Epidemiology of severe ocular trauma following the implementation of alcohol restrictions in Far North Queensland

Abstract

Importance: Indigenous communities of Far North Queensland (FNQ) have one of the highest incidences of alcohol-related ocular trauma globally. Background: To review the epidemiology of closed-and open-globe trauma admitted to Cairns Hospital from FNQ health districts following the implementation of alcohol restrictions in Indigenous communities. Design: Retrospective study of cases from January 2014 to December 2018. Participants: A total of 142 cases identified from ICD-10 clinical-coding data. Methods: Records were reviewed to determine demographics, clinical details and outcomes. Main Outcome Measures: Annual incidence by demography and ethnicity (Indigenous vs non-indigenous). Results: Estimated annual incidence was 10.4/100 000 population (openglobe: 3.6/100 000, closed-globe: 6.8/100 000 population). Incidence rate ratio was 2.8× higher in Indigenous (22.8/100 000 population) compared to nonindigenous populations. Injury from assault was 8.2× higher in the Indigenous population. Alcohol was involved in 76% of assaults. Paediatric injuries comprised 20.4% of the cohort, with Indigenous children over-represented (44.8% of children). Visual acuity (VA) at presentation ranged from −0.08 logMAR to no-perception of light (NPL), with 41.8% poorer than +1.00 logMAR. Final VA ranged from −0.18 logMAR to NPL. Mean final VA was significantly better for closed-than open-globe injuries (+0.43 vs +1.01 logMAR). Ruptures had the poorest outcomes (mean +1.65 logMAR). Conclusions and relevance: The overall incidence of severe ocular trauma in FNQ has decreased compared to that reported from 1995 to 2002. The extremely high incidence observed in the Indigenous communities of Cape York has decreased dramatically since the introduction of Alcohol Management Plans. Nevertheless, the Indigenous population still experiences significantly higher rates of severe ocular trauma, particularly from assault.

Epidemiology, aetiology and outcome of paediatric ocular trauma in Sydney

“…Preventative strategies focusing on Indigenous Australians, particularly in regional and remote areas are urgently needed 7 . and should take account of cultural and socio‐economic factors including unemployment and incarceration 21 . For children, education at school and in the community of the dangers of objects likely to cause OGIs is needed along with the need to attend for aftercare.…”

“…7 and should take account of cultural and socio-economic factors including unemployment and incarceration. 21 For children, education at school and in the community of the dangers of objects likely to cause OGIs is needed along with the need to attend for aftercare.…”

Ocular trauma: are we doing enough?

“…7 Dorman et al have also recently reported a reduction in OGI following implementation of a strategy to reduce alcohol consumption in Far North Queensland in Australia. 8 As Lee et al discuss, in many countries general public health measures such as mandatory wearing of seat belts in vehicles have reduced morbidity and mortality rates. With the known risk of occupation-related OGI, can measures be improved to protect employees in workplaces from injuries?…”

Ocular trauma and prevention measures

“…A clear understanding of the nature of ocular trauma and the impact of any interventions can guide future prevention strategies. In the current issue, Dorman et al describe a more than 4‐fold reduction in ocular trauma associated with the introduction of alcohol management plans 2 . Their findings confirm that with up to 90% of ocular trauma preventable, 3 preventative efforts should be based on an understanding of why, when and where ocular trauma occurs.…”