Skip to main content

Military Health System

Editorial: The Department of Defense/Veterans Affairs Vision Center of Excellence

Image of U.S. Army Spc. Angel Gomez, right, assigned to Charlie Company, 173rd Brigade Support Battalion, wraps the eye of a fellow Soldier with a simulated injury, for a training exercise as part of exercise Saber Junction 16 at the U.S. Army’s Joint Multinational Readiness Center in Hohenfels, Germany, April 5, 2016. Saber Junction is a U.S. Army Europe-led exercise designed to prepare U.S., NATO and international partner forces for unified land operations. The exercise was conducted March 31-April 24. (U.S. Army photo by Pfc. Joshua Morris). U.S. Army Spc. Angel Gomez, right, assigned to Charlie Company, 173rd Brigade Support Battalion, wraps the eye of a fellow Soldier with a simulated injury, for a training exercise as part of exercise Saber Junction 16 at the U.S. Army’s Joint Multinational Readiness Center in Hohenfels, Germany, April 5, 2016. Saber Junction is a U.S. Army Europe-led exercise designed to prepare U.S., NATO and international partner forces for unified land operations. The exercise was conducted March 31-April 24. (U.S. Army photo by Pfc. Joshua Morris)

Recommended Content:

Medical Surveillance Monthly Report | Centers of Excellence

Vision and visual function are essential for performance across multiple activities. When vision is compromised, it can negatively affect behavioral health, social functioning, and overall quality of life.1 Studies have also linked decreased visual function to increased mortality.2 In military populations, optimal visual function is required for demanding tasks ranging from effective weapons utilization3 to aircraft-based flight operations.4

Ocular injuries present a particular problem for service members and the providers charged with their care. These injuries are associated with a substantial cost in terms of resources, rehabilitation, and training.5 In response to the need for increased focus on ocular injuries and their treatment across the continuum of care, the Department of Defense (DOD)/Veterans Affairs (VA) Vision Center of Excellence (VCE) was established by congressional mandate in 2008 under the National Defense Authorization Act (Public Law 110-181, Section 1623) as a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of military eye injuries, including visual dysfunction related to traumatic brain injury (TBI).6 Consistent with the requirement of all Defense Centers of Excellence to provide expertise across the entire clinical spectrum of care for a patient, the VCE addresses the full scope of vision care, from the prevention of diseases and treatment of clinical conditions through rehabilitation and transition to civilian life.7

The VCE continually executes initiatives in support of the 2008 mandate. In 2015, the VCE collaborated with the Joint Trauma System (JTS), the Committee on Tactical Combat Casualty Care (TC3), and the Defense Health Agency's Medical Logistics Division to increase the availability of rigid eye shields in the individual first aid kit. These eye shields are essential for preventing further damage to a traumatized eye until definitive treatment is available. This effort to increase the availability of rigid eye shields resulted in changes to the TC3 card (DD Form 1380) to allow for documentation of eye shield use (check boxes for eye shield use).8 In further collaboration with the JTS, the VCE has initiated and/or contributed to multiple clinical practice guidelines (CPGs) designed to provide best care practices across the spectrum of ocular injuries. For example, the "Ocular Injuries and Vision-Threatening Conditions in Prolonged Field Care" CPG is currently available at https://jts.amedd.army.mil/index.cfm/PI_CPGs/cpgs, and the "Evaluation and Disposition of Temporary Visual Interference and Ocular Injury after Suspected Ocular Laser Exposure" CPG is pending publication on the JTS website.

A specific area of focus mandated to the VCE is visual dysfunction following TBI. To address this complex set of conditions, the VCE, in collaboration with a panel of experts in vision, rehabilitation, and TBI across the DOD, VA, and the civilian sector's diverse group of subject matter experts, including the Defense and Veterans Brain Injury Center, oversaw the production of clinical recommendations and associated clinical support tools for the care of visual dysfunction after TBI. These aids to clinical care include "Eye and Vision Care Following Blast Exposure and/or Possible Traumatic Brain Injury", "Care of Visual Field Loss Associated with Traumatic Brain Injury", and "Care of Oculomotor Dysfunctions Associated with TBI". 9–11 In coordination with the Uniformed Services University of the Health Sciences, the VCE is conducting a review of current visual dysfunction documentation, intervention options, and best practices. The article on visual dysfunction following TBI in this issue of the MSMR was developed to provide additional information on this diverse set of conditions, update current recommendations, and inform future clinical and research efforts.12

The VCE established the World Wide Ocular Trauma and Readiness Curriculum Teleconference to engage international, multiagency, and cross-specialty attendees spanning multiple sites in review of vision cases and identification of clinical process improvements. The monthly calls serve as a key platform for providing feedback and follow-up to deployed providers and for developing and disseminating best practices and clinical lessons learned.

