Veterans with Hidden
Vision Problems
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The picture of a wounded soldier with eye damage is usually seen as a person with bandages wrapped around their head and eyes. But those who have suffered from traumatic brain injuries (TBI) may still score high with Snellen letter testing, but may experience diplopia or movement of words on a page as well as other related symptoms.
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These problems are often very difficult to discover and treat and may have severe effects on a patient's life. Due to the efforts of interested parties such as Dr. William
Padula, legislation is in place to help these soldiers who return with vision problems. Dr. Padula heads the Padula Institute of Vision in Guilford, Conn., and has spent most of his professional career researching the links between traumatic brain injuries and vision problems. The incidence of TBI has been one of the most serious injuries sustained by returning vets from Iraq and Afghanistan. When roadside bombs or mortars strike, the shock waves emanating from the explosion source may cause neurological problems in spite of the fact that no outward signs of damage are noticed. Dr. Padula states, "Even though there are eye injuries coming back from Iraq and Afghanistan, the majority of the soldiers also endure traumatic brain injuries that are causing brain processing problems in the visual cortex. This causes the visual process to become dysfunctional. It may also affect their speech, movement and behavior."
Since the start of the war, 13 percent of the 9,000 seriously wounded casualties who were evacuated from Iraq and Afghanistan suffered physical injuries to their eyes, according to The Blinded Veterans Association. Dr. R. Cameron
Vanroekel, an optometrist at Walter Reed Army Medical Center in Washington, D.C. reported that almost one third of all the soldiers treated at the hospital had
TBI. He felt that 75 percent of that group had demonstrated problems with vision, hearing, reading, lack of peripheral vision, color blindness, poor concentration and total blindness. It is felt that the numbers are drastically higher now than they were three years ago.
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Dr. William Padula and two other doctors at Walter Reed applied for a grant through the Blinded Veterans Association advocacy group as well as the office of Sen. John F. Kerry of Mass. Consequently, Sen. Kerry sponsored the Neuro-Optometric Center of Excellence bill. This would make $5 million available for the Dept. of Defense to create a model of prevention, diagnosis, mitigation, treatment and rehabilitation of military eye injuries via a registry that tracks the handling of combat eye injuries and would set up research at Walter Reed regarding the screening and diagnosis of "visual dysfunction related to traumatic brain injury." Observers conclude that blast victims who are protected by body armor can survive but may sustain severe injuries to the extremities and face. The soldier’s use of protective eyewear has limited effect since the explosions are so powerful that they can reduce vehicles to scraps. One cannot expect high expectations from protective goggles.
Col. Francis McVeigh, OD is chief of the optometry service at Walter Reed and states that doctors at the Department of Veterans Affairs identified some of the TBI related problems that included blurry vision and a "perceived shift in the visual midline." Like post traumatic stress disorder, many vision impaired soldiers are not quickly diagnosed because the eye injuries are not easily apparent. Some physicians don't know what to look for. If they are only looking for physical injury to the eye itself they may miss the brain injury as the causative factor for the symptoms.
McVeigh adds that there are about 2 million TBI nationally every year because of car accidents and falls. Before the war hardly any attention was given to these cases. Dr. Padula reveals that he has identified and researched two syndromes related to TBI, post traumatic vision syndrome and visual midline shift syndrome. Treatment involves prescribing special lenses and prisms that will lead to correcting the problem. It is pointed out that many may be rehabilitated but a cure is not yet guaranteed. The therapy requires a multidisciplinary team. This may include physical therapists, occupational therapists, orthopedists, psychologists and optometrists. In addition to the hopes for passing bills to supply these needed services for our men and women in the armed forces it will also raise the awareness of millions of people who are victims of TBI and encourage them to seek the help that they need.
A few days after experiencing a mortar explosion in Iraq which almost threw him off his heavy duty recon vehicle, Glen Minney reported to sick call with a headache and itchy eyes. He was treated for pink eye. A month later he woke up blind in his right eye. He was evacuated to Germany where surgery was performed on both eyes. He was returned to the states to recuperate. The second day he was home he lost his vision completely. He was told that the surgeries were successful, but the optic nerve was damaged beyond repair as a result of TBI. Minney had brain damage in the vision center of the occipital lobe as a result of the blast, which is not uncommon when the concussion shock from an explosion whips the head back. The impact can stretch or tear actual brain tissue. The brain cells can begin to necrose and produce the vision damage associated with these cases.
