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Vision Care Coordinator Improves Eye Care for Injured Service Members

Ophthalmologist prepares to cut a suture during a trauma surgery to repair a patient's eye

Maj. (Dr.) Lisa Mihora, a 332nd Expeditionary Medical Operations Squadron ophthalmologist, prepares to cut a suture during a trauma surgery to repair a patient's eye. For military service members suffering eye trauma, it is important to find a facility where an ophthalmic surgeon can operate on the eye quickly. (U.S. Air Force photo by Senior Airman Julianne Showalter)

For military service members suffering eye trauma anywhere in the world, it is important to find a facility where an ophthalmic surgeon can operate on the eye quickly. It is also important to make sure that patients get timely follow-on care with the right ocular specialists as service members make their way home. Coordinating that care can be challenging. 

Jo Ann Egan is the Vision Care Services Coordinator for the Department of Defense Vision Center of Excellence (VCE) located at the Walter Reed National Military Medical Center in Bethesda, Maryland. The VCE integrates vision care in the DOD and Veterans Affairs healthcare systems. Its primary function is to provide optimal care coordination and to improve vision health, optimize operational readiness and enhance the quality of life for injured service members and veterans. 

Egan’s daily mission is to ensure that a service member with an eye injury is referred to the appropriate facility and that those providers are aware of the patient transfer. An RN with more than 30 years’ experience, she has worked in both ophthalmic nursing and Wounded Warrior case management. 

More than 40 years ago, eye care coordination was limited. Mass casualties arrived without advance notice to military doctors and some patients lacked details of medical care provided at the point of injury. Today, due to advancements in medicine and specialty eye care, patients are moved quickly through several levels of care at echelon level I (medic or battalion aid station), and level II (forward surgical team), to Landstuhl Regional Medical Center in Germany and then stateside. 

Depending on the injury and treatment required, patients are referred to one of four military ocular specialty centers: Walter Reed; Madigan Army Medical Center in Tacoma, Washington; San Antonio Military Medical Center; or the Naval Medical Center in San Diego, California. They may also be referred to a community-based military medical facility or a VA polytrauma rehabilitation center. 

Egan stays in contact with theater ophthalmologists and monitors various databases for ocular diagnoses, patient location, and where that patient is headed. “I alert providers about the incoming patient. Sometimes it takes some detective work to find the patient because some of the databases limit the diagnosis to the top two to three major or life-threatening injuries affecting the patient and the eye injury may not rise to that level of perceived importance,” said Egan. 

Egan said if a patient is listed as a head injury case, there is a 30 percent chance of an associated significant eye injury. Also, looking carefully at other entries, she might discover an eye injury that was not listed prominently. 

“The eyeball is one cubic inch, the size of a quarter, and it is divided into eight specialty areas,” said Dr. Robert Mazzoli, the VCE director of education, training, simulation and readiness, and an ocular plastic and reconstructive surgical specialist. “Jo Ann knows the eye specialty capabilities at the military facilities and she works to ensure seamless transfer of care, continuity and efficiency of care which is better for the patient and more cost effective.” 

“The experience and knowledge I have can make a difference,” Egan said. “I offer my expertise as a resource to case managers.”