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Sir, We read with interest Acar et al's1 article on their newly proposed paediatric penetrating ocular trauma score (POTS). The authors have designed POTS to be used specifically in paediatric penetrating injuries to prognosticate for future visual acuity (VA) rather than using the more widely recognised but non-specific ocular trauma score (OTS) designed by Kuhn et al2 as part of the United States Eye Injury Registry. We appreciate that the authors felt that the age of the patient and location of the wound were important prognostic factors and so included them in the scoring system. The authors decided to downscale the amount of points scored for initial VA due to problems that were inherently present when trying to obtain an accurate VA in children, especially those with a significant injury. They identified that the POTS was statistically significant in predicting final VA. As the article stands, the authors have not demonstrated any reasons why POTS should be used instead of OTS for paediatric penetrating injuries. VA still needs to be obtained to enter into the POTS system. We therefore suggest two ways in which POTS could be more rigorously tested to demonstrate any benefit. First, the POTS could be calculated without using the VA score. As the authors pointed out, the relationship between initial VA and final VA is statistically significant. It would be interesting to see whether POTS without any VA inclusion gives a statistically significant result or whether it is purely the initial VA prognostic factor that makes POTS statistically significant in predicting final VA. Second, the authors could apply the OTS to their data and compare the two scores directly to identify any benefit of one over the other. Unless a clear benefit of POTS over OTS can be demonstrated, there would be no reason to use POTS preferentially. As the authors demonstrated in their study, VA can usually be obtained in all but the very youngest children, and so it may be that VA is the most important factor and can be used as a stand-alone predictor of final VA. The authors declare no conflict of interest.

Comment on a new ocular trauma score in pediatric penetrating eye injuries