Eyeworld

152 | EYEWORLD | APRIL 2019 O UTSIDE THE OR MD, thinks that getting that second eye operation sooner rather than later could help lessen fall risk, even in borderline cases. Beyond the falls The study results bring attention to other eye trauma pearls that ophthalmologists should share with patients, according to sources. First, parents should be educated about the use of protective eyewear in children, including sports-related eye protection, Dr. Shah said. Dr. Jarstad agreed. "I try to emphasize wear- ing eye protection with polycarbonate lenses," he said. Second, anyone training to use a gun should remember the cardinal rule of never aiming at another person, Dr. Jarstad said. This could help avoid eye trauma, not to mention serious injury or death. injuries caused by objects and machinery made up the largest chunk of primary diagnosis cases (30.1%). Among all patients, the elderly com- posed the largest overall age group. Most of the patients (59.3%) were male, had a lower income, were publicly insured through Medicare or Medic- aid, and were from the South (36.7%). Focusing on falls Among the study's findings, the connection with falls was of particular concern to the researchers. "Falls continue to occur in high-risk populations, which I think calls for a reexamination of our existing prevention strategies," Dr. Shah said. "A fall is considered a 'never event' in hospitals, and it's time that we make it a never event outside the hospitals as well." Ophthalmologists should proactively identify patients at risk for falls, Dr. Shah said. Those at higher risk can be referred for low vision services, something that Howard R. Krauss, MD, often does. It's also important to address fall risk with any family members present at the exam, Drs. Shah and Krauss said. Dr. Krauss will make a note in the electron- ic medical record about patients who are at risk for falls, so the primary care doctor can follow up accordingly. He also sees patients at risk for falls who need further neurological assessment, particularly because he specializes in neuro-oph- thalmology. One challenge, according to Dr. Krauss, is that ophthalmologists may not always get a sense of who is at a higher risk for falls during an exam, due to the short amount of time with a patient. However, staff members may have valuable insight based on how a patient walks to and from the waiting area and exam room. Another chal- lenge is with patients receiving certain treatments, for example, those with age-related macular degeneration who return to a practice for regular injections. Eye doctors may not always have the time to assess or ask how these patients are man- aging their vision loss in terms of preventing falls, Dr. Krauss said. Ophthalmologists should take a more global view on preventing falls by working with phy- sicians across specialties to recognize at-risk patients, Dr. Shah said. Although there is a tendency nowadays to put off second eye cataract surgery, John S. Jarstad, Eye trauma stats 1 • Two million to 2.4 million cases of eye trauma occur each year. • Of those cases, about 1 million have permanent significant visual impairment. • Twenty-seven percent or more of serious eye injuries in the U.S. lead to legal blindness. • A primary diagnosis of eye trauma decreased from 2001 to 2014, but secondary diagnoses of eye trauma increased. • A rise in the secondary diagnosis of eye trauma was linked to an increasing frequency of falls among those age 65 or older. • A primary diagnosis of eye trauma was more common in children and teens, African Americans and Hispanics, uninsured patients, and those receiving Medicaid. continued from page 150 Reference 1. Iftikhar M, et al. Changes in the incidence of eye trauma hos- pitalizations in the United States from 2001 through 2014. JAMA Ophthalmol. 2019;137:48–56. Financial interests Jarstad: None Krauss: None Shah: None

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