Sir,

We read with interest the paper by Morris et al1 regarding 1-year incidence of serious eye injury in Scotland. The authors conclude that the incidence of serious ocular trauma requiring hospital admission for observation or treatment had decreased fourfold, from 8.14 per 100 000 in 1992 to 1.96 per 100 000 in 2009.1 They postulate that under-reporting may account for a portion of this difference, noting a discrepancy between the Scottish Morbidity Records (SMR01) admission data and those reported through the British Ophthalmic Surveillance Unit.

We would like to report the annual incidence of serious eye injuries in our tertiary unit in Scotland at a similar time. Our stand-alone unit receives all serious ocular trauma in Edinburgh and the Lothians. Patients were identified from the ward admission logbook and cross-checked with theatre logbooks to ensure consistency. We identified 71 cases of ocular trauma requiring hospital admission in Edinburgh between January 2005 and December 2008 inclusive. This gives an annual incidence of 2.17 per 100 000 of population.2

Visual outcomes at 12 months were obtained for 49 patients undergoing surgical repair of open-globe injury (Table 1). These were grouped by severity of initial ocular trauma, as categorised by the Ocular Trauma Score (OTS).3 Comparing our outcomes with those of the original OTS data, we found initial visual acuity (VA) to have a similar predictive value of final VA to the OTS-predicted outcomes (correlation coefficient 0.785 vs 0.720; Figure 1). Moreover, out of the OTS variables noted on initial examination, linear regression analysis showed the presence of a relative afferent pupillary defect (RAPD) to be the single greatest predictor of poor visual outcome (Table 2).

Table 1 Visual outcomes 12 months after injury
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Figure 1
figure 1

(a) Scattergraph plotting rank correlation of visual acuity at initial examination against final visual acuity. Correlation coefficient 0.785. (b) Scattergraph plotting rank correlation of OTS points allocated at initial examination against final visual acuity. Correlation coefficient 0.720.

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Table 2 Results of regression analysis on the our data
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Our data, gathered over 4 years, also demonstrate a reduced hospital admission rate for serious ocular trauma, supporting that of Morris et al. Prevention strategies, along with improvements in ocular trauma management, are likely to account for the reduced incidence and improved visual outcomes. Clinicians are reminded that initial VA and the presence of an RAPD are important prognostic indicators in ocular trauma.