Fall-related ocular trauma in patients over 90 years in tertiary ophthalmic center in Germany: 90-TOSG Report 1.

PURPOSE: To investigate the clinical characteristics of fall-related ocular trauma in patients over 90 years of age. METHODS: Retrospective, medical record reviews. Patients over the age of 90 years treated in a tertiary center with fall-related ocular trauma were included in the study. RESULTS: Fifty consecutive patients (fifty eyes) were analyzed. The mean age was 93.6 ± 1.8 years and 41 patients (82%) were female. The most common site of the injuries was orbital fracture (18 patients, 36%), accompanied with open globe rupture (OGR) in three patients, and globe contusion in two patients. Seventeen patients (34%) presented with OGR. Ocular trauma score in those patients was category 1 in 10 patients (58.8%) and category 2 in the others. Conjunctival hemorrhage and/or periocular contusion was seen in 14 patients (28%) and globe contusion in six patients (12%). At the presentation, the mean best corrected visual acuity (BCVA) was 2.82 ± 0.24 logMAR in patients with OGR and 1.98 ± 0.81 logMAR in six patients with globe contusion. Three of the patients with OGR had a final vision of 20/200 or better whereas the remaining patients had hand movements or less. The most common risk factors were female gender (82%) and use of antihypertensive drugs (46%). CONCLUSION: Patients with OGR had a poor visual outcome despite the early treatment. It is important to raise public awareness about of the poor prognosis of ocular injuries due to falls in the elderly population in order to establish preventive measures.

Influence of Patient Age and Presence of Optic Disc Drusen on Fluctuations in Retinal Nerve Fiber Layer Thickness.

BACKGROUND: It is generally believed that optic disc drusen (ODD) change only over long periods of time. Because, in our experience, this does not apply to younger patients, we investigated the natural course of changes of the peripapillary retinal nerve fiber layer (RNFL) in patients with ODD. METHODS: In this retrospective study, 40 eyes with and 40 eyes without ODD were examined, both cohorts were equally subdivided into younger subjects (20 years or younger) and older subjects (21 years or older). Three optical coherence tomography (OCT) scans of the peripapillary RNFL that had an interval of at least 1 month were required for each patient to be included in this study. The largest difference in total RNFL thickness (delta RNFL-t) and in RNFL thickness of the most differing sector (delta RNFL max) measured by OCT was compared. RESULTS: The differences in total RNFL thickness and in the most differing RNFL sector in the group of patients with ODD younger than 21 years were significantly larger than in each of the other 3 groups ( P = 0.0001). The other 3 groups did not differ significantly. CONCLUSIONS: Patients with ODD younger than 21 years have distinct variations in peripapillary RNFL thickness without evidence of increased intracranial pressure. In the absence of further pathological findings or neurological symptoms, an observational approach seems adequate in these patients.

[Interdisciplinary communication: ophthalmologists' letters to practices specializing in diabetic patients]. / Interdisziplinäre Kommunikation: Augenarztbriefe an diabetologische Schwerpunktpraxen (DSP).

BACKGROUND: Ophthalmologists' letters and medical reports play an important role in the interdisciplinary cooperation between general practitioner, internist, diabetologist and ophthalmologist providing means of information and communication for the avoidance, delay and treatment of diabetic retinopathy (DR). METHODS: In a cross-sectional study (NCT02311504) the ophthalmologicsts' letters and other clinical parameters were extracted from electronic patient records (EPR) of 810 patients with diabetes. Files were classified into different categories of formats, tested with respect to topicality and content structure and analyzed according to the topic complex of the national treatment guidelines for retinal complications. RESULTS: In 59% of the patients an ophthalmologist's medical report was identified in the EPR. Of these, 26% were computer-generated documents, 73% were handwritten. 55% used the standard form of the national guidelines, 21% were self-designed formats, 16% detailed letters, 5% short reports and 3% short messages. The information was written on average 19 months ago. Of the documents 25% were older than 2 years at the time of the study. Of the patients 75% visited an ophthalmologist in the previous 12 months, yielding a report rate of only 40%. The prevalence of DR reported in the forms was 12%, in detailed letters 32%. CONCLUSION: Although standardized forms are widely distributed in the ophthalmologists' communication with diabetologists, there is room for improvement in the face of the low report rate to enable a timely consideration of relevant findings. The high number of handwritten documents shows the large untapped potential of electronic formats in the interdisciplinary communication.