| in the entire research process, the thesis completed research work mainly includes the combination of clinical ophthalmology and forensic medicine, the current situation of the ocular trauma in judicial appraisal of our country, medical examination technology application and relevant evaluation standard are studied, this paper discusses the various medical examination technology application in the field of forensic medicine value, corresponding to the damage degree for ocular trauma and disability identification analysis demonstrates the technical standards, it is concluded that the improvement parts identification standard, result, and put forward specific Suggestions.Ocular trauma factors influencing the quality of judicial authentication in China are analyzed and discussed. At present, the ocular trauma in judicial authentication check overall quality is low, the subjective factors of the judicial appraiser, the authentication institutions and judicial administrative department of the objective factors. Judicial authentication is the surveyor based on the objective facts of logical reasoning and judgment, and the appraiser’s own professional accomplishment, knowledge, skills, individual cognition and individual psychological factors related, so the judicial appraisal is scientific empirical activities but of subjectivity, appraiser’s subjective factors have a direct influence on the formation of the appraisal conclusion, the influence factors include identification methods, the expert of the selected medical inspection equipment and personal knowledge and experience will lead to the formation of different expert opinion. At present, the judicial appraiser engaged in ocular trauma appraisement relying too heavily on forensic identification of the medical institution for information. There are reasons for this are that due to the particularity of ophthalmology and professional, expert witnesses without relevant professional training, lack of ophthalmic medical professional knowledge and skills in ocular traumatic identification technology canot dominate position, is usually a passive acceptance of clinical data and information, to analyze evaluation appraisal as the basis. As the judicial appraiser’s practice activities, the judicial authentication institutions existing objective factors also not allow to ignore. Comparison of living in other parts of the human body forensic medical appraisal, appraisal of ocular trauma more medical examination instruments and equipment to obtain evidence of eye injury, eye face ministry in the human body, through some professional inspection equipment for damage eyeball organization direct observation, all kinds of medical examination technology play an irreplaceable role in identification of ocular trauma. Currently engaged in ocular trauma in forensic medicine inspection appraisal agencies generally lack of instruments and equipment configuration and the establishment of relevant laboratory, in his subjective factors under the common effect of objective factors and the judicial authentication institutions, ocular trauma judicial authentication test case not high quality to carry out the situation for a long time.In ocular trauma judicial authentication, medical inspection technology in an important position in the ocular trauma test case. Various types of medical examination equipment applied in ophthalmology, but not all suitable for forensic identification of personal injury. In this paper, from the perspective of application of forensic practice, discusses ocular trauma related inspection technology, the value of forensic medical examination technology the eye. In the different methods of visual acuity, ordinary box logarithmic eye chart that simple operation, low price, are widely used in ophthalmic outpatient and ward to patient assessment of visual acuity, but this method visual acuity is mainly rely on inspectors to cooperate, in the forensic test case it can’t alone as the basis of evaluating visual impairment. Eye chart projector can be automatic, fast and accurately reflects all kinds of standard and individual standard, for the identification of pseudo blind and pseudo low vision has application value. Computer and check refractometer shadow belongs to objective visual acuity test optometry, do not need to be inspectors identified as standard for visual acuity. But what computer optometry instrument for measuring ball lens refractive value is high, vision inspection result is not accurate, after cycloplegia computer optometry can improve the accuracy of the vision value. Screening shadow optometry is a method of objective visual acuity is mainly rely on inspectors check shadow optometry technology, inspectors by emission mirror reflection checked into the light reflected light movements within the eye pupil, shape, speed and intensity, the refractive status of inspection for inspection, the visual value is more objective and accurate. But the inspectors have higher technical requirements, applied in ocular trauma judicial authentication is limited by the lack of professional talents of shadow optometry. Visual electrophysiological examination can provide objective evidence of optic nerve and retinal damage, is to identify fake blind and pseudo low vision recognized objective examination means, in the actual test case, expert witnesses and even will be some visual electrophysiological examination as absolute basis for the visually impaired. In this paper, this kind of influence factors of medical examination technology, this paper discusses the limitation and put forward based on visual electrophysiological examination results as an appraisal on the matters should be paid attention to. Retinal electric diagram and visual evoked potential examination technology joint application, through two tests of diagnostic information than single application of visual evoked potential eliminates pseudo blind and pseudo low vision more objective and reliable.In the evaluation of visual function, visual field defect and visual impairment are equally important, can make the loss of the injured to identify the surrounding environment, object orientation and the ability to move, the serious influence the quality of life of the wounded. The world health organization vision less than 10°, even if the central vision is normal also belongs to the blind. This paper discusses the recent progress in vision inspection technology and the influence factors of visual field in, put forward the suitable for ocular trauma judicial authentication visual field, and the analysis of the judicial appraiser in view when the results of the tests. For medical imaging examination in ocular trauma identification of forensic science value are discussed in this paper, for the judicial appraiser in ocular trauma case choose imaging examination provide guidance. Eye type B ultrasound for traumatic vitreous hemorrhage, retinal detachment with choroid detachment, DVD edema and optic nerve atrophy unique value, and according to the different morphological performance to identify fresh injury or chronic injuries. Ultrasound for ocular trauma common ciliary body detachment and separation of biological microscope is irreplaceability, is the only way to live in a state of knowledge of posterior chamber and ciliary body medical inspection technology, can be clearly the presence of ciliary body leakage corner. Optical coherence tomography(OCT) is applied to the eye check ups are a relatively new technology, OCT for retinal contusion check has a unique value, can present feeling between layer and pigment epithelial layers of the retina nerve injuries, image on the retina contusion caused by layer from nerve sensation, traumatic macular hole, retinal hemorrhage, nervous feeling layer thinning and nervous feeling of radiographic evidence of interlayer edema provide objective. Layer computer tomography(CT) in diagnosis of orbital bone fractures and intraocular foreign bodies left has a unique advantage, damage to the lens, hyphema, extraocular muscle injury and optic nerve contusion, etc all can obtain satisfactory imaging findings. Magnetic resonance imaging(MRI) can provide from the brainstem to the extraocular muscle of cranial nerve pathways important imaging information, for the evaluation of the optic nerve, optic nerve sheath hematoma and ischemic change, depending on the cross, nerve bundle, geniculate body, depending on the radiation and pathological changes of the occipital lobe unique value.Appraisal standard of the human body damage degree since come into force on January 1, 2014, for personal injury level injury identification in the field of judicial authentication in China has played a positive progress. This paper found that in the process of the study of ocular trauma appraisal standard, ocular trauma to set up and regulations of the standards, there is still a provision is not rigorous, up and down regulation imbalance injury and defects such as semantic ambiguity part clause deserves further discussion and perfect. The following example. "Drooping eyelids cover on the side of a minor injury secondary pupils" provision is the semantic ambiguity. On the side of the drooping eyelids cover the pupil can be interpreted as the pupil covered completely, also can be covered completely. On the basis of serious injury in the secondary side ptosis completely covered the pupil and minor injuries in the primary "drooping eyelids pupil covered more than 1/2" on the side of the regulation, the author proposed to minor injuries in the secondary "on the side of the drooping eyelids cover pupil" changed to "on the drooping eyelids cover the pupil on the side of the edge", is more scientific and rigorous. Set up in the minor injuries secondary side eyelid closure is not complete, when there is a bilateral eyelid closure not full-time how to judge the injury, not standard is given. The author suggest in the minor level increase in "bilateral eyelid closure insufficiency" provision. Trauma caused by pupil deformation or the pupil is set loose big clause in minor injuries secondary, "the pupil enlargement about muscle injuries to the pupil significant deformation or the pupil loose big(more than 0.6 cm in diameter)". This provision, the author thinks that there are two problems, one is the cause of the deformation of traumatic pupil is not separately for the pupil sphincter damage caused by, iris damaged nerve fibers, torn iris mechanical and roots severed all can lead to deformation of the pupil, iris will only pupillary sphincter injury as the deformation of the pupil qualification clearly is not the appropriate; Second, the provisions of the "pupil" significant deformation "significantly" with the damage degree of old series widely criticized in the standard of "completely", "partial", "most", "clear", "severe" and other words belong to uncertainty qualifiers, easy to produce ambiguity and controversy, different judges have different interpretation, should not be used in the appraisal standard. Appraisal standards in addition to the above discuss, the author of the appraisal standard of human body damage degree and lack of eyelid defect, eyelid ectropion, varus eyelid and lacrimal apparatus injury, bone fracture, depending on the machine vision loss and appearance was damaged in the Settings, and under the terms related to eye damage are analyzed and discussed, and puts forward some concrete Suggestions on perfecting.The injured disability evaluation of road traffic accidents(GB 18667-2002), mainly is suitable for the compensation for the victims of road traffic accidents and relevant civil litigation and insurance claims, etc., at the same time, other information can also be applied to personal injury disability level appraisal. This standard system will disable grade from grade Ⅰ to Ⅹ division, the lightest levels for Ⅹ heaviest for Ⅰ, at every level of disability from top to bottom in the anatomical structure of the classification system of classification: the brain, spinal cord and peripheral nerve injury, facial injury, spinal injury, neck injury, chest injury, abdominal injury, basin of injury, perineal damage, physical injury and the body surface damage. In this paper, the study found that the standard system is in setting the problems existing in the terms of ocular trauma, such as traumatic brain injury may cause visual dysfunction, head of facial injury may also result in visual dysfunction, there will be a clause set of one-sided and repeat. Ⅱ, for example, the level of disability in the brain, spinal cord and peripheral nerve injury caused by "eyes blind level 5" provision, with in the facial injury to disable Ⅱ class header "eyes blind level 5" provision is repeat, this is obviously not scientific. Again as in Ⅹ class disable brain, spinal cord and peripheral nerve injury, "strabismus and diplopia, optical illusion, nystagmus visual dysfunction such as" the terms of craniocerebral injury caused by eye movement nerve injury can cause the occurrence of strabismus and diplopia, extraocular muscles that are a direct result of traumatic injuries can also cause the occurrence of strabismus and diplopia, only the damage result in traumatic brain injury is one-sided. In addition, in Ⅹ class disable "optical illusion" provision, exist on the concept of error. Optical illusion refers to when the human eye observation target objects, because the objective factors of interference or formed by their own psychological factors at the mercy of the wrong perception and judgment. Optical illusion is a physiological phenomenon, rather than pathological changes, is common in our life, such as different color will bring us visual illusion, white objects to appear larger expand feeling, blue objects have contractive feeling appear smaller, at the same time, the target of different shapes, lines can present a area size, direction, inconsistent, parallel lines bend, such as optical illusions, and see things improper reference to relevant experience or target. Optical illusion is not a eye damage as a result, and depending on the "distortion" in clinical ophthalmology belong to two concepts. "Optical illusion" does not belong to the visual organ injury consequence, suggest delete this clause or amended as "deformation" vision. And the appendix part of the appraisal standard is generally used to explain the terms of the division of the basis, to guide the identification standard application, is an effective supplement to the body of the standard part, is an important part of the appraisal standard, indispensable for the surveyor understanding, applicable standards, has a pivotal role. The appendix part no trauma in the standard terms and conditions set in the technical basis and related regulations, such as the specific scope of blindness and low vision damage, whether for reference to the world health organization(who) grading of blindness and low vision of visual impairment provisions set, not put calculation method of visual field loss in appendix content, lack of technical instructions.Labor ability appraisal Worker of industrial injury and occupational disease disability grade in accordance with the standard code of fixed number of years of release, respectively: GB/T 16180-1996, GB/T 16180-2006, GB/T 16180-2014, GB/T 16180-2014 on January 1, 2015 implementation of standards revision for this latest version. This standard is formulated in order to safeguard the laborers suffering injury or occupational disease treatment of industrial injury insurance and personal injury compensation. In addition to apply to the laborer damage degree of disability identification, in practice is also applied to other types of disability caused by personal injury, is currently in the field of judicial authentication forensic appraiser used one of the most standard. Of labor ability appraisal and the difference between the judicial authentication as well as the judicial authentication institutions could be discussed in this paper, of labor ability appraisal of labor ability appraisal are compared with those of the common personal injury compensation system, in the three versions of the ocular trauma identification standard for content, the two revised ideas for appraisal standard of ocular trauma carding and comparison analysis, for the visually impaired, traumatic glaucoma, eyelid defect, such as traumatic cataract intraocular lens implantation ocular trauma provision to the research and discussion, the evaluation standard system of appraisal terms associated with ocular trauma was analyzed and put forward the still need to improve. |
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