Abstract
Purpose :
Commotio retinae (CR) results from trauma to the eye or orbit. Though self-limiting, it often prompts scheduled follow-up with retinal specialists. We performed an outcomes and cost analysis in a cohort of patients presenting emergently.
Methods :
We reviewed 150 patients presenting to the Mass Eye & Ear ED from 1/1/2020–1/1/2022 for contusion or other injuries of the eye/orbit (ICD-10 codes S05.1 and S05.8). Of these, 71 patients (47.3%) had CR on their ED exam and were included for analysis. We collected demographic information, exam findings, and ancillary testing. Dollars spent per retinal tear detection was calculated by summating imaging and visit costs in a facility setting (using established CMS estimates) prior to commotio resolution and dividing by tears found on follow-up.
Results :
The mean age at presentation was 30.7 ± 14.1 years. Most patients were male (78.9%), white (62.0%), and not Hispanic (76.1%). Only 67.6% of patients returned for follow up. For imaging, 38% of all patients received fundus photography, and 39.4% received OCT. Five patients (7%) developed retinal tears, and one patient (1.4%) demonstrated a retinal detachment. Tears were detected on initial visit in two out of five cases (40%). The only case of detachment was also detected on initial visit. Tears detected on follow-up were always preceded by worsening symptoms (flashes/floaters). Mean visits to CR resolution was 1.73 ± 1.47 visits, with an average of 35.4 ± 61.5 days. Overall, 28 OCTs, 29 fundus photos, and 104 follow-up visits were performed prior to CR resolution, totaling $26,889. Dollars spent to detect one retinal tear is $8,963. There was no difference (t = 0.376, p = 0.709) in final VA between patients receiving imaging (mean logMAR 0.10 ± 0.39) and those who did not (mean logMAR 0.15 ± 0.25). There was no correlation between number of follow up visits and VA (R = -0.080, p = 0.597).
Conclusions :
In this more recent case series, patients with CR infrequently develop retinal complications and have a high rate of loss to follow up (no show). There is significant cost associated with subsequent examinations and imaging following initial presentation. Complications were always heralded by worsening symptoms necessitating re-examination. Additional follow-ups and increased costs did not appear to result in better visual outcomes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.