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The Vision Center of Excellence (VCE) recently released a new clinical recommendation and support tools to help eye care providers identify and treat Service members and Veterans who have sustained eye- or vision-related disturbances following a blast exposure or Traumatic Brain Injury (TBI).

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Indirect traumatic optic neuropathy (ITON) refers to optic nerve injury resulting from impact remote to the optic nerve. The mechanism of injury is not understood, and there are no confirmed protocols for prevention, mitigation or treatment. Most data concerning this condition comes from case series of civilian patients suffering blunt injury, such as from sports- or motor vehicle-related concussion, rather than military-related ballistic or blast damage. Research in this field will likely require the development of robust databases to identify patients with ITON and follow related outcomes, in addition to both in-vivo animal and virtual human models to study the mechanisms of damage and potential therapies.

This memo outlines how VCE will continue to work alongside both military and civilian organizations to ensure that only evidence-based management and equipment is used in the event of ocular trauma.

As much as we depend on our mobile devices for viewing and responding to emails, checking the weather, reading headline news and posting status updates on Facebook, our smartphones may be causing vision problems. Staring at those tiny screens can bring on an array of eye issues, such as blurred vision, headaches, sore eyes, headaches, muscle strain and dry eye.

The Defense Department wants service members to take care of their eyes by wearing eye protection when performing dangerous work, reducing eye strain and routinely undergoing eye examinations.

Concussion can cause changes to vision that are sometimes overlooked during an initial medical evaluation. Vision experts stress that eye exams should be part of the diagnosis and treatment of mild traumatic brain injury (TBI).

For military service members suffering eye trauma anywhere in the world, it is important to find a facility where an ophthalmic surgeon can operate on the eye quickly. It is also important to make sure that patients get timely follow-on care with the right ocular specialists as service members make their way home. Jo Ann Egan is the Vision Care Services Coordinator for the Department of Defense Vision Center of Excellence (VCE) located at the Walter Reed National Military Medical Center in Bethesda, Maryland.

Given the potential for biologic warfare, an understanding of its health consequences including those related to ocular health is vital for training and containment efforts.

U.S. Navy Capt. Penny Walter, executive director, VCE, spoke at the National Museum of Health and Medicine during Healthy Vision Month on May 26, 2015 on certain types of eye injuries and the treatments being developed to repair vision for service members.

The Ocular Trauma Course at the Uniformed Services University of the Health Sciences helps prepare military ophthalmologists by allowing them to practice new techniques on simulators.

Ocular injury requires expert care and treatment by an ophthalmologist. The primary role of the non-ophthalmologist is to suspect and identify an ocular injury that requires further care and to expedite transfer, minimizing added trauma along the way.

Education and training for Service members and civilians are key to proper identification and response to chemical weapon attacks.

If there is suspicion of an ocular wound, first responders should place the shield over the eye and secure it in place with tape without placing anything under the shield. The addition of the eye-shield to the Individual First Aid Kit is important as first responders to an injury are often fellow Service members.

Serious eye injuries can occur at home, at work and on the battlefield. Since 2000, preventing and tracking of military-related eye injuries has become an area of increased focus for the Tri-Service Vision Conservation and Readiness Program.

To help primary care providers assess and manage patients complaining of vision problems, the Vision Center of Excellence (VCE), in collaboration with Defense and Veterans Brain Injury Center (DVBIC), a center of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCOE), developed a clinical recommendation and reference card, “Assessment and Management of Visual Dysfunction Associated with Mild TBI Reference Card and Clinical Recommendation.”

Wounded warriors with traumatic eye injuries may have a chance to see again with the support of a new research effort called the Horus Vision Restoration Project coordinated by the U.S. Army Medical Research and Materiel Command.

The VCE’s Worldwide Ocular Trauma Video Teleconference (VTC) is a monthly meeting where providers and support organizations discuss ocular trauma cases from point of injury through the most recent level of care.

Combat is an extremely visual task and therefore, keratoconus is an operationally-important diagnosis that carries a number of mission-relevant consequences. Additionally, the rise in sophisticated battlefield technology reliant on vision (e.g., computer screens), creates an environment in which Service members are increasingly dependent upon maintaining vigilance in their visual processing.

Veterans with blast-induced traumatic brain injury (TBI) reported poorer vision quality on questionnaires, according to a report by Sonne Lemke, Ph.D., of the VA Palo Alto Health Care System, Menlo Park, Calif., and colleagues.

The use of contact lenses in environmentally unpredictable, austere and unhygienic environments inherently found in field conditions and combat theaters (i.e., dry, dusty, dirty), places vision health at an unnecessary risk for injury or even permanent vision loss.

Congress will boost funding for research and treatment of battlefield eye injuries to $10 million for the remainder of 2013.
Congress Budgets $10M for Eye-Injury Research , Military.com, April 4, 2013

Military and Veteran Affairs Department officials are launching a first-of-its-kind eye injury and vision registry to help improve care for the many service members who have returned home from war with ocular damage.

Service members of the U.S. Armed Forces and veterans are affected by many visually disabling conditions, including combat eye injury, traumatic brain injury (TBI)-related visual dysfunction, and age-related eye diseases.

In August 2011, the DoD/VA Vision Center of Excellence Consensus Conference on Technology for the Visually Impaired addressed the opportunities and challenges related to digital information technologies, the impact of current federal regulations, and tips for ensuring information technologies are accessible and usable to all persons with a disability.

Soldiers whose eyes are injured during combat have a better chance of returning to duty with their vision intact due to some revisions in the Army's first-aid kit.

President of the United States of America proclaimed October 15, 2013, as Blind Americans Equality Day. Read the transcript from the speech.

This is part one of a two-part series about three Soldiers who were blinded in combat and their journeys back to active duty.

Dr. Robert Mazzoli, MD, FACS, Director of Education, Training, Simulation and Readiness for the Vision Center of Excellence (VCE), was the invited keynote speaker at the Optometric Council on Refractive Technology (OCRT) Annual Meeting held in conjunction with the 2013 annual meeting of the American Academy of Optometry (AAO) in Seattle, Washington.

Next month will mark a major milestone in advancing care for wounded warriors suffering debilitating eye injuries with a ribbon-cutting at the Walter Reed National Military Medical Center in Bethesda, Md.

Ten years of conflict has given rise, not only to the world’s best body armor and state-of-the-art battlefield technologies, but also a new understanding about ways to prevent eye injuries and treat those who suffer from them.

The Vision Center of Excellence (VCE) participated in the annual Blinded Veterans Association (BVA) Conference in Spokane, Washington, August 19 – 23 2013