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Ocular Pathology in Patients with Hip Fractures

Ocular Pathology in Patients with Hip Fractures. Mr. P. Walmsley MRCSEd SpR Orthopaedics Ms. R. Sanders Consultant Ophthalmologist Mr. I. Brenkel FRCSEd Consultant Orthopaedics. Background. Ongoing prospective audit of Hip and Knee Arthroplasty Possible extension of audit to include # NOF

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Ocular Pathology in Patients with Hip Fractures

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  1. Ocular Pathology in Patients with Hip Fractures Mr. P. Walmsley MRCSEd SpR Orthopaedics Ms. R. Sanders Consultant Ophthalmologist Mr. I. Brenkel FRCSEd Consultant Orthopaedics

  2. Background • Ongoing prospective audit of Hip and Knee Arthroplasty • Possible extension of audit to include # NOF • Results of pilot study

  3. Risk Factors for # NOF • Osteoporosis • Visual impairment • Neuromuscular impairment • Medical co-morbitiy • Dementia • Smoking • Alcohol Intake • Immobilization

  4. Visual Impairment • Visual Acuity ≤6/18 (WHO) • 15-30% of Population2 • 1 Am J Epidemiology • 2 BJO 1990

  5. Previous studies 0.8% totally blind 21% partially sighted 42% no optician contact in last 5 years3 Ocular Pathology Undocumented 3 Watson et al, Age & Ageing 1978

  6. Study Protocol • 1 year prospective study, 4 centres • Patients aged > 65 years, admitted with #NOF • History, Mental state, Full ophthalmic examination • Grading of Ocular Pathology

  7. Results • 537 patients (35%) • 19 patients excluded - severe cognitive impairment • 239 (46%) VISUALLY IMPAIRED

  8. Aetiology of Visual Impairment • Cataract 118 (49%) • Macular degeneration 51 (21%) • Uncorrected refractive error 40 (17%) • Glaucoma 8 (3%) • Other 22 (9%)

  9. Demographics • Significantly older (mean age 85 vs 79 yrs, p<0.001) • More in institutional care (28% vs 6%, p<0.001) • Mental state –Abbreviated Mental Test

  10. Ophthalmic History • Significantly fewer had optometrist contact in the preceding 3 years • (15% vs 29%, p < 0.001) • Significantly more visual complaints • (58% vs 26%, p < 0.001)

  11. Fall History • Previous 5 years falls more common (64% vs 49%, p < 0.001) • Fracture of opposite hip more common (9% vs 5%, p = 0.092) 97% of #NOF due to falls / accidents in whole group.

  12. Deprivation scores/Postal Codes • 1998 Scottish Deprivation Index Score > 9 (40% vs 26%, p < 0.001) • Visual Impairment more common in deprived areas

  13. Conclusions • Visual Impairment in #NOF more prevalent than in general population of same age • Most visual deficit potentially treatable • Poor access to ophthalmic / optometric care

  14. Implications • Visual assessment at every elderly fall/accident encounter • 75 year GP assessment • Cost of spectacles

  15. Acknowledgements A.Cox & C. J. McEwan – Ninewells D.Jones & D. Holding – Gartnavel K.Thompson & D. Holding – Crosshouse Thank You

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