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No improvement found in pediatric ocular injury rates in 25 years
No improvements were observed in the severity or incidence of pediatric ocular injury rates in the past 25 years, according to the U.K. Paediatric Ocular Trauma Study 3.
“Whilst our ndings suggest that pediatric ocular trauma is being appropriately assessed and managed throughout the U.K., we are reminded that prevention remains far better than cure,” the researchers wrote. “Ultimately, we believe that interventions aimed at avoiding unnecessary injury are far more effective at preventing visual loss than any form of medical or surgical intervention following injury.”
Researchers conducted a prospective, observational study of 86 episodes of pediatric ocular trauma reported by U.K.-based ophthalmologists between June 1, 2014. and May 30, 2015. Clinicians filled out recording cards to note instances of ocular and orbital trauma in children 16 years old and younger requiring day-case or inpatient admission. Standardized questionnaires were also used by reporting ophthalmologists to collect information on initial injury management and clinical features.
Globe trauma was reported in 76.7% of patients, 60.1% of which were open globe. Additionally, anterior segment trauma was reported in 66.3% of patients, with 26.7% in the posterior segment.
Twenty-five of the 86 patients sustained trauma resulting in corrected visual acuity worse than 6/60 Snellen — a figure similar to a 1999 survey of childhood ocular trauma for children 14 years old or younger in Scotland. The 1999 survey reported one case of pediatric ocular trauma with acuity worse than 6/60 Snellen with an incidence ratio of 0.1 per 100,000 (95% CI, 0.02-0.6), showing an increase in instances of severe pediatric ocular trauma when compared to the incidence rate of 0.19 per 100,000 (95% CI, 0.13-0.29) of the current study.
“We have previously advocated for the use of appropriate eye protection for children engaging in ‘high-risk’ activities and increased education for those supervising children in domestic and play environments,” the authors wrote. “Through dissemination of the results of the U.K. Paediatric Ocular Trauma Study, we hope to improve both primary prevention of injury and secondary care for affected children in the U.K. and beyond.” – by Eamon Dreisbach
References:
Desai P, et al. Br J Ophthalmol. 1996;doi:10.1136/bjo.80.7.592.
MacEwen CJ, et al. Br J Ophthalmol. 1999;doi:10.1136/bjo.83.8.933.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Ocular trauma is a significant public health concern, with 2.4 million injuries occurring in the U.S. every year (Tichauer). Approximately one-third of these occur in children under the age of 17 years and can result in lifelong visual impairment and decreased quality of life.
While the U.K.-based POTS3 study offers compelling support for the prevention of ocular trauma, the results may not apply to many primary care optometrists. All the study subjects were admitted to the hospital, with half (54.7%) requiring examination under anesthesia. Thus, the severity of their injuries is likely higher than what is seen in outpatient settings. The study also noted a reduced incidence of open globe injuries overall; but, as the authors note, this may be because only the most severe cases are seen for hospital-based ophthalmological care.
Overall, this study confirms what we already intuitively know: Ocular trauma is very different in children than in adults; prevention is “far better than cure” and as primary eye care providers we need to be equipped to assess and manage these pediatric cases.
Reference:
Tichauer MB. Ocular trauma: Eight potentially devastating eye injuries. Medscape. Posted April 21, 2017. Accessed August 20, 2019.
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