Researchers have found a strong association between ocular trauma in geriatric patients and increased 5-year mortality. Specifically, a retrospective cohort study, led by researchers at the University of North Carolina, analyzed outcomes in 1,668 patients ages 65 and older and found that those with a history of eye trauma had significantly higher mortality rates than those with nontraumatic cataracts.

Using the I2B2 Carolina Data Warehouse, researchers compared 2 patient cohorts:

• Study group: 602 patients ages 65 and older with ocular trauma (including globe, orbital, and adnexal injuries)
• Control group: 1,066 patients of similar age with age-related nuclear cataracts

To ensure a balanced comparison, a postmatching cohort was created using 1:1 covariate matching based on cardiovascular and neurological comorbidities, which resulted in 141 matched patients per group.

Among prematching mortality rates, the researchers found 5-year mortality was 11.3% in the trauma group vs 6.47% in controls. No significant differences were observed at years 2, 3, or 5, but the 1-year mortality rate was 4.15% (trauma) vs 1.03% (controls). Four-year mortality was also significant at 2.54% (trauma) vs 0.88% (controls).

Postmatching overall mortality was 48.2% in the trauma group vs 13.5% in controls. When the investigators broke out the rates by gender, they found rates of 43% (trauma) vs. 11% (controls) in female participants and 58% (trauma) vs. 17% (controls) in male participants.

Mortality differences were most pronounced in patients aged 70 to 89, according to the study. Participants with ocular trauma had a 33% rate of mortality compared with 10.6% in controls. That rate jumped to 55% in participants who were in their 80s and had ocular trauma, compared with 15.1% in controls. No significant differences were found in participants who were 65 to 69 or 90+.

Among matched patients, ocular trauma patients with specific comorbidities exhibited markedly higher mortality:

• Dementia: 92% mortality in trauma group vs 0% in controls
• Ischemic heart disease: 84% vs 0%
• Heart failure: 67% vs 0%
• Hypertensive heart disease: 56% vs 0%
• Diabetes: 53% vs 19%

“Ocular trauma may serve as a sentinel event signaling underlying frailty rather than a direct cause of mortality,” the study authors wrote. They added that such trauma could reflect impaired reflexes, neurodegeneration, and cognitive deficits—especially when it results from falls.

Notably, most increased mortality occurred within the first year following trauma.

“Significantly higher mortality rates in patients with ocular trauma underscore the potential of vision screening by trauma providers, facilitating timely referrals for management of chronic conditions,” the authors continued. Interventions could include multidisciplinary fall prevention strategies and posttrauma screening for fall risk and systemic decline.

The study cohort was predominantly White and derived from a single health care system, which may limit generalizability. Additionally, factors such as socioeconomic status and prior visual acuity were not directly controlled but may influence mortality outcomes.

Despite these limitations, the authors conclude that the findings highlight a potentially underrecognized consequence of ocular trauma in the elderly and support its consideration as a high-risk event requiring comprehensive follow-up. OM

Source: PLOS ONE