Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

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)

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...

Article
Jul 1, 2023

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries Among Non-Service Member Beneficiaries of the Military Health System, 2022

This report represents an updated summary of care provided to non-service members in the MHS during calendar year 2022. MHS beneficiaries are diverse and heterogeneous, including active component service members, activated National Guard and Reserve service members, active component immediate family, retirees, and their family members, with differing ...

Article
Jul 1, 2023

Medical Evacuations out of U.S. Central and U.S. Africa Command Among Active and Reserve Components, U.S. Armed Forces, 2022

This report summarizes the nature, numbers, and trends of conditions for which military members were medically evacuated from the U.S. Central Command (CENTCOM) or Africa Central Command (AFRICOM) operations during 2022, with historical comparisons to the previous four years.

Article
Jul 1, 2023

Morbidity Burdens Attributable to Various Illnesses and Injuries Among Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2022

This annual estimate of illness- and injury-related morbidity and health care burdens on the U.S. Armed Forces and MHS updates previous analyses of these burden distributions among active and reserve component service members in deployed settings. This report focuses on the health encounters of service members during deployment to U.S. Central Command ...

Report
Jun 1, 2023

MSMR Vol. 30 No. 6 - June 2023

.PDF | 1.55 MB

This annual issue quantifies the impacts of various illnesses and injuries in 2022 among members of the active component of the U.S. Armed Forces as well as the U.S. Coast Guard; health care burden metrics include the total number of medical encounters, including hospitalizations and ambulatory services, as well as numbers and types of individuals ...

Article
Jun 1, 2023

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries Among Active Component Members, U.S. Armed Forces, 2022

This annual summary uses several health care burden measures to quantify the impacts of various illnesses and injuries in 2022 among members of the active component of the U.S. Armed Forces. Health care burden metrics include the total number of medical encounters, individuals affected, and hospital bed days.

Article
Jun 1, 2023

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries Among Active Component Members, U.S. Coast Guard, 2022

This report employs the same disease classification system and health care burden measures as employed in the MSMR burden analysis of the U.S. Armed Forces active component to quantify the impacts of various illnesses and injuries among members of the active component of the U.S. Coast Guard in 2022.

Report
May 1, 2023

MSMR Vol. 30 No. 5 - May 2023

.PDF | 1023.59 KB

The May 2023 MSMR reintroduces a monthly reportable medical event (RME) summary for the active component and MHS beneficiaries; then features a review of enhanced mpox outbreak case detection among MHS beneficiaries through ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics); followed by a report on ...

Skip subpage navigation
Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery