Purchase this article with an account.
Masih Ahmed, Osama Sabbagh, John Nguyen; Visual outcome of open globe injuries in a rural, Appalachian elderly population. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6039.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
According to the 2010 United States census, 19.3% of the population lived in rural areas with those over the age of 65 comprising more than 70% of the group. Previous studies of open-globe injuries (OGI) in urban dwelling elderly patients found poor visual prognosis, and there is a dearth of information for those in rural areas. Our aims are to characterize the nature of OGI and to determine the long-term visual outcome in elderly patients seen at a tertiary center in West Virginia. As ocular trauma is one of the most common preventable public health problems, this knowledge can be used to improve care in this vulnerable population.
Retrospective chart review of patients over the age of 65 seen in the West Virginia University Hospital for OGI between January 2000 and December 2014 was performed. Data including demographics, injury settings, type of injury, exam findings, immediate intervention, and long-term outcome and complications were collected. Descriptive statistical analysis was performed.
49 patients between 65 and 98 years old were identified. 37.2% were male, and 62.8% were female. 87.8% were trauma related, and 12.2% were from surgical wound dehiscence. Of the traumatic cases, the causes were fall (60.5%), yard work injury (16.3%), ATV accident (9.3%), and motor vehicle accident (2.3%). 42.9% involved the right eye. 91.9% occurred at home, and 8.1% happened in nursing facility settings. Over 60% had prior cataract and/or corneal transplant surgery. Initial average visual acuity was 20/812, and 20.4% were NLP. Concurrent adnexal injuries included eyelid lacerations (32.6%) and orbital fractures (16.3%). 100% underwent primary OGI repair within 24 hours of admission. 97.8% underwent primary ruptured globe repair, and 2.2% had primary enucleation. Average follow-up time was 1.4 years. 13.9% underwent subsequent enucleation. Other surgeries included vitrectomy (18.6%), penetrating keratoplasty (9.3%), and retinal detachment repair (6.9%). Final average visual acuity was 20/412, and 25.6% remained NLP.
Elderly living in rural Appalachia with traumatic open globe injury have a poor visual prognosis. While fall is the most common cause, yard work and all-terrain-vehicle accidents are more prominent in this population. Implementation of fall prevention programs and proper facial protective equipment may help to decrease these injuries and to maintain continued independence.
This PDF is available to Subscribers Only