Legends of the fall: How optometry can prevent serious harm

Eye traumas as a secondary admitting diagnosis to hospitals are on the rise, a new study says.

Published online Oct. 4 in JAMA Ophthalmology, the study looked at the incidence of eye trauma hospitalizations and the demographics and outcomes for hospitalized patients with primary and secondary diagnoses of eye trauma.

For the study, about 940,000 inpatient admissions to U.S. community hospitals between 2001 and 2014 with eye trauma were reviewed. Patients were part of the National Inpatient Sample, a large database compiled for the Healthcare Cost and Utilization Project. The relatively good news was that the incidence of eye trauma as a primary admitting diagnosis dropped from 3.9 to 3.0 per 100,000 population over the period. Overall, primary diagnoses were made in about 17% of the total inpatient admissions and secondary trauma in about 83% of the total inpatient admissions in the study.

The grounds for concern? The incidence of eye trauma as a secondary admitting diagnosis rose 31% (from 14.5 to 19.0 per 100,000 population). Falls by individuals over 65 years old were largely responsible for the increase, say the researchers from John Hopkins University School of Medicine and the University of Pittsburgh School of Medicine.

Falls are a leading cause of morbidity and mortality among the elderly, reported the researchers, who also referenced their impact on patients' economic productivity. The most common primary trauma diagnoses were orbital fracture, ocular laceration and eyelid laceration. The most frequent secondary trauma diagnoses were contusion of eye and adnexa, orbital floor fracture and superficial injury of the eye and adnexa. Other eye trauma cited included burns of the eye and adnexa and foreign body on external eye.

"These findings suggest that the increasing number of falls in individuals older than 65 years and the high risk of primary eye trauma in populations such as children and adolescents warrant the development and implementation of effective prevention strategies," the researchers wrote.

According to the Centers for Disease Control and Prevention, 1 in 4 seniors fall each year—with their medical care costing more than $50 billion in 2015. Yet, many falls are preventable, says a September 2018 study in the American Journal of Preventive Medicine. Interventions, the study pointed out, could save up to $442 million annually and improve patients' health independence and quality of life. Among the interventions for older adults mentioned in the journal were home modification and vitamin D supplements.

Optometry can be part of the solution, says William T. Reynolds, O.D., AOA vice president, who sees a number of patients with Medicare where he practices in Richmond, Kentucky.

Essential: Regular, comprehensive eye exams

Dr. Reynolds notes that many of the injuries in the study were attributable to falls. Falls can be due to impaired visual acuity, which can be caused by such eye conditions as cataracts, age-related macular degeneration and glaucoma. Read more about vision as we age.

"Doctors of optometry are part of the answer," Dr. Reynolds says. "Ocular conditions, which decrease your ability to see potential obstacles, make you much more likely to fall. A routine, comprehensive eye examination provided by a doctor of optometry can diagnose vision-threatening conditions so that appropriate action can be taken before an accident occurs."

Optometry is positioned to be even more proactive, Dr. Reynolds adds. Doctors of optometry serve 10,000 communities nationwide. In a third of these communities, they are the sole eye care providers and provide a critical path to reaching patients. They can evaluate, diagnose and treat eye trauma, plus provide a referral if needed to the appropriate health care specialist, he says. They also can counsel patients on how to prevent injury, whether it's through advising on protective eyewear and safety head gear or modification of their living and working spaces. Among tripping hazards are rugs, doormats and poorly lit rooms

Most importantly, Dr. Reynolds says, doctors of optometry can underscore the necessity of regular, in-person, comprehensive eye examinations.

"Doctors of optometry provide the vast majority of the primary eye care in this country," Dr. Reynolds says. "As primary eye care providers, it is our responsibility not only to address patients' vision and ocular health needs but also to discuss safety concerns with patients and their families' concerns about falls and injuries."