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 Population 2 1 Am J Epidemiology 2 BJO 1990

5. Previous studies 0.8% totally blind 21% partially sighted 42% no optician contact in last 5 years 3 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 Visually Impaired Visually >6/12 Normal139 (58%)244 (87%) Moderately Impaired 64 (27%)29 (10%) Severely impaired 36 (15%)6 (3%)

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