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Vision Care Service Coordinators Support Ocular Care Management

Image of Military health personnel giving an eye appointment. Click to open a larger version of the image. Air Force Maj. Brett Ringger, an optometrist from the Texas Air National Guard’s 136th Airlift Wing, tests a patient’s vision at a health-care clinic being operated by the Air National Guard and U.S. Navy Reserve at Lee County High School in Beattyville, Ky., June 23, 2018 (Air National Guard photo by Lt. Col. Dale Greer).

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Eye injuries that impact readiness come in all shapes and sizes - from minor shrapnel injuries, to getting hit with an object, to toxic chemicals splashed into the eyes.

The Defense Health Agency's Vision Center of Excellence vision care service coordinator team interacts with more than 11,000 serious eye or ocular injuries in service members each year, on average. These injuries are due to occupational, training, and conflict events.

Vision care service coordinators are located at Walter Reed National Military Medical Center in Bethesda, Maryland; Brooke Army Medical Center in San Antonio, Texas; and the Naval Medical Center in San Diego, California.

Each of these military hospitals has a full complement of ophthalmological subspecialists, such as retina, cornea, and ocular plastic surgery specialists, according to Helen White, a VCE branch chief. Additionally, those hospitals all have identical capabilities, and each has an assigned vision care service coordinator, she said.

The vision care service coordinators also work with military hospitals and clinics across the United States and overseas to assist with ocular care management needs.

In addition to service member care coordination support services for those with vision-threatening conditions such as ocular trauma and other vision loss injuries, the staff provides support for other beneficiaries with high-risk conditions, such as retinopathy of prematurity. This condition affects the development of the retina in babies born before 31 weeks with low birth weights, and requires frequent follow-up and specialized treatment to assure the best visual outcomes, White said

"Vision care service coordinators understand the unique needs of patients with complex eye injuries and vison dysfunctions and are dedicated to ensuring that they get the specialized care they need to aid and facilitate the patient's optimum vision outcome," said White. This includes collaboration and coordination between the Military Health System and the Department of Veterans Affairs, she added.

Military health personnel giving an eye appointment
Air National Guard Optometrist, Capt. Jill Holler, assigned to the Ohio National Guard’s 180th Fighter Wing, conducts a vision screening for Master Sgt. Christopher Ice, a health systems specialist also assigned to the 180FW (Air National Guard Photo by Senior Master Sgt. Beth Holliker).

The vision care service coordinator reaches out and offers ocular care management support to care managers assigned to patients with ocular injuries and conditions treated at military hospitals. And they work with VA liaisons at military hospitals to facilitate the transfer of eligible service members to Department of Veterans Affairs services, such as the VA low-vision telemedicine program or the Blindness Rehabilitation Service, White said.

Vision care service coordinators support the service member and their family to understand that there is life after eye injury, she added.

They work with the VCE's blind rehabilitation staff to develop tools and resources to better assist military hospital staff that support service members, White explained.

She noted, "On the outpatient level, the service members may have limited access to or information on low-vision equipment and support services. The clinic staff may also have a limited list of resources in geographical areas." Vision care service coordinators are well-versed in these special needs and have access to local and regional resources.

VCE is tasked with implementing and managing a registry of information to track diagnoses, interventions and 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 & Veterans Eye Injury Vision Registry, or DVEIVR, was developed to address this requirement. Vision care service coordinators have access to patients enrolled in the DVEIVR so they can assist in helping identify their ocular care coordination needs.

Dr. David Eliason, an ophthalmologist and deputy division chief for VCE, explained how the hope for the future is how the registry will be used more for coordinating patient care.

"A potential point is that the registry could assist clinicians and caregivers in military treatment facilities in early identification of the ocular care coordination needs between the MTFs and VA for our service members," he said.

"The collaborative and cohesive working environment of DOD and VA staff facilitates the mission of VCE and strengthens our relationship with VA in support of our service members and veterans. Our VA partnership enhances our ability to serve the service member from injury through rehabilitation in support of optimizing the patient's vision outcomes," Eliason said.

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