In order to ensure continuity of care from injury through rehabilitation, the VCE developed a collection of reference guides that include vision resources across the DOD and VA as well as at the state and national level. The "Vision Care Coordination Reference Guide" expands network capabilities between stakeholders, increases partnerships, and enables care coordinators to assist in a rapid and thorough response to the patient population requiring trauma and vision care specialties. In addition, the VCE produces fact sheets to educate the care community to assist with engaging a visually impaired patient.

With continued emphasis on military readiness, the VCE is expanding focus beyond combat-related traumatic conditions to include disease and non-battle injuries. Ocular and vision-related conditions can have great impact on readiness and retention. The first article in this issue characterizes the burden of ocular and vision conditions and was developed to provide a broad overview of these conditions.13 This information will provide key information to guide further initiatives and programs across the Military Health System.

The VCE was tasked with implementing and managing a registry of information to track diagnoses, interventions/treatments, and follow-up for each case of significant eye injury sustained by a member of the Armed Forces while serving on active duty. The Defense Vision and Eye Injury and Vision Registry (DVEIVR) was developed to address this requirement. Registry data are available to ophthalmological and optometric personnel of the DOD and VA for purposes of encouraging and facilitating the conduct of research and the development of best practices and clinical education on eye injuries incurred by members of the Armed Forces in combat. Registry data have been used by DOD and academic institutions to better characterize the complex field of ocular trauma. DVEIVR data are also shared with the VA Blind Rehabilitation Service to maximize continuity of care. The VCE is currently incorporating DVEIVR data along with other data sources focused on providing evidence-based care recommendations.

The VCE continually strives to improve the recognition and management of ocular injuries and vision-threatening conditions across military and veteran populations. Such efforts supporting improved care and coordination of care are essential for maintaining the visual performance of U.S. service members and veterans. Additional information on the VCE and its products is available at https://vce.health.mil/. Further inquiries can be sent via email to dha.ncr.dod-va.mbx.vce@mail.mil.

References

  1. Nyman SR, Gosney MA, Victor CR. Psychosocial impact of visual impairment in working-age adults. Br J Ophthalmol. 2010;94(11):1427–1431.
  2. Taylor HR, McCarty CA, Nanjan MB. Vision impairment predicts five-year mortality. Trans Am Ophthalmol Soc. 2000;98;91–99.
  3. Hatch BC, Hilber DJ, Elledge JB, Stout JW, Lee RB. The effects of visual acuity on target discrimination and shooting performance. Optom Vis Sci. 2009;86(12):e1359–e1367.
  4. Tanzer DJ, Brunstetter T, Zeber R, et al. Laser in situ keratomileusis in United States Naval aviators. J Cataract Refract Surg. 2013;39(7):1047–1058.
  5. Frick KD, Singman EL. Cost of military eye injury and vision impairment related to traumatic brain injury: 2001–2017. Mil Med. 2019;184(5–6):e338–e343.6. National Defense Authorization Act for Fiscal Year 2008, Public Law 110–181, section 1623. 2008.
  6. United States Government Accountability Office. GAO-16-54, Centers of Excellence: DOD and VA Need Better Documentation of Oversight Procedures. https://www.gao.gov/assets/680/673936.pdf. Published 2 Dec. 2015. Accessed 28 Aug. 2019.
  7. Defense Health Agency. Procedural Instruction 6040.01. Implementation Guidance for the Utilization of DD Form 1380, Tactical Combat Casualty Care (TCCC) Card, June 2014. 20 Jan. 2017.
  8. Department of Defense/Veterans Affairs Vision Center of Excellence. Clinical Recommendations for the Eye Care Provider. Eye and Vision Care Following Blast Exposure and/or Possible Traumatic Brain Injury. https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations/Eye-Care-and-TBI. Revised 24 Nov. 2015. Accessed 05 Aug. 2019.
  9. Department of Defense/Veterans Affairs Vision Center of Excellence. Clinical Recommendation for the Eye Care Provider and Rehabilitation Specialists. Rehabilitation of Patients with Visual Field Loss Associated with Traumatic or Acquired Brain Injury. https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations/VFL. Revised 27 April 2016. Accessed 05 Aug. 2019.
  10. Department of Defense/Veterans Affairs Vision Center of Excellence. Clinical Recommendation for the Eye Care Provider. Assessment and Management of Oculomotor Dysfunctions Associated with Traumatic Brain Injury. https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations/Oculomotor. Revised 13 Dec. 2016. Accessed 05 Aug. 2019.
  11. Reynolds ME, Barker II FM, Merezhinskaya N, Oh G, Stahlman S. Incidence and temporal presentation of visual dysfunction following diagnosis of traumatic brain injury, active component, U.S. Armed Forces, 2006-2017. MSMR. 2019;26(9):13–24.
  12. Reynolds ME, Williams VF, Taubman SB, Stahlman S. Absolute and relative morbidity burdens attributable to ocular and vision-related conditions, active component, U.S. Armed Forces, 2018. MSMR. 2019;26(9): 4–11.

