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F. Kuhn, R. Morris, D. Witherspoon, L. Mann; Ocular Trauma in Patients 60 Years of Age and Over. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4057.
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To analyze injuries occurring in elderly patients.
5,223 patients with serious injury in the United States Eye Injury Registry (www.useironline.org) database were analyzed. Of these 548 were elderly (60 years of age and older), the remaining served as control.
A significantly (p<0.001) greater percentage (40% vs. 30%) of eyes in the control group vs. among the elderly had no prior abnormality. A significantly (p<0.001) higher percentage of elderly patients were hospitalized after a serious eye injury than in the control group (31% vs. 50%, respectively). A blunt object was the most common cause in the elderly (31%). The home was the most frequent place (60%), which is significantly (p<0.001) more than in the control group (38%). Rupture was significantly (p<0.001) more common among the elderly than in the control group (31% vs. 11%, respectively). The retina was injured less frequently (p<0.01) in the elderly than in the control group (39% vs. 45%, respectively), as were the macula (7% vs. 11%, p<0.01) and the optic nerve (4% vs. 5%). Elderly patients underwent a significantly (p<0.001) higher mean number of initial and additional operations (3.18 vs. 2.46) than those in the control group (p<0.001), even after controlling for the initial visual acuity. For the elderly, there was twice as high a risk of having poor vision after a serious injury than for those in the control group. This elevated risk for older vs younger eyes remained high even after controlling for pre-existing eye abnormality (RR 1.75 for poor initial and 1.85 for poor final vision, p<0.001).
Elderly patients are more likely to have poorer outcome than those under 60 years of age, even when controlling for prior eye disease or poor initial vision. This is caused mainly by higher injury severity (rupture due to fall) but also because of a less effective healing process; treatment is pursued just as much in elderly patient as in the young.
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