The UK paediatric ocular trauma study 2 (POTS2):Demographics and mechanisms of injuries

Freda Sii,1,2 Robert J Barry,1 Joseph Abbott,3 Richard J Blanch,1,4 Caroline J MacEwen,5 Peter Shah1,2,6,7 1Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, 2Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, 3Department of Ophthalmology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, 4Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, 5Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, 6National Institute of Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, 7Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK Purpose: Pediatric ocular trauma is an important cause of visual morbidity worldwide, accounting for up to one-third of all ocular trauma admissions. It has long-term implications for those affected and significant economic consequences for healthcare providers. It has been estimated that 90% of all ocular trauma is preventable. Targeted strategies are required to reduce the incidence and the severity of pediatric ocular trauma; this requires an understanding of the epidemiology and characteristics of these injuries and the children involved. Methods: Prospective, observational study of pediatric ocular trauma cases presenting to UK-based ophthalmologists over a 1-year period; reporting cards were distributed by the British Ophthalmological Surveillance Unit, and clinicians were asked to report incidents of acute orbital and ocular trauma in children aged ≤16 years requiring inpatient or day-case admission. A validated, standardized questionnaire was sent to reporting ophthalmologists to collect data on the demographics and circumstances of injury. Results: Median age at presentation was 7.7 years, with boys more than twice as likely to be affected than girls (M:F =2.1:1.0). Almost 50% of injuries occurred at home, with 25% occurring in school or nursery. A total of 67% of injuries occurred during play, and 31% involved a sharp implement. Conclusion: Pediatric ocular trauma remains an important public health problem. At least three-quarters of all injuries are preventable through measures, including education of children and responsible adults, restricting access to sharp implements, improving adult supervision, and appropriate use of eye protection. Keywords: etiology, childhood eye injury, epidemiology, penetrating eye injury, perforating eye injury, preventio

The UK Paediatric Ocular Trauma Study 1 (POTS1):development of a global standardized protocol for prospective data collection in pediatric ocular trauma

Freda Sii,1,2 Robert J Barry,1 Richard J Blanch,1 Joseph Abbott,3 Caroline J MacEwen,4 Peter Shah1,2,5,6 1Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, 2Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, 3Department of Ophthalmology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, 4Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, 5National Institute of Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, 6Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK Background: Ocular trauma is an important cause of visual morbidity in children worldwide. Pediatric ocular trauma accounts for up to one third of all ocular trauma admissions, with significant economic implications for health care providers. It is estimated that 90% of all ocular trauma is preventable. Development of strategies to reduce the incidence and severity of pediatric ocular trauma requires an understanding of the epidemiology of these injuries and their characteristics. This will enable appropriate targeting of resources toward prevention and allow effective service planning. At present, there is no standardized methodology for the collection of global cross-sectional data in pediatric ocular trauma, and the ability to undertake detailed epidemiological and health-economic analyses is limited. Furthermore, it is difficult to draw international comparisons in incidence, etiology, and outcomes of pediatric ocular trauma due to the range of published reporting criteria. This study describes two novel questionnaires for standardized data collection in pediatric ocular trauma, which can be adopted across a range of health care settings internationally.Methods: Two standardized data collection questionnaires have been developed from previously reported templates. The first enables collection of demographic and incident data on serious pediatric ocular trauma requiring hospitalization, and the second enables follow-up outcome data collection. Both the questionnaires are designed to collect primarily categorical data in order to increase ease of completion and facilitate quantitative analysis. These questionnaires enable acquisition of standardized data on the incidence, etiology, and outcomes of pediatric ocular trauma.Discussion: These questionnaires enable collection of standardized data and are designed for global use across all health care settings. Through prospective data collection, epidemiological trends can be determined, allowing health care providers to develop collaborative global preventive strategies. Furthermore, the same questionnaires may be used in future studies to draw comparisons with baseline data, allowing assessment of the efficacy of targeted preventative interventions. Keywords: childhood eye injury, epidemiology, health economic analyses, international standardization, penetrating eye injury, perforating eye injury, preventio

Diabetic Retinopathy: more patients, less laser. A longitudinal population-based study in Tayside, Scotland

