings, lesion severity, and visual acuity. The information regarding ocular injuries was classified and recorded according to the International Ocular Trauma Classification 20 . Previous studies have used this classification and scoring method to classify ocular traumas according to visual acuity, pupillary light response, zone, and type of injury. 2.2 Study settings According to the World Health Organization (WHO), Iraq's healthcare system has 2,652 facilities, of which 61 are teaching hospitals. This study was conducted in two governorates (Baghdad, the Iraqi capital, and Al-Qadisiyah), a total of three teaching hospitals: Ibn Al-Haitham Teaching Hospital (in Baghdad), Al-Nauman Teaching Hospital‎ (in Baghdad), and Al-Diwaniyah Teaching Hospital (in Al-Diwaniyah), and the three forensic centers associated with these hospitals. Patients were interviewed initially in the emergency department; if the ocular trauma related to motorcycle injuries were confirmed, the patient would be transferred to the ophthalmology department when the patient was managed and interviewed for the study. Ibn Al-Haitham Teaching Hospital is Iraq's primary and largest ophthalmology hospital. This hospital only receives patients with ophthalmological conditions. It has a large inpatient capacity (200 beds) and many operating rooms (16 Operating Rooms) for various ophthalmic procedures. Al-Nauman Teaching Hospital is one of the largest teaching hospitals in Baghdad, and it contains various departments, including emergency and ophthalmology departments. Finally, Al-Diwaniyah Teaching Hospital is the largest teaching hospital in the Al-Diwaniyah governorate, with large emergency and ophthalmology departments. Reviewer Comments - 5/ It should also be made clear where exactly the study participants were gotten, were they Emergency Departments? The authors should consider revising the findings and present them according to conventions of reporting scientific findings. The findings reported in this study started presenting ages and sex. It would be important for the readers to know the denominator, the total number of participants then proceed to present the distribution different categories . Author response The answer to this question is provided in the previous question. Reviewer Comments - 6/ The authors should strive to improve the discussion section by focusing the discussion on how the major findings of the study relates with other findings in previous studies. This has not been adequately achieved. The public health implication of the study findings and the implication of the findings to practice and policy should be addressed where possible. Consider also revising the study limitations and draw three or four from study design, settings or data collection instruments. The work is a good effort but it can still be improved. Author response We improved both the results and the discussion accordingly. Abstract The study was conducted in three Teaching hospitals and forensic centers in Baghdad and Al-Qadisiyah in Iraq. Information regarding ocular injuries, recorded and classified according to the International Ocular Trauma Classification, was gathered from motorcycle crash injuries that were presented to the emergency departments of these facilities from June 1, 2019, to June 1, 2023. Results During the four years of the study, 6,243 patients presented with motorcycle injuries in the three Teaching hospitals and their forensic centers. Of those (5.37%), 335 patients were identified to have ocular trauma from the road crash. Table 1 presents the characteristics of motorcycle crash cases with ocular trauma. The ages of those with ocular trauma ranged from 10 to 67 years old, with a mean age of ‎27.84± 9.6‎ years. Most of them were 324 (96.7%) males, with a male-to-female ratio of 29 to 1, and there were only 11 females as passengers; 39 (11.6%) ‎had injuries in both eyes‎, as shown in Table 1. Regarding the type of eye lesions during their presentation, there were 60.9% of patients with lid laceration with or without sub-conjunctival hemorrhage, ‎‎22.1% with corneoscleral injury, 17.9% with commotio retinae, and it was the leading cause ‎of decreased visual acuity, 9% with lens capsule damage with or without iris prolapse, and 8.1% with ‎ruptured capsule, as shown in Table 2.‎ Reviewer Comments - 7/ I have also taken an effort to be more clear by adding proposed suggestions in track changes. If this is required Ill provide it. I think it has captured lots of details as well. Author response I appreciate your help; your notes and corrections improved the work, and we changed the article accordingly. Best regards Dear Reviewer, Reviewer Comments - I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs to be revised and additional information added to it to make it complete. For example, the background of the study needs to be revised to improve on its readability. I have provided details in track changes which can be viewed in the file linked Reviewer Notes from Tracked file - 1/ The reference needs to be counterchecked. The authors talk of the American Academy of Ophthalmology that has an annual occurrence of 2.5 million eye injuries. However, the references appear to be from other sources, not the academy. Kindly countercheck and update appropriately. Author response Reference 3 was counterchecked, and it was inappropriately placed; below is the correct reference: American Academy of Ophthalmology and American Society of Ocular Trauma, United States Eye Injury Registry summary report, 1998–2002. Available at: http://www​.aao.org/newsroom​/guide/upload​/Eye-Injuries-BkgrnderLongVersFinal-l​.pdf Reviewer Notes from Tracked file - 2/ Also consider revising the sentence. Do the authors mean , for example, or could consider this kind of wordings: “ According to the America Academy of Ophthalmology, a total of 2.5 million eye injuries are reported/occur in USA annually, with 50,000 individuals experiencing either partial or complete loss of vision” (American Academy of Ophthalmology Report, 20..) Author response We agree with the reviewer; the entire sentence lacks clarity; as such, we rephrase it to the following: According to the