Army Maj. Marcus Colyer, a vitreoretinal surgeon at the Walter Reed National Military Medical Center in Bethesda, Md., teaches an Ocular Trauma Course to ophthalmology residents at the Uniformed Services University of the Health Sciences, the training ground for future military and combat medical leaders. 

“Ocular trauma surgery is probably the most challenging of all surgeries to undertake,” said Colyer. “Engineering has advanced substantially during the past 20 years to use smaller and more effective instruments to perform vitrectomy, the surgery which removes the internal tissues of the eye in trauma. Illumination and surgical microscopes have also improved to facilitate better surgery.” 

There is a need for specialized courses focusing on teaching the basics of trauma management and surgery, according to Dr. Robert Mazzoli, an ocular plastic and reconstructive surgical specialist. He is the director of education, training, simulation and readiness at the Department of Defense’s Vision Center of Excellence. “It is particularly critical that military ophthalmologists maintain that expertise for wartime.” 

In wartime, a first responder provides aid to a service member at the point of injury and identifies if an ocular injury requires further care. The first responder manages and expedites the patient’s transfer to an ophthalmic surgeon. Ocular trauma is any event that causes damage to the delicate structures of the eye and surrounding tissues. "While ocular trauma may lead to severe vision loss, vision is maximized by proper early treatment by ophthalmologists," said Mazzoli. 

However, steps must be taken at the point of impact to prevent further injury during transport. A VCE training program called “Shield and Ship” reminds first responders not to place pressure on the eye and to protect it by covering it with a rigid eye shield and avoid applying ointment or drops to the eye. 

For the past three years, Colyer has used a surgery simulator prototype during training on loan from Massachusetts General Hospital in Boston. “The simulator was initially designed to incorporate the eyeball and the eyelid, and eye socket trauma,” said Mazzoli. “They had to start somewhere so they focused on the eyelid first. Later it was expanded to include facial and jaw injuries as well.” 

Colyer agreed and said the current focus of the simulator is eyelid injuries, but they are developing some early prototypes of critical ocular injuries such as corneal laceration.

Nearly all active duty military ophthalmologists have completed the Ocular Trauma Course. More than 80, approximately one quarter of all military ophthalmologists, attended this year. All military residents attend the course during their second year of training and after they have acquired basic surgical skills before performing surgeries on patients, Colyer said. 

The VCE integrates vision care in the Department of Defense and Department of Veterans Affairs health care systems. Its primary function is to provide optimal care coordination and to improve vision health, optimize operational readiness and enhance the quality of life for injured service members and veterans.  They work closely with eye surgeons at Walter Reed, faculty members at the medical university and medical groups throughout the Military Health System.