Epidemiology of severe ocular trauma following the implementation of alcohol restrictions in Far North Queensland

IMPORTANCE: Indigenous communities of Far North Queensland (FNQ) have one of the highest incidences of alcohol-related ocular trauma globally. BACKGROUND: To review the epidemiology of closed- and open-globe trauma admitted to Cairns Hospital from FNQ health districts following the implementation of alcohol restrictions in Indigenous communities. DESIGN: Retrospective study of cases from January 2014 to December 2018. PARTICIPANTS: A total of 142 cases identified from ICD-10 clinical-coding data. METHODS: Records were reviewed to determine demographics, clinical details and outcomes. MAIN OUTCOME MEASURES: Annual incidence by demography and ethnicity (Indigenous vs non-indigenous). RESULTS: Estimated annual incidence was 10.4/100 000 population (open-globe: 3.6/100 000, closed-globe: 6.8/100 000 population). Incidence rate ratio was 2.8× higher in Indigenous (22.8/100 000 population) compared to non-indigenous populations. Injury from assault was 8.2× higher in the Indigenous population. Alcohol was involved in 76% of assaults. Paediatric injuries comprised 20.4% of the cohort, with Indigenous children over-represented (44.8% of children). Visual acuity (VA) at presentation ranged from -0.08 logMAR to no-perception of light (NPL), with 41.8% poorer than +1.00 logMAR. Final VA ranged from -0.18 logMAR to NPL. Mean final VA was significantly better for closed- than open-globe injuries (+0.43 vs +1.01 logMAR). Ruptures had the poorest outcomes (mean +1.65 logMAR). CONCLUSIONS AND RELEVANCE: The overall incidence of severe ocular trauma in FNQ has decreased compared to that reported from 1995 to 2002. The extremely high incidence observed in the Indigenous communities of Cape York has decreased dramatically since the introduction of Alcohol Management Plans. Nevertheless, the Indigenous population still experiences significantly higher rates of severe ocular trauma, particularly from assault.