American Academy of Ophthalmology, 2.5 million eye injuries are reported/occur in the USA annually, with 50,000 individuals experiencing either partial or complete loss of vision. Reviewer Notes fromTracked file - 3/Regarding the number of previous studies on motorcycle accidents in Iraq, Author response This is the first study to examine motorcycle ocular injury in Iraq; as such, no previous study can be reported. We used estimated facts from developing countries to reflect the numbers. Reviewer Comments - 4/ The Section on Methods needs to be reexamined. For example, the authors should make it clear to readers, who may not be familiar with the study settings, sufficient geographical to introduce the study sites. Many readers may not be familiar with Iraq or the teaching hospitals and forensic centers. Equally important is to add the reasons why the teaching hospitals and forensic centers were chosen. (I have included an example of a study that has shown how to do this in a reference indicated in track changes). Author response We agree with the review suggestion; we included more details regarding the requested information as mentioned below: 2.1 Study design This study presented motorcycle accident injuries patients to the Emergency Department from June 1, 2019, to June 1, 2023. After admission, patients were screened to identify the motorcycle injuries that presented ocular trauma; for those identified to have ocular trauma, written consent was sought and obtained from the patients to participate in the study. Information was obtained from the injured patients, whether they were stable enough or from those who accompanied them for care. Written consent was obtained from the patients if they were over 18 years old or from their caregivers after providing an adequate explanation of the aims and methods of the study. Further information was gathered on the age, sex, laterality, type of ocular injury, ocular findings, lesion severity, and visual acuity. The information regarding ocular injuries was classified and recorded according to the International Ocular Trauma Classification 20 . Previous studies have used this classification and scoring method to classify ocular traumas according to visual acuity, pupillary light response, zone, and type of injury. 2.2 Study settings According to the World Health Organization (WHO), Iraq's healthcare system has 2,652 facilities, of which 61 are teaching hospitals. This study was conducted in two governorates (Baghdad, the Iraqi capital, and Al-Qadisiyah), a total of three teaching hospitals: Ibn Al-Haitham Teaching Hospital (in Baghdad), Al-Nauman Teaching Hospital‎ (in Baghdad), and Al-Diwaniyah Teaching Hospital (in Al-Diwaniyah), and the three forensic centers associated with these hospitals. Patients were interviewed initially in the emergency department; if the ocular trauma related to motorcycle injuries were confirmed, the patient would be transferred to the ophthalmology department when the patient was managed and interviewed for the study. Ibn Al-Haitham Teaching Hospital is Iraq's primary and largest ophthalmology hospital. This hospital only receives patients with ophthalmological conditions. It has a large inpatient capacity (200 beds) and many operating rooms (16 Operating Rooms) for various ophthalmic procedures. Al-Nauman Teaching Hospital is one of the largest teaching hospitals in Baghdad, and it contains various departments, including emergency and ophthalmology departments. Finally, Al-Diwaniyah Teaching Hospital is the largest teaching hospital in the Al-Diwaniyah governorate, with large emergency and ophthalmology departments. Reviewer Comments - 5/ It should also be made clear where exactly the study participants were gotten, were they Emergency Departments? The authors should consider revising the findings and present them according to conventions of reporting scientific findings. The findings reported in this study started presenting ages and sex. It would be important for the readers to know the denominator, the total number of participants then proceed to present the distribution different categories . Author response The answer to this question is provided in the previous question. Reviewer Comments - 6/ The authors should strive to improve the discussion section by focusing the discussion on how the major findings of the study relates with other findings in previous studies. This has not been adequately achieved. The public health implication of the study findings and the implication of the findings to practice and policy should be addressed where possible. Consider also revising the study limitations and draw three or four from study design, settings or data collection instruments. The work is a good effort but it can still be improved. Author response We improved both the results and the discussion accordingly. Abstract The study was conducted in three Teaching hospitals and forensic centers in Baghdad and Al-Qadisiyah in Iraq. Information regarding ocular injuries, recorded and classified according to the International Ocular Trauma Classification, was gathered from motorcycle crash injuries that were presented to the emergency departments of these facilities from June 1, 2019, to June 1, 2023. Results During the four years of the study, 6,243 patients presented with motorcycle injuries in the three Teaching hospitals and their forensic centers. Of those (5.37%), 335 patients were identified to have ocular trauma from the road crash. Table 1 presents the characteristics of motorcycle crash cases with ocular trauma. The ages of those with ocular trauma ranged from 10 to 67 years old, with a mean age of ‎27.84± 9.6‎ years. Most of them were 324 (96.7%) males, with a male-to-female ratio of 29 to 1, and there were only 11 females as passengers; 39 (11.6%) ‎had injuries in both eyes‎, as shown in Table 1. Regarding the type of eye lesions during their presentation, there were 60.9% of patients with lid laceration with or without sub-conjunctival hemorrhage, ‎‎22.1% with corneoscleral injury, 17.9% with commotio retinae, and it was the leading cause ‎of decreased visual acuity, 9% with lens capsule damage with or without iris prolapse, and 8.1% with ‎ruptured capsule, as shown in Table 2.