Army Staff Sergeant Brian Pearce lost his sight when shrapnel cut into his right occipital lobe in Iraq. The day after the injury, his wife Angela learned that her husband had gone blind. His head injury was so severe that he was in a comatose state for 47 days. The doctors decided that his vision problems were not cared for due to the severity of his primary problem. Angela Pearce regrets that her husband was not referred to a TBI center since his visual acuity was 20/20 and his eyes were healthy. The problem concerned his inability to interpret the signals sent to the brain. He wonders how much better his vision would be if his TBI problems were addressed earlier. Some cases may take as long as 15 to 20 years to diagnose.
Four years ago, Staff Sgt. Jay Wilkerson's Humvee took a hit from a powerful roadside bomb near Baghdad. He was in a coma for 12 days. He lost two fingers and the left side of his face was in shreds. He couldn't walk for months. Wilkerson and his doctors failed to see what else was wrong. It concerned his vision. He had Hemianopsia. It is a brain malfunction which eliminates the effectiveness of his visual field. In his case, objects to the left of midline were invisible. Dr. Glenn Cockerham, chief of ophthalmology at the Palo Alto V.A., took to calling them “occult” injuries since they seemed to escape detection. He says, "If you ask these soldiers how they are doing, they'll say they are doing fine. But when the examiner asks specific questions whose answers can be compared to other cases, they’ll then demonstrate that they are not doing as well as previously imagined." Many of the veterans would bump into things.
Dr. Gregory Goodrich, V.A. Research Psychologist joins Dr. Cockerham as a leader in the forefront of research and development of TBI investigations. He states, “Visual problems go hand in hand with cognitive or physical problems as well as psychological problems such as depression. The patient may isolate himself because he doesn't want to be put in the world bumping into people or losing his way. He may have a fear of crowds or feel embarrassed because he can't visualize the expressions on his friends' faces. This social isolation can be devastating and can lead to depression, anxiety and even substance abuse.” In an interview by Victoria T. McDonough, writing for Brainline, Dr. Goodrich reveals that it is difficult to conduct a conclusive study since TBI cases are so diverse and varied and funding is very limited.
Dr. Goodrich revealed that they are considering three treatments that may be effective:
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A technique to teach scanning wherein a person is taught to use an alternate area of the retina for best vision.
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A device to take advantage of brain plasticity to increase the needy vision field. Stimuli are administered to the vision field left intact and the area bordering it to allow a wider interpretation of the combined fields of vision as they are meshed.
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A device from Australia that uses a light board with rows of colored lights. A behavioral technique is employed that uses head motions to scan into the lost visual area. The motion somewhat resembles an observer of a tennis match as the ball goes back and forth.
Dr. Goodrich advises that any victim of a TBI should be tested for visual acuity, vision fields, contrast sensitivity and binocular vision. A conclusion must be reached to define each particular case as either a simple need for spectacles or is it related to something else? Further information is available via
VisionAWARE.org. It is a free, not for profit online resource center which can help veterans who are blind or have low vision problems and their families to continue to lead satisfying, enriched lives by providing helpful resources and practical everyday hints. Details are also available on how to readjust life skills, train for a new job and utilize an adapted computer and other devices for better daily living tasks.
Direct links are provided to the sites of the U.S. Dept of Veterans Affairs, Blinded Veterans Assoc., Disabled American Veterans and National Assoc. of Blind Veterans. A viewer will learn how to schedule a low vision exam to determine whether certain appliances may be helpful. Other online venues instruct how better lighting or other types of training can help a person to use available vision more effectively. The sites mention Vision Rehabilitation Service such as Orientation and Mobility and Vision Rehabilitation Therapy. This therapy can restore everyday functioning after vision loss and is similar to physical therapy utilized to help stroke victims. There are self help vision loss support groups and self-study options that can help veterans and their families cope with the emotional impact of vision impairment.
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