Ocular trauma in a major Australian tertiary centre: a 10-year review of clinical outcomes and economic costs

Session Details

Session Title: Ocular Infections & Other Topics

Session Date/Time: Sunday 15/09/2019 | 08:00-10:00

Paper Time: 09:24

Venue: Free Paper Forum: Podium 4

First Author: : B.Lee AUSTRALIA

Co Author(s): :    D. Hunter   D. Robaei   C. Samarawickrama                       

Abstract Details

Purpose:

Ocular trauma is a significant cause of vision loss. In Australia, the incidence has been reported to be 79 per 100,000 persons per year. It also accounts for 10,000 work-related eye injuries annually with an associated cost of $60 million Australian Dollars (AUD). This study aimed to investigate the clinical and visual outcomes of traumatic ocular injuries that underwent surgical intervention at a major Australian tertiary referral hospital over a 10-year period (2008-2018). Additionally, the costs to the healthcare system associated with these ocular injuries were calculated.

Setting:

Westmead Hospital, Sydney, New South Wales, Australia 2145. Institutional Review Board approval was obtained from the Western Sydney Local Health District.

Methods:

Retrospective, consecutive review of all patients from December 2008 to November 2018 identified by codes from the International Classification of Disease and Australian Medicare Benefits Scheme. Injuries were classified according to the Birmingham Eye Trauma Terminology system. Data extracted from eligible records included patient demographics, eye protection, substance use, source and location of the injury, and best-corrected visual acuity (BCVA) (at initial, each follow-up, and final visit). The Ocular Trauma Score (OTS) was utilised as a prognostic tool. To calculate the healthcare system costs, data on the number and duration of admissions, surgical procedures completed, and follow-up visits were collected.

Results:

156 eyes were included. Median age was 47 (range=16-99), and 79.5% were male. 35.3% (55) were work-related with 89.1% wearing no eye protection. Falls caused a high proportion of injuries in the elderly (46.7%). Presenting mean LogMAR BCVA was 1.984±0.083 (HM) [95%CI=1.818-2.150]. At final visit, it was 1.402±0.093 (6/120) [95%CI=1.218-1.586], 46.2% attained ≥6/60 and 6.2% required enucleation. The OTS effectively prognosticated visual outcomes (r=0.782, p=0.001). The median injury resulted in 5 hospitalised days (IQR=3-8.75, range=2-97), 2 theatre visits (95%CI=1.7-2.1), and 9 follow-up appointments (IQR=5-15, range=1-45) over 5 months (range=0.06-120), equating to a median healthcare cost of $33,150AUD.

Conclusions:

Ocular trauma carries a high burden for both patients and the healthcare system. There was a high proportion of preventable ocular injuries and stricter adherence to work safety policies should be encouraged and enforced. A rising trend for ocular injuries at home due to falls in the elderly was observed. Therefore, cost-effective public health initiatives to improve visual function in the elderly, such as frequent vision checks, appropriate visual aids, and cataract surgery when needed, should be implemented to reduce the burden of these significant injuries.

Financial Disclosure:

None