‎ Reviewer Comments - 7/ I have also taken an effort to be more clear by adding proposed suggestions in track changes. If this is required Ill provide it. I think it has captured lots of details as well. Author response I appreciate your help; your notes and corrections improved the work, and we changed the article accordingly. Best regards Competing Interests: None Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 30 Aug 2024 Hayder A Fawzi , Department of Pharmacy, Al-Mustafa ‎University ‎College, Baghdad, Iraq 30 Aug 2024 Author Response Dear Reviewer, Reviewer Comments - I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs ... Continue reading Dear Reviewer, Reviewer Comments - I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs to be revised and additional information added to it to make it complete. For example, the background of the study needs to be revised to improve on its readability. I have provided details in track changes which can be viewed in the file linked Reviewer Notes from Tracked file - 1/ The reference needs to be counterchecked. The authors talk of the American Academy of Ophthalmology that has an annual occurrence of 2.5 million eye injuries. However, the references appear to be from other sources, not the academy. Kindly countercheck and update appropriately. Author response Reference 3 was counterchecked, and it was inappropriately placed; below is the correct reference: American Academy of Ophthalmology and American Society of Ocular Trauma, United States Eye Injury Registry summary report, 1998–2002. Available at: http://www​.aao.org/newsroom​/guide/upload​/Eye-Injuries-BkgrnderLongVersFinal-l​.pdf Reviewer Notes from Tracked file - 2/ Also consider revising the sentence. Do the authors mean , for example, or could consider this kind of wordings: “ According to the America Academy of Ophthalmology, a total of 2.5 million eye injuries are reported/occur in USA annually, with 50,000 individuals experiencing either partial or complete loss of vision” (American Academy of Ophthalmology Report, 20..) Author response We agree with the reviewer; the entire sentence lacks clarity; as such, we rephrase it to the following: According to the American Academy of Ophthalmology, 2.5 million eye injuries are reported/occur in the USA annually, with 50,000 individuals experiencing either partial or complete loss of vision. Reviewer Notes fromTracked file - 3/Regarding the number of previous studies on motorcycle accidents in Iraq, Author response This is the first study to examine motorcycle ocular injury in Iraq; as such, no previous study can be reported. We used estimated facts from developing countries to reflect the numbers. Reviewer Comments - 4/ The Section on Methods needs to be reexamined. For example, the authors should make it clear to readers, who may not be familiar with the study settings, sufficient geographical to introduce the study sites. Many readers may not be familiar with Iraq or the teaching hospitals and forensic centers. Equally important is to add the reasons why the teaching hospitals and forensic centers were chosen. (I have included an example of a study that has shown how to do this in a reference indicated in track changes). Author response We agree with the review suggestion; we included more details regarding the requested information as mentioned below: 2.1 Study design This study presented motorcycle accident injuries patients to the Emergency Department from June 1, 2019, to June 1, 2023. After admission, patients were screened to identify the motorcycle injuries that presented ocular trauma; for those identified to have ocular trauma, written consent was sought and obtained from the patients to participate in the study. Information was obtained from the injured patients, whether they were stable enough or from those who accompanied them for care. Written consent was obtained from the patients if they were over 18 years old or from their caregivers after providing an adequate explanation of the aims and methods of the study. Further information was gathered on the age, sex, laterality, type of ocular injury, ocular findings, lesion severity, and visual acuity. The information regarding ocular injuries was classified and recorded according to the International Ocular Trauma Classification 20 . Previous studies have used this classification and scoring method to classify ocular traumas according to visual acuity, pupillary light response, zone, and type of injury. 2.2 Study settings According to the World Health Organization (WHO), Iraq's healthcare system has 2,652 facilities, of which 61 are teaching hospitals. This study was conducted in two governorates (Baghdad, the Iraqi capital, and Al-Qadisiyah), a total of three teaching hospitals: Ibn Al-Haitham Teaching Hospital (in Baghdad), Al-Nauman Teaching Hospital‎ (in Baghdad), and Al-Diwaniyah Teaching Hospital (in Al-Diwaniyah), and the three forensic centers associated with these hospitals. Patients were interviewed initially in the emergency department; if the ocular trauma related to motorcycle injuries were confirmed, the patient would be transferred to the ophthalmology department when the patient was managed and interviewed for the study. Ibn Al-Haitham Teaching Hospital is Iraq's primary and largest ophthalmology hospital. This hospital only receives patients with ophthalmological conditions. It has a large inpatient capacity (200 beds) and many operating rooms (16 Operating Rooms) for various ophthalmic procedures. Al-Nauman Teaching Hospital is one of the largest teaching hospitals in Baghdad, and it contains various departments, including emergency and ophthalmology departments. Finally, Al-Diwaniyah Teaching Hospital is the largest teaching hospital in the Al-Diwaniyah governorate, with large emergency and ophthalmology departments. Reviewer Comments - 5/ It should also be made clear where exactly the study participants were gotten, were they Emergency Departments? The authors should consider revising the findings and present them according to conventions of reporting scientific findings. The findings reported in this study