Combat Eye Trauma
Prevention, treatment, and rehabilitation of military eye injuries
One of the most prevalent yet less publicized areas of combat injury from Iraq and Afghanistan is eye trauma, primarily resulting from improvised explosive devices (IEDs) and other blasts. According to the Department of Veterans Affairs (VA) Office of Public Health, from Oct. 1, 2001, through Dec. 31, 2011, a total of 97,600 new veterans with military-related eye injuries entered the VA health system.
While the majority of those – about 72 percent, according to Tom Zampieri, Ph.D., director of government relations for the Blinded Veterans Association (BVA) – were classified as mild, “there are 9,000 retinal injuries, 4,843 service members with burn injuries to their eyes, more than 1,200 optic nerve injuries – which tend to come from brain penetration injuries – and 4,154 service members at very high risk of eventual blindness as a result of blast-related eye injuries.
“The VA should have more data now for the first half of 2012; I don’t know how much higher the number has grown in those six months, but surgeons in Afghanistan say about 16 percent of all wounded evacuated to Landstuhl [U.S. Regional Medical Center, Germany] have some form of eye trauma,” he added.
“An Air Force surgeon on his third combat deployment recently told me the magnitude of facial injuries from this war is unbelievable. In the past, people with such horrific injuries never would have made it off the battlefield alive. Today, they do and we have to figure out how to put a private’s face back together and often restore vision.”
In 2007, the BVA and other veterans and vision care groups lobbied Congress to create a Vision Center of Excellence (VCE). That was mandated in the National Defense Authorization Act of 2008, with Col. Don Gagliano, a retinal ophthalmologist, named as the center’s first executive director.
Headquartered at the new Walter Reed National Military Medical Center in Bethesda, Md., the VCE does not treat patients. Its mandate includes creating a military eye trauma registry, looking at long-term outcomes from surgery and other treatments, helping coordinate transfers between Department of Defense (DoD) and VA facilities for vision rehabilitation, and participating in peer reviews of defense-related eye trauma research grants.
“The reality is, it is very difficult for us to know exactly what the prevalence of eye injury is, because it is often intertwined with other polytrauma,” Gagliano said at the opening of the VCE, which is equally divided between VA and DoD personnel. “Early on, we elected to be a center that would work with and through the existing system rather than being a single place.
“It is very unique in structure and that is what allows us to function across both systems as effectively as we have. It helps us bring together the entire vision care team of both the Defense Department and the VA to function effectively as an integrated team … We are leading the nation in trying to determine the best ways to address these issues.”
When all veterans and all causes of vision problems are included, the VA’s Blind Rehabilitation Services (BRS) estimates there are some 157,000 U.S. veterans classified as legally blind and more than 1 million with low vision who have lost the ability to perform common daily tasks. While the immediate needs of those suffering eye trauma in combat today differ substantially from the needs of the overall veterans population, there are some common factors, making vision a major health care issue for veterans and the VA.
“Beginning in 2008, the VA implemented a progressive plan to expand vision and blind rehabilitation to veterans and eligible active duty service members with visual impairments, ranging from earliest vision loss to total blindness,” according to Blind Rehabilitation Services. “New programs in BRS provide opportunities to keep those with early vision loss active and integrated in their families and communities.