Group fights to address increase in combat eye injuries

As the military health system addresses an increase in head injuries sustained in Iraq and Afghanistan, many of the wounded could be at risk of a severe complication: vision loss or complete blindness.

The Blinded Veterans Association (BVA), a congressionally chartered organization, is sounding the alarm about wounded soldiers whose visual problems go undetected and untreated, leading not only to premature degenerative eye conditions, but also to lifelong disability with psychological implications.

One of the BVA’s primary concerns is that there is no accurate information on how many direct eye-trauma cases result from the wars in Iraq and Afghanistan. Nor is there a central tracking system to ensure those affected are free of serious complications after leaving the hospital and being discharged from the military, or even redeployed.

The BVA is stepping up its lobbying efforts on Capitol Hill to influence legislation that would establish a military eye-injury registry and set up a joint traumatic brain-injury optometry screening program between the Pentagon and the Department of Veterans.

BVA’s director of government relations, Thomas Zampieri, said he is looking at the now-stalled Senate defense authorization bill and the appropriations markup process in the upper chamber.

Instances of two types of eye injuries have become more prevalent, especially given the commonness of roadside bombs in Iraq: direct blast injury to the eye and traumatic brain injury, in which the eyes do not necessarily suffer cuts or contusions but severe brain concussion affects nerve pathways related to sight.

Between 2001 and 2007, data recorded by the military shows 936 members of the military have been reported to have battle-related eye injuries, ranging from open wounds to contusions and burns.

More than 16 percent of all casualties evacuated from Iraq sustained eye injuries, according to data compiled between 2003 and 2005. The Walter Reed hospital in the last five years has surgically treated about 700 soldiers with blindness or moderate-to-severe visual injuries. The Bethesda National Naval Medical Center lists more than 450 eye injuries that have required surgery.

Such numbers reflect injuries requiring immediate optical surgery and care, but mild-to-severe head injuries can fail to get appropriate attention until it is too late to correct them. Visual disorders associated with traumatic brain injury (TBI) include diplopia (double vision), convergence disorder (an eye-muscle disorder affecting near vision), photophobia (light sensitivity), ocular-motor dysfunction (also an eye-muscle disorder) and an inability to interpret print.  

Losing depth perception can be one of the most devastating long-term effects of eye injuries, according to Zampieri.

Rep. John Boozman (R-Ark.), a trained optometrist with a focus on eye injuries who has visited Water Reed, told The Hill that the war in Iraq presents an “unusual” phenomenon in eye-related injuries.

The injured may experience low reading speeds, inability to concentrate and an inability to process visual information.
“As we try to get [some soldiers] back into deployment, it is frustrating if they do not know what is wrong,” he said. “They do not understand it and the people they work with do not understand it.”

Boozman stressed that much research is needed to understand what is happening and learn how to treat the conditions.
He said he is talking to the Department of Defense and the Department of Veterans Affairs to establish a pilot program to identify the harder-to-detect problems.

Many patients could exhibit sound ocular health following a TBI, but it is important to perform neuro-optometric exams.
The legislation BVA is targeting seeks $5 million over five years to establish a joint traumatic brain injury optometry-screening program between the Pentagon and the Department of Veterans.  

Funding for a centralized eye-injury repository would cost about $3 million over five years, to cover updated computer systems and researchers’ salaries and support staff.

Because of the high-tech body armor issued to soldiers in Iraq and Afghanistan, doctors now confront profoundly injured troops who once would have died of thoracic and abdominal wounds before non-fatal injuries to eyes and extremities received medical attention.

About 20 blinded military personnel who fought in Afghanistan and Iraq will attend BVA’s 62nd national convention next month in Albuquerque, N.M. ABC correspondent Bob Woodruff, who sustained a severe head injury from a roadside bomb blast in Iraq, is invited as the keynote speaker. He lost 30 percent of the vision in his left eye as a result of the injury.

The BVA runs a program called “Operation Peer Support,” which matched recently blinded soldiers with veterans from previous wars so they may share experiences, learn about the current efforts and develop a healthy attitude about blindness.

Sen. Chuck Hagel (R-Neb.), with Sens. Barack Obama (D-Ill.) and Sherrod Brown (D-Ohio), introduced legislation in late June that would help the Department of Veterans Affairs meet the increasing demands of today’s blind veteran population.
The legislation directs the Secretary of Veterans Affairs to establish a scholarship program for students studying blindness rehabilitation. Recipients of the scholarship would be required to work at least three years in the VA system.

Hagel, a Vietnam war veteran, will continue to work with organizations such as the BVA on possible legislation that would aid in the care of our service members and veterans, his spokesman said.