WSTĘP. Celem badania było porównanie występowania retinopatii cukrzycowej i makulopatii wymagających leczenia laseroterapią z kontrolą czynników ryzyka w populacji chorych na cukrzycę mieszkających w Tayside, w Szkocji w latach 2001-2006. MATERIAŁ I METODY. Analizie poddano zabieg laseroterapii siatkówki, przesiewowe badania dna oka oraz okresowe badania monitorujące przebieg cukrzycy wykonywane w latach 2001-2006. Końcowym, głównym kryterium oceny była liczba pacjentów, u których wykonano pierwszą lub kolejną laseroterapię z powodu retinopatii cukrzycowej lub makulopatii. W czasie badania analizowano również średnie stężenie HbA1c, wartość ciśnienia tętniczego oraz liczbę wykonanych przesiewowych badań dna oka. WYNIKI. W ciągu 6 lat liczba chorych na cukrzycę w Tayside zwiększyła się z 9694 do 15 207 (wzrost o 57%). Liczba pacjentów wymagających laseroterapii zmniejszyła się z 222 do 138, a liczba laseroterapii wykonywanych po raz pierwszy zmniejszyła się ze 100 (1,03% w populacji chorych na cukrzycę) do 56 (0,37%). Liczba chorych na cukrzycę typu 2 leczonych z powodu makulopatii zmniejszyła się ze 180 do 103 w latach 2001&#8211;2006 (spadek o 43%; p = = 0,03). Średnie stężenie HbA1c zmniejszyło się zarówno w populacji osób z cukrzycą typu 1, jak i typu 2 (p < 0,01); u chorych na cukrzycę typu 2 obserwowano zmniejszenie średnich wartości ciśnienia tętniczego (p < 0,01). Liczba pacjentów uczestniczących w corocznym przesiewowym fotograficznym badaniu dna oka zwiększyła się z 3012 do 11 932. WNIOSKI. W ciągu 6 lat obserwacji częstość laseroterapii przeprowadzonych z powodu makulopatii cukrzycowej wśród chorych na cukrzycę typu 2 zamieszkujących Tayside zmniejszyła się, mimo zwiększonej częstości występowania cukrzycy i wykonywania badań przesiewowych. Autorzy niniejszej pracy uważają, że wcześniejsza identyfikacja cukrzycy typu 2 i ulepszona kontrola czynników ryzyka wpłynęły na zmniejszenie częstości występowania makulopatii wymagającej wykonania laseroterapii.INTRODUCTION. We aim to correlate the incidence of diabetic retinopathy and maculopathy requiring laser treatment with the control of risk factors in the diabetic population of Tayside, Scotland, for the years 2001-2006. MATERIALS AND METHODS. Retinal laser treatment, retinal screening, and diabetes care databases were linked for calendar years 2001-2006. Primary end points were the numbers of patients undergoing first or any laser treatment for diabetic retinopathy or maculopathy. Mean HbA1c and blood pressure and retinal screening rates were followed over the study period. RESULTS. Over 6 years, the number of patients with diabetes in Tayside increased from 9694 to 15 207 (57% increase). The number of patients receiving laser treatment decreased from 222 to 138 and first laser treatments decreased from 100 (1.03% of diabetic population) to 56 (0.37%). The number of patients with type 2 diabetes treated for maculopathy decreased from 180 in 2001 to 103 in 2006 (43% reduction; p = 0.03). Mean HbA1c decreased for type 1 and type 2 diabetic populations (p < 0.01) and a reduction in blood pressure was observed in type 2 diabetic patients (p < 0.01). The number of patients attending annual digital photographic retinopathy screening increased from 3012 to 11 932. CONCLUSIONS. Laser treatment for diabetic maculopathy in type 2 diabetic patients has decreased in Tayside over a six-year period, despite an increased prevalence of diabetes and increased screening effort. We propose that earlier identification of type 2 diabetes and improved risk factor control has reduced the incidence of maculopathy severe enough to require laser treatment

Long-term visual and treatment outcomes of whole-population pre-school visual screening (PSVS) in children:a longitudinal, retrospective, population-based cohort study

BACKGROUND: This study reports the long-term visual and treatment outcomes in a whole-population, orthoptic-delivered pre-school visual screening (PSVS) programme in Scotland and further examines their associations with socioeconomic backgrounds and home circumstances. METHODS: Retrospective case review was conducted on 430 children who failed PSVS. Outcome measures included best corrected visual acuity (BCVA), severity of amblyopia (mild, moderate and severe), binocular vision (BV) (normal, poor and none), ophthalmic diagnosis and treatment modalities. Parameters at discharge were compared to those at baseline and were measured against the Scottish index of multiple deprivation (SIMD) and Health plan indicator (HPI), which are indices of deprivation and status of home circumstances. RESULTS: The proportion of children with amblyopia reduced from 92.3% (373/404) at baseline to 29.1% (106/364) at discharge (p < 0.001). Eighty percent (291/364) had good BV at discharge compared to 29.2% (118/404) at baseline (p < 0.001). Children from more socioeconomically deprived areas (OR 2.19, 95% CI 1.01–4.30, p = 0.003) or adverse family backgrounds (OR 3.94, 95% CI 1.99–7.74, p = 0.002) were more likely to attend poorly and/or become lost to follow-up. Children from worse home circumstances were five times more likely to have residual amblyopia (OR 5.37, 95% CI 3.29–10.07, p < 0.001) and three times more likely to have poor/no BV (OR 3.41, 95% CI 2.49–4.66, p < 0.001) than those from better home circumstances. CONCLUSIONS: Orthoptic-delivered PSVS is successful at screening and managing amblyopia. Children from homes requiring social care input are less likely to attend and are more likely to have poorer visual outcomes