started presenting ages and sex. It would be important for the readers to know the denominator, the total number of participants then proceed to present the distribution different categories . Author response The answer to this question is provided in the previous question. Reviewer Comments - 6/ The authors should strive to improve the discussion section by focusing the discussion on how the major findings of the study relates with other findings in previous studies. This has not been adequately achieved. The public health implication of the study findings and the implication of the findings to practice and policy should be addressed where possible. Consider also revising the study limitations and draw three or four from study design, settings or data collection instruments. The work is a good effort but it can still be improved. Author response We improved both the results and the discussion accordingly. Abstract The study was conducted in three Teaching hospitals and forensic centers in Baghdad and Al-Qadisiyah in Iraq. Information regarding ocular injuries, recorded and classified according to the International Ocular Trauma Classification, was gathered from motorcycle crash injuries that were presented to the emergency departments of these facilities from June 1, 2019, to June 1, 2023. Results During the four years of the study, 6,243 patients presented with motorcycle injuries in the three Teaching hospitals and their forensic centers. Of those (5.37%), 335 patients were identified to have ocular trauma from the road crash. Table 1 presents the characteristics of motorcycle crash cases with ocular trauma. The ages of those with ocular trauma ranged from 10 to 67 years old, with a mean age of ‎27.84± 9.6‎ years. Most of them were 324 (96.7%) males, with a male-to-female ratio of 29 to 1, and there were only 11 females as passengers; 39 (11.6%) ‎had injuries in both eyes‎, as shown in Table 1. Regarding the type of eye lesions during their presentation, there were 60.9% of patients with lid laceration with or without sub-conjunctival hemorrhage, ‎‎22.1% with corneoscleral injury, 17.9% with commotio retinae, and it was the leading cause ‎of decreased visual acuity, 9% with lens capsule damage with or without iris prolapse, and 8.1% with ‎ruptured capsule, as shown in Table 2.‎ Reviewer Comments - 7/ I have also taken an effort to be more clear by adding proposed suggestions in track changes. If this is required Ill provide it. I think it has captured lots of details as well. Author response I appreciate your help; your notes and corrections improved the work, and we changed the article accordingly. Best regards Dear Reviewer, Reviewer Comments - I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs to be revised and additional information added to it to make it complete. For example, the background of the study needs to be revised to improve on its readability. I have provided details in track changes which can be viewed in the file linked Reviewer Notes from Tracked file - 1/ The reference needs to be counterchecked. The authors talk of the American Academy of Ophthalmology that has an annual occurrence of 2.5 million eye injuries. However, the references appear to be from other sources, not the academy. Kindly countercheck and update appropriately. Author response Reference 3 was counterchecked, and it was inappropriately placed; below is the correct reference: American Academy of Ophthalmology and American Society of Ocular Trauma, United States Eye Injury Registry summary report, 1998–2002. Available at: http://www​.aao.org/newsroom​/guide/upload​/Eye-Injuries-BkgrnderLongVersFinal-l​.pdf Reviewer Notes from Tracked file - 2/ Also consider revising the sentence. Do the authors mean , for example, or could consider this kind of wordings: “ According to the America Academy of Ophthalmology, a total of 2.5 million eye injuries are reported/occur in USA annually, with 50,000 individuals experiencing either partial or complete loss of vision” (American Academy of Ophthalmology Report, 20..) Author response We agree with the reviewer; the entire sentence lacks clarity; as such, we rephrase it to the following: According to the American Academy of Ophthalmology, 2.5 million eye injuries are reported/occur in the USA annually, with 50,000 individuals experiencing either partial or complete loss of vision. Reviewer Notes fromTracked file - 3/Regarding the number of previous studies on motorcycle accidents in Iraq, Author response This is the first study to examine motorcycle ocular injury in Iraq; as such, no previous study can be reported. We used estimated facts from developing countries to reflect the numbers. Reviewer Comments - 4/ The Section on Methods needs to be reexamined. For example, the authors should make it clear to readers, who may not be familiar with the study settings, sufficient geographical to introduce the study sites. Many readers may not be familiar with Iraq or the teaching hospitals and forensic centers. Equally important is to add the reasons why the teaching hospitals and forensic centers were chosen. (I have included an example of a study that has shown how to do this in a reference indicated in track changes). Author response We agree with the review suggestion; we included more details regarding the requested information as mentioned below: 2.1 Study design This study presented motorcycle accident injuries patients to the Emergency Department from June 1, 2019, to June 1, 2023. After admission, patients were screened to identify the motorcycle injuries that presented ocular trauma; for those identified to have ocular trauma, written consent was sought and obtained from the patients to participate in the study. Information was obtained from the injured patients, whether they were stable enough or from those who accompanied them for care. Written consent was obtained from the patients if they were over 18 years old or from their caregivers after providing an adequate explanation of the aims and methods of the study. Further information was gathered on the age, sex, laterality, type of ocular injury, ocular findings, lesion severity, and visual acuity. The information regarding ocular injuries was classified and recorded according to the International Ocular Trauma Classification 20 . Previous studies have used this classification and scoring method to classify ocular traumas according to visual acuity, pupillary light response, zone, and type of injury. 2.2 Study settings According to the World Health Organization (WHO), Iraq's healthcare system has 2,652 facilities, of which 61 are teaching hospitals. This study was conducted in two governorates (Baghdad, the Iraqi capital, and Al-Qadisiyah), a total of three teaching hospitals: Ibn Al-Haitham Teaching Hospital (in Baghdad), Al-Nauman Teaching Hospital‎ (in Baghdad), and Al-Diwaniyah Teaching Hospital (in Al-Diwaniyah), and the three forensic centers associated with these hospitals. Patients were interviewed initially in the emergency department; if the ocular trauma related to motorcycle injuries were confirmed, the patient would be transferred to the ophthalmology department when the patient was managed and interviewed for the study. Ibn Al-Haitham Teaching Hospital is Iraq's primary and largest ophthalmology hospital. This hospital only receives patients with ophthalmological conditions. It has a large inpatient capacity (200 beds) and many operating rooms (16 Operating Rooms) for various ophthalmic procedures. Al-Nauman Teaching Hospital is one of the largest teaching hospitals in Baghdad, and it contains various departments, including emergency and ophthalmology departments. Finally, Al-Diwaniyah Teaching Hospital is the largest teaching hospital in the Al-Diwaniyah governorate, with large emergency and ophthalmology departments. Reviewer Comments - 5/ It should also be made clear where exactly the study participants were gotten, were they Emergency Departments? The authors should consider revising the findings and present them according to conventions of reporting scientific findings. The findings reported in this study started presenting ages and sex. It would be important for the readers to know the denominator, the total number of participants then proceed to present the distribution different categories . Author response The answer to this question is provided in the previous question. Reviewer Comments - 6/ The authors should strive to improve the discussion section by focusing the discussion on how the major findings of the study relates with other findings in previous studies. This has not been adequately achieved. The public health implication of the study findings and the implication of the findings to practice and policy should be addressed where possible. Consider also revising the study limitations and draw three or four from study design, settings or data collection instruments. The work is a good effort but it can still be improved. Author response We improved both the results and the discussion accordingly. Abstract The study was conducted in three Teaching hospitals and forensic centers in Baghdad and Al-Qadisiyah in Iraq. Information regarding ocular injuries, recorded and classified according to the International Ocular Trauma Classification, was gathered from motorcycle crash injuries that were presented to the emergency departments of these facilities from June 1, 2019, to June 1, 2023. Results During the four years of the study, 6,243 patients presented with motorcycle injuries in the three Teaching hospitals and their forensic centers. Of those (5.37%), 335 patients were identified to have ocular trauma from the road crash. Table 1 presents the characteristics of motorcycle crash cases with ocular trauma. The ages of those with ocular trauma ranged from 10 to 67 years old, with a mean age of ‎27.84± 9.6‎ years. Most of them were 324 (96.7%) males, with a male-to-female ratio of 29 to 1, and there were only 11 females as passengers; 39 (11.6%) ‎had injuries in both eyes‎, as shown in Table 1. Regarding the type of eye lesions during their presentation, there were 60.9% of patients with lid laceration with or without sub-conjunctival hemorrhage, ‎‎22.1% with corneoscleral injury, 17.9% with commotio retinae, and it was the leading cause ‎of decreased visual acuity, 9% with lens capsule damage with or without iris prolapse, and 8.1% with ‎ruptured capsule, as shown in Table 2.‎ Reviewer Comments - 7/ I have also taken an effort to be more clear by adding proposed suggestions in track changes. If this is required Ill provide it. I think it has captured lots of details as well. Author response I appreciate your help; your notes and corrections improved the work, and we changed the article accordingly. Best regards Competing Interests: None Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 11 Mar 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 30 Aug 24 read read Version 1 11 Mar 24 read read Japheths Ogendi , Maseno University, Maseno, Kenya Debapriya Mukhopadhyay , Debapriya Mukhopadhyay Vision Research Institute, Kolkata, India Najah Mohammad , University of Baghdad, Baghdad, Iraq Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Mohammad N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Apr 2025 | for Version 2 Najah Mohammad , University of Baghdad, Baghdad, Iraq 0 Views copyright © 2025 Mohammad N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This article deals with the important subject of ocular injury by motorcycles; no previous study estimates the impact of these accidents in Iraq. Additionally, this study reports initial estimates regarding the type of injuries. Since it was carried out in multiple centers, this will provide a broader picture of the current problem in multiple centers. I have several minor questions: 1/ Please calculate the 95% confidence interval of the overall prevalence of ocular injuries. 2/ Why did you choose this particle type of equation to calculate the sample size, and what is the power of detection? 3/ To better present your data, I recommend adding Figures, not just tables, as part of your results. 