Surveillance of traumatic optic neuropathy in the UK

Abstract

Aims The aim of this study is to provide epidemiological data on the incidence, aetiology, management, and visual outcome in traumatic optic neuropathy (TON) in the UK. Methods Patients with TON were identified prospectively by population-based active surveillance through the British Ophthalmic Surveillance Unit over a 2-year period with data obtained from an incident questionnaire and follow-up questionnaire sent to positive reporters. Results Incident and follow-up data were available on 121 and 97 (80%) patients, respectively. The minimum estimated incidence was 1.005 per million. Leading causes included falls (25.6%), road traffic accidents (RTAs) (21.5%), and assaults (20.7%). The median age was 31 years. There were 95 (78.5%) men. Presenting visual acuity (VA) was 6/60 or worse in 85 (70%) patients, with 43 patients (36%) with no perception of light. Associated injuries included 47 (39%) orbital wall fractures, 37 (31%) closed globe injuries, 23 (19%) ocular adnexal injuries, 23 (19%) skull fractures, and 18 (16%) intracranial bleeding. Sixty-five percent (75/116) received no acute treatment and 35% (41/116) received steroids and/or surgery. Of the treated group, 24% (8/ 33) and of the untreated group 20% (11/56) improved three lines or more of VA (P ¼ 0.61). Prompt ophthalmic examination (P ¼ 0.002), orbital fracture (P ¼ 0.046), high Glasgow Coma Scale (GCS) score (P ¼ 0.023), and poor initial VA (P ¼ 0.009) were associated with increased likelihood of treatment. Poor initial VA (Po0.001), orbital fracture (P ¼ 0.004), and significant head injury (P ¼ 0.038) were associated with poor visual outcome. Conclusions This study suggested that young men were at greatest risk of TON. We detected a trend towards conservative management of this condition in the UK. TON was associated with significant ocular, orbital, and head injuries that highlighted the need for multidisciplinary management.

Differential Protection of Injured Retinal Ganglion Cell Dendrites by Brimonidine

“…If the days-long period of dendritic pruning after ONC accurately models important aspects of what happens in RGCs of TON patients, then brimonidine may provide enhanced recovery in TON. In support of this potential for recovery, epidemiological studies have reported a portion of untreated TON cases attain 3 or more Snellen lines improvement of visual acuity between presentation and final follow up 42,43. Similarly, growing experimental evidence suggest neuroprotective treatments may increase preservation of vision in glaucoma patients.44- 46 Thus, the present findings support further studies to define the neuroprotective requirements of all RGC subtypes.…”

Mechanisms and management of vision loss following orbital and facial trauma

“…There is no good evidence that either corticosteroids or surgery have any benefit in terms of long-term visual acuity and both may carry the risk of significant morbidity [31,41]. This is reflected in the finding be Lee et al [20 ] of a trend towards conservative management of TON in the UK.…”

“…Most studies of TON have shown a significant correlation between initial and final visual acuities, patients with direct TON or no light perception at presentation have a poorer prognosis. Lee et al [20 ] found that there was no statistically significant difference in improvement in visual acuity between those patients treated with steroids and/or surgery and the untreated group. There is no good evidence that either corticosteroids or surgery have any benefit in terms of long-term visual acuity and both may carry the risk of significant morbidity [31,41].…”

“…TON is a clinical diagnosis supported by a history of trauma. In a large survey in the UK, Lee et al [20 ] have reported a minimum prevalence of 1.005 per million. The majority of these were young men in their early 30s following falls (25.6%), road traffic accidents (21.5%) and assaults (20.7%).…”

A 2-year prospective surveillance of pediatric traumatic optic neuropathy in the United Kingdom

“…There were 26 cases of TON in this age group reported over 2 years; thus, the reported incidence was 0.99 per million population. 10,11 This has important implications for increasing awareness among the public and health professionals about the effect of TON on the health of both children and adults.…”