You also may be interested in...

Case Report: Tick-borne Encephalitis Virus Infection in Beneficiaries of the U.S. Military Healthcare System in Southern Germany

Article
11/1/2019
A paratrooper with 1st Squadron, 91st Cavalry Regiment, 173rd Airborne Brigade lies concealed in a forest and observes his target during a combined sniper exercise with the British Army's 1st Battalion, Royal Irish Regiment as part of Exercise Wessex Storm at the 7th Army Joint Multinational Training Command's Grafenwoehr Training Area, Germany, July 30, 2015. Wessex Storm is an annual maneuver exercise for British forces, integrating NATO allies and partners. (U.S. Army photo by Visual Information Specialist Gertrud Zach/released)

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Trends in Opioid Prescription Fills Among U.S. Military Service Members During Fiscal Years 2007–2017

Article
10/1/2019
U.S. Air Force Tech Sgt. Ryan Marr, 18th Medical Group pharmacy craftsman, processes prescriptions, June 8, 2018, at Kadena Air Base, Japan. The pharmacy processes and fills prescriptions for hundreds of different medical needs. (U.S. Air Force photo by Staff Sergeant Jessica H. Smith) Merriam/Released)

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Influenza Immunization Among U.S. Armed Forces Healthcare Workers, Aug. 2014–April 2019

Article
10/1/2019
181129-N-GR847-3000 ARABIAN GULF (Nov. 29, 2018) Hospitalman Jay Meadows, from Weaver, Ala., administers an influenza vaccine to a Sailor during a regularly scheduled deployment of the Essex Amphibious Ready Group (ARG) and 13th Marine Expeditionary Unit (MEU). The Essex ARG/13th MEU is flexible and persistent Navy-Marine Corps team deployed to the U.S. 5th Fleet area of operations in support of naval operations to ensure maritime stability and security in the Central Region, connecting to the Mediterranean and the Pacific through the western Indian Ocean and three strategic choke points. (U.S. Navy photo by Mass Communication Specialist 3rd Class Reymundo A. Villegas III)

Recommended Content:

Medical Surveillance Monthly Report

Measles, Mumps, Rubella, and Varicella Among Service Members and Other Beneficiaries of the Military Health System, 1 Jan. 2016–30 June 2019

Article
10/1/2019
U.S. Air Force Airmen of the 163d Attack Wing line up to  receive a flu vaccine at March Air Reserve Base, California, Nov. 4, 2018. The flu vaccine is an annual requirement for military members to help curb the spread of the flu and limit its impact within the unit. (U.S. Air National Guard photo by Tech. Sgt. Julianne M. Showalter)

Recommended Content:

Medical Surveillance Monthly Report

Animal Bites and Rabies Post-exposure Prophylaxis, Active and Reserve Components, U.S. Armed Forces, 2011–2018.