4/ Please emphasize the study recommendations (Future perspective). Best regards Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Ophthalmology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Mohammad N. Peer Review Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.170553.r373593) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-183/v2#referee-response-373593 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Mukhopadhyay D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Sep 2024 | for Version 2 Debapriya Mukhopadhyay , Debapriya Mukhopadhyay Vision Research Institute, Kolkata, India 0 Views copyright © 2024 Mukhopadhyay D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The study is now a good read, Informative & comprehensive. Competing Interests No competing interests were disclosed. Reviewer Expertise Public Health, Healthcare Strategy, Healthcare Administration, Community Eye Health, Diabetes, Medical imaging, Ophthalmology, Optometry, Medical Investigations & research, Cell biology research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Mukhopadhyay D. Peer Review Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.170553.r319026) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-183/v2#referee-response-319026 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Mukhopadhyay D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Jul 2024 | for Version 1 Debapriya Mukhopadhyay , Debapriya Mukhopadhyay Vision Research Institute, Kolkata, India 0 Views copyright © 2024 Mukhopadhyay D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. The meticulous classification of injuries according to the International Ocular Trauma Classification has allowed for a detailed understanding of the types and severities of ocular trauma. The findings highlight the importance of protective gear and safety measures for motorcyclists, as the majority of injuries were to young males, indicating a demographic at high risk. The study's extensive data collection over four years offers a solid foundation for developing strategies to prevent such injuries and improve outcomes for those affected. It's a significant step towards enhancing road safety and healthcare protocols for ocular injuries in Iraq and potentially other regions with similar contexts. The study gap The study presents a significant contribution to understanding the ocular trauma associated with motorcycle accidents in Iraq, highlighting the prevalence of such injuries among young male riders. However, the research reveals gaps that warrant further investigation. The disproportionate representation of male patients could be indicative of cultural or behavioral patterns that influence motorcycle usage and risk exposure, suggesting a need for gender-specific safety interventions. Additionally, the study's focus on tertiary centers in urban areas may not capture the full spectrum of ocular injuries, particularly those treated in rural or non-hospital settings. The classification of injuries, while standardized, does not account for long-term outcomes or the socioeconomic impact on the patients. Future studies could benefit from a longitudinal approach, assessing the recovery trajectory and quality of life post-injury, as well as exploring preventive measures tailored to the local context. Moreover, integrating multidisciplinary perspectives, including ophthalmology, trauma surgery, and public health, could provide a more comprehensive understanding of the factors contributing to these injuries and the strategies needed to mitigate them. Statistical significance is missing in the results. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Public Health, Healthcare Strategy, Healthcare Administration, Community Eye Health, Diabetes, Medical imaging, Ophthalmology, Optometry, Medical Investigations & research, Cell biology research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 23 Aug 2024 Hayder A Fawzi, Department of Pharmacy, Al-Mustafa ‎University ‎College, Baghdad, Iraq Dear Reviewer, Reviewer Comments - What went well? The comprehensive study conducted across multiple centres in Iraq provides valuable insights into the ocular injuries resulting from motorcycle accidents. The meticulous classification of injuries according to the International Ocular Trauma Classification has allowed for a detailed understanding of the types and severities of ocular trauma. The findings highlight the importance of protective gear and safety measures for motorcyclists, as the majority of injuries were to young males, indicating a demographic at high risk. The study's extensive data collection over four years offers a solid foundation for developing strategies to prevent such injuries and improve outcomes for those affected. It's a significant step towards enhancing road safety and healthcare protocols for ocular injuries in Iraq and potentially other regions with similar contexts. The study gap 1/ The study presents a significant contribution to understanding the ocular trauma associated with motorcycle accidents in Iraq, highlighting the prevalence of such injuries among young male riders. However, the research reveals gaps that warrant further investigation. The disproportionate representation of male patients could be indicative of cultural or behavioral patterns that influence motorcycle usage and risk exposure, suggesting a need for gender-specific safety interventions. Author response We agree with the reviewer the high prevalence of ocular injuries in males is attributed to couturier factors, such as males representing the majority of the drivers in our country, and which will lead to a higher proportion of males inflicted with ocular injuries. Reviewer Comments - 2/ Additionally, the study's focus on tertiary centers in urban areas may not capture the full spectrum of ocular injuries, particularly those treated in rural or non-hospital settings. Author response We chose the largest hospitals in the country since other locations have low presentation of such access. We agree with the reviewer that there is a strong need to examine ocular injury in non-tertiary hospitals and other health care facilities. However, this is beyond the scope of the current study. Reviewer Comments - 3/ The classification of injuries, while standardized, does not account for long-term outcomes or the socioeconomic impact on the patients. Future studies could benefit from a longitudinal approach, assessing the recovery trajectory and quality of life post-injury, as well as exploring preventive measures tailored to the local context. Moreover, integrating multidisciplinary perspectives, including ophthalmology, trauma surgery, and public health, could provide a more comprehensive understanding of the factors contributing to these injuries and the strategies needed to mitigate them. Author response We agree with the reviewer that this work should be the basis of further studies in this direction. Reviewer Comments - 4/ Statistical significance is missing in the results. Author response This is a descriptive study; there is no comparison between the different groups, so no statistical analysis applies to the current work. Best regards View more View less Competing Interests None reply Respond Report a concern Mukhopadhyay D. Peer Review Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.156471.r303232) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-183/v1#referee-response-303232 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Ogendi J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 May 2024 | for Version 1 Japheths Ogendi , Maseno University, Maseno, Kisumu County, Kenya 0 Views copyright © 2024 Ogendi J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs to be revised and additional information added to it to make it complete. For example, the background of the study needs to be revised to improve on its readability. I have provided details in track changes which can be viewed in the file linked here . The Section on Methods needs to be reexamined. For example, the authors should make it clear to readers, who may not be familiar with the study settings, sufficient geographical to introduce the study sites. Many readers may not be familiar with Iraq or the teaching hospitals and forensic centers. Equally important is to add the reasons why the teaching hospitals and forensic centers were chosen. (I have included an example of a study that has shown how to do this in a reference indicated in track changes). It should also be made clear where exactly the study participants were gotten, were they Emergency Departments? The authors should consider revising the findings and present them according to conventions of reporting scientific findings. The findings reported in this study started presenting ages and sex. It would be important for the readers to know the denominator, the total number of participants then proceed to present the distribution different categories . The authors should strive to improve the discussion section by focusing the discussion on how the major findings of the study relates with other findings in previous studies. This has not been adequately achieved. The public health implication of the study findings and the implication of the findings to practice and policy should be addressed where possible. Consider also revising the study limitations and draw three or four from study design, settings or data collection instruments. The work is a good effort but it can still be improved. I have also taken an effort to be more clear by adding proposed suggestions in track changes. If this is required Ill provide it. I think it has captured lots of details as well. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Hashim Z, Mohammed‎ S, Abdulla M, Fawzi H: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq. F1000Research . 2024; 13 . Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise My areas of research are in Epidemiology with emphasis on Epidemiology of NCDs and road traffic injuries. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 30 Aug 2024 Hayder A Fawzi, Department of Pharmacy, Al-Mustafa ‎University ‎College, Baghdad, Iraq Dear Reviewer, Reviewer Comments - I have gone through the work. This is an important study that touches on a major public health concern, ocular injuries. However, the study needs to be revised and additional information added to it to make it complete. For example, the background of the study needs to be revised to improve on its readability. I have provided details in track changes which can be viewed in the file linked Reviewer Notes from Tracked file - 1/ The reference needs to be counterchecked. The authors talk of the American Academy of Ophthalmology that has an annual occurrence of 2.5 million eye injuries. However, the references appear to be from other sources, not the academy. Kindly countercheck and update appropriately. Author response Reference 3 was counterchecked, and it was inappropriately placed; below is the correct reference: American Academy of Ophthalmology and American Society of Ocular Trauma, United States Eye Injury Registry summary report, 1998–2002. Available at: http://www​.aao.org/newsroom​/guide/upload​/Eye-Injuries-BkgrnderLongVersFinal-l​.pdf Reviewer Notes from Tracked file - 2/ Also consider revising the sentence. Do the authors mean , for example, or could consider this kind of wordings: “ According to the America Academy of Ophthalmology, a total of 2.5 million eye injuries are reported/occur in USA annually, with 50,000 individuals experiencing either partial or complete loss of vision” (American Academy of Ophthalmology Report, 20..) Author response We agree with the reviewer; the entire sentence lacks clarity; as such, we rephrase it to the following: According to the American Academy of Ophthalmology, 2.5 million eye injuries are reported/occur in the USA annually, with 50,000 individuals experiencing either partial or complete loss of vision. Reviewer Notes fromTracked file - 3/Regarding the number of previous studies on motorcycle accidents in Iraq, Author response This is the first study to examine motorcycle ocular injury in Iraq; as such, no previous study can be reported. We used estimated facts from developing countries to reflect the numbers. Reviewer Comments - 4/ The Section on Methods needs to be reexamined. For example, the authors should make it clear to readers, who may not be familiar with the study settings, sufficient geographical to introduce the study sites. Many readers may not be familiar with Iraq or the teaching hospitals and forensic centers. Equally important is to add the reasons why the teaching hospitals and forensic centers were chosen. (I have included an example of a study that has shown how to do this in a reference indicated in track changes). Author response We agree with the review suggestion; we included more details regarding the requested information as mentioned below: 2.1 Study design This study presented motorcycle accident injuries patients to the Emergency Department from June 1, 2019, to June 1, 2023. After admission, patients were screened to identify the motorcycle injuries that presented ocular trauma; for those identified to have ocular trauma, written consent was sought and obtained from the patients to participate in the study. Information was obtained from the injured patients, whether they were stable enough or from those who accompanied them for care. Written consent was obtained from the patients if they were over 18 years old or from their caregivers after providing an adequate explanation of the aims and methods of the study. Further information was gathered on the age, sex, laterality, type of ocular injury, ocular findings, lesion severity, and visual acuity. The information regarding ocular injuries was classified and recorded according to the International Ocular Trauma Classification 20 . Previous studies have used this classification and scoring method to classify ocular traumas according to visual acuity, pupillary light response, zone, and type of injury. 2.2 Study settings According to the World Health Organization (WHO), Iraq's healthcare system has 2,652 facilities, of which 61 are teaching hospitals. This study was conducted in two governorates (Baghdad, the Iraqi capital, and Al-Qadisiyah), a total of three teaching hospitals: Ibn Al-Haitham Teaching Hospital (in Baghdad), Al-Nauman Teaching Hospital‎ (in Baghdad), and Al-Diwaniyah Teaching Hospital (in Al-Diwaniyah), and the three forensic centers associated with these hospitals. Patients were interviewed initially in the emergency department; if the ocular trauma related to motorcycle injuries were confirmed, the patient would be transferred to the ophthalmology department when the patient was managed and interviewed for the study. Ibn Al-Haitham Teaching Hospital is Iraq's primary and largest ophthalmology hospital. This hospital only receives patients with ophthalmological conditions. It has a large inpatient capacity (200 beds) and many operating rooms (16 Operating Rooms) for various ophthalmic procedures. Al-Nauman Teaching Hospital is one of the largest teaching hospitals in Baghdad, and it contains various departments, including emergency and ophthalmology departments. Finally, Al-Diwaniyah Teaching Hospital is the largest teaching hospital in the Al-Diwaniyah governorate, with large emergency and ophthalmology departments. Reviewer Comments - 5/ It should also be made clear where exactly the study participants were gotten, were they Emergency Departments? The authors should consider revising the findings and present them according to conventions of reporting scientific findings. The findings reported in this study started presenting ages and sex. It would be important for the readers to know the denominator, the total number of participants then proceed to present the distribution different categories . Author response The answer to this question is provided in the previous question. Reviewer Comments - 6/ The authors should strive to improve the discussion section by focusing the discussion on how the major findings of the study relates with other findings in previous studies. This has not been adequately achieved. The public health implication of the study findings and the implication of the findings to practice and policy should be addressed where possible. Consider also revising the study limitations and draw three or four from study design, settings or data collection instruments. The work is a good effort but it can still be improved. Author response We improved both the results and the discussion accordingly. Abstract The study was conducted in three Teaching hospitals and forensic centers in Baghdad and Al-Qadisiyah in Iraq. Information regarding ocular injuries, recorded and classified according to the International Ocular Trauma Classification, was gathered from motorcycle crash injuries that were presented to the emergency departments of these facilities from June 1, 2019, to June 1, 2023. Results During the four years of the study, 6,243 patients presented with motorcycle injuries in the three Teaching hospitals and their forensic centers. Of those (5.37%), 335 patients were identified to have ocular trauma from the road crash. Table 1 presents the characteristics of motorcycle crash cases with ocular trauma. The ages of those with ocular trauma ranged from 10 to 67 years old, with a mean age of ‎27.84± 9.6‎ years. Most of them were 324 (96.7%) males, with a male-to-female ratio of 29 to 1, and there were only 11 females as passengers; 39 (11.6%) ‎had injuries in both eyes‎, as shown in Table 1. Regarding the type of eye lesions during their presentation, there were 60.9% of patients with lid laceration with or without sub-conjunctival hemorrhage, ‎‎22.1% with corneoscleral injury, 17.9% with commotio retinae, and it was the leading cause ‎of decreased visual acuity, 9% with lens capsule damage with or without iris prolapse, and 8.1% with ‎ruptured capsule, as shown in Table 2.‎ Reviewer Comments - 7/ I have also taken an effort to be more clear by adding proposed suggestions in track changes. If this is required Ill provide it. I think it has captured lots of details as well. Author response I appreciate your help; your notes and corrections improved the work, and we changed the article accordingly. Best regards View more View less Competing Interests None reply Respond Report a concern Ogendi J. Peer Review Report For: Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2024, 13 :183 ( https://doi.org/10.5256/f1000research.156471.r267248) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-183/v1#referee-response-267248 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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