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Vision Care After TBI: New Clinical Recommendation for Best Practices

Clinical Recommendations for The Eye Care Provider

The Vision Center of Excellence (VCE) released a clinical recommendation and support tools to help eye care providers identify and treat Service members and Veterans who have sustained eye- or vision-related disturbances following a blast exposure or Traumatic Brain Injury (TBI).

Nearly 383,947 cases of TBI were reported in the U.S. Military from 2000 to 2018 Q1  [i] and it has been reported that as many as 75% of these TBI patients reported having vision changes [ii]. If left untreated, persistent symptoms, such as blurred vision, persistent headaches and sensitivity to light, can have a significant impact on a Service member or Veteran’s quality of life. “TBI-related visual dysfunctions are often subtle clinically, but because they can interfere with daily visual tasks, such as reading, they may dramatically affect the ability of a Service member or Veteran to reintegrate into family life, employment and society,” said Dr. Felix Barker, VCE’s Director of Rehabilitation and Reintegration. “Being aware of the signs or changes in vision is critical to understanding when the individual should consult a qualified eye care provider who can help in minimizing the impact of visual dysfunctions of all causes, and thereby maximizing the potential for patient recovery.”

VCE’s “Clinical Recommendation for the Eye Care Provider: Eye and Vision Care Following Blast Exposure and/or Possible Traumatic Brain Injury” outlines the procedural recommendations regarding the assessment, management and rehabilitation of patients. This clinical tool offers a practical approach to help eye care providers identify and to manage patients with TBI who may benefit from more specialized care.

This suite of tools includes:

Clinical Recommendation: This detailed “Algorithm of Care” provides a recommended, step-by-step approach to help eye care providers refer, evaluate and manage affected Service members and Veterans. These steps include:
• Basic eye exam
• TBI-related ocular history evaluation
• Supplemental testing for oculomotor dysfunction
• Urgent eye care management
• Non-urgent eye care management
• Referral or specialized care considerations

Clinical Support Tool: This “Algorithm Card” reference tool helps conveniently guide the eye care provider through the recommended course of care.

Educational Brochure: This patient-focused, informational tool informs patients of the vision changes associated with TBI, possible symptoms and when to see a doctor.

Dr. Barker concluded, “We need to integrate best practices such as these to the care and support of Service members and Veterans. Knowing signs, symptoms and proper treatment of visual dysfunction due to TBI contributes directly to the individual’s quality of life, as well as the strength of the force.”

VCE encourages the sharing of this suite of tools, and welcomes feedback. 

[i] Defense Medical Surveillance System and the Theater Medical Data Store (DMSS-TMDS). (2018). Provided by the Armed Forces Health Surveillance Center (AFHSB). Prepared by the Defense Veterans Brain Injury Center (DVBIC). http://dvbic.dcoe.mil/dod-worldwide-numbers-tbi.
[ii] Stelmack, J. A., Frith, T., Van Koevering, D., Rinne, S., & Stelmack, T. R. (2009). Visual function in patients followed Veterans Affairs Polytrauma Network site: An electronic medical record review. Optometry, 80(8), 419-424.