Article
10/1/2019
Big Brown Bat stock photo (iStock.com)

Animal Bites and Rabies Post-exposure Prophylaxis, Active and Reserve Components, U.S. Armed Forces, 2011–2018

Recommended Content:

Medical Surveillance Monthly Report

Incidence and Temporal Presentation of Visual Dysfunction Following Diagnosis of Traumatic Brain Injury, Active Component, U.S. Armed Forces, 2006–2017

Article
9/1/2019
SAN DIEGO (April 6, 2017) Cmdr. John Cason, program director Navy Refractive Surgery, performs the second Small Incision Lenticular Extraction (SMILE) procedure at Naval Medical Center San Diego. The SMILE procedure is the latest advancement in refractive surgery for correcting myopia or nearsightedness. (U.S. Navy photo by Mass Communication Specialist 1st Class Elizabeth Merriam/Released)

Recommended Content:

Medical Surveillance Monthly Report

Incidence and Prevalence of Selected Refractive Errors, Active Component, U.S. Armed Forces, 2001–2018

Article
9/1/2019
U.S. Army Spc. Angel Gomez, right, assigned to Charlie Company, 173rd Brigade Support Battalion, wraps the eye of a fellow Soldier with a simulated injury, for a training exercise as part of exercise Saber Junction 16 at the U.S. Army’s Joint Multinational Readiness Center in Hohenfels, Germany, April 5, 2016. Saber Junction is a U.S. Army Europe-led exercise designed to prepare U.S., NATO and international partner forces for unified land operations. The exercise was conducted March 31-April 24. (U.S. Army photo by Pfc. Joshua Morris)

Recommended Content:

Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens Attributable to Ocular and Vision-Related Conditions, Active Component, U.S. Armed Forces, 2018

Article
9/1/2019
Senior Airman Breanna Daniels, 559th Medical Group optometry technician, takes images of Tech. Sgt. Stephanie Edmiston, 559th MDG trainee health flight chief, during an eye exam Oct. 19 at the Reid Clinic on Joint Base San Antonio-Lackland, Texas. The 559th MDG is home to the largest optometry and public health flight in the Department of Defense; the DOD's first military training consultation service. (U.S. Air Force photo/Staff Sgt. Kevin Iinuma)

Recommended Content:

Medical Surveillance Monthly Report

Incident and Recurrent Cases of Central Serous Chorioretinopathy, Active Component, U.S. Armed Forces, 2001–2018

Article
9/1/2019
A patient looks through a phoropter at Hurlburt Field, Fla., Jan. 9, 2017. A phoropter is an instrument used to determine an individual’s eyeglass prescription by measuring the eye’s refractive error and switching through various lens until the persons vision is normal. (U.S. Air Force photo by Airman Dennis Spain)

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Incidence of Rickettsial Diseases Among Active and Reserve Component Service Members, U.S. Armed Forces, 2010–2018

Article
8/1/2019
Digitally colorized scanning electron microscope image depicting a grouping of numerous, Gram-negative anaerobic Borrelia burgdorferi bacteria derived from a pure culture. Credit: CDC/Claudia Molins

Recommended Content:

Medical Surveillance Monthly Report

Epidemiology of Impulse Control Disorders and Association With Dopamine Agonist Exposure, Active Component, U.S. Armed Forces, 2014–2018

Article
8/1/2019
A dopamine molecule

Recommended Content:

Medical Surveillance Monthly Report

Historical Review: Rickettsial Diseases and Their Impact on U.S. Military Forces

Article
8/1/2019
Digitally colorized scanning electron microscope image depicting a grouping of numerous, Gram-negative anaerobic Borrelia burgdorferi bacteria derived from a pure culture. Credit: CDC/Claudia Molins

Recommended Content:

Medical Surveillance Monthly Report

Evaluation of Serological Testing for Lyme Disease in Military Health System Beneficiaries in Germany, 2013–2017

Article
8/1/2019
Dorsal view of a female American dog tick, Dermacentor variabilis. Credit: CDC/Gary O. Maupin

Recommended Content:

Medical Surveillance Monthly Report

Update: Routine Screening for Antibodies to Human Immunodeficiency Virus, Civilian Applicants for U.S. Military Service and U.S. Armed Forces, Active and Reserve Components, Jan. 2014–June 2019

Article
8/1/2019
A hospitalman draws blood at Naval Medical Center Portsmouth’s Laboratory Department. DoD Photo

Recommended Content:

Medical Surveillance Monthly Report

Commentary: Gaps in Reportable Medical Event Surveillance Across the Department of the Army and Recommended Training Tools to Improve Surveillance Practices

Article
8/1/2019
Cover 1

Recommended Content:

Medical Surveillance Monthly Report
<< < ... 11 12 13 14 15  ... > >> 
Showing results 196 - 210 Page 14 of 17
Refine your search
Last Updated: October 31, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery