2019 VRP Programmatic Panel Member Vignette
Title: Addressing the Unique Challenges of Military Eye Trauma
VRP FY19 Programmatic Panel Chair: COL Mark Reynolds, MD; DoD Vision Center of Excellence

The primary focus of the DoD Vision Research Program is to support research in finding better treatments, interventions, for not only the diagnosis and treatment of ocular injuries but also for rehabilitation and for vision restoration whenever possible.

Eye trauma presents a particular challenge, especially in any kind of deployed and expeditionary environment, for many different reasons. First of all, the chain of evacuation is not always guaranteed. Most of the time we can get casualties evacuated within an hour of the injury, but that’s not always possible.

Most of the time, eye injuries, if they’re initially treated, they don’t get any kind of definitive treatment until they get to the Level 3. So we also have to instruct the frontline providers of how to stabilize the injury, what they should do, and the interventions to avoid that could make the injuries worse.

And, for the interventions that the medics and the forward providers need to use, they have to be portable and very durable, very lightweight, and ideally they have to be multiple use, so if you’re carrying something in your aid bag, you can use it for many different things.

In the most recent conflicts, blast injuries were almost the signature injury. And the pressure of the blast and the secondary blast injury, all the shrapnel and the foreign bodies penetrating the eye and penetrating the orbit, leads to a very complex injury pattern where you can have injuries to several different layers of the eye along with neurologic injuries and other systemic injuries, which makes evaluating and treating the ocular injury even more challenging.

But, as the operational situation changes, then the technology of the adversary increases. As their technology increases, then the threat of other things, such as directed energy, which is a completely different approach than you would take towards blast injury. So we have to try and stay ahead of what’s going on in the operational environment so that we can have treatment recommendations and rehabilitation methods matched to the injuries that we know we’re going to see.

The VRP is dedicated solely to military eye trauma, which is a very unique sphere of interest to look at. The military eye trauma does not have that many correlates out in the civilian world, both for the severity of the trauma, the frequency of the trauma, and the limitations around the treatment options itself.

I got involved in the Vision Research Program when I was working at the Army Public Health Center—initially as a reviewer on the VRP—and then, this past year, I was a full panel member.

It’s very enlightening to review the grants. First of all, you get an idea of the state of the science and also—what are the capabilities.

One of the challenges is taking all of the possibilities that are there and trying to link them up to what are the greatest gaps that need to be filled in. Because there’s many gaps at many different levels.

The Programmatic Panel is made up of military members across the Services and representatives from the Veterans Administration Medical System as well. We have optometrists and ophthalmologists for the eye care portion, and then there’s specialists from the National Eye Institute, from the National Institute of Health, and essentially across academia as well, so that we can get a view not only of what the gaps are in the military, but where that fits into work that’s being done by other agencies and how that incorporates into the longitudinal care for injured Service members.

I think that what I can add is the operational side, the operational relevance, having deployment experience, and seeing eye care at different levels and medical care in general at different levels, and then also seeing how ocular injuries affect not only military readiness, but also military retention, and then how they go on to affect post-Service functioning as well.

At the Vision Center of Excellence, we work on many different things with eye injuries, and one of the things that we’re doing is identifying where the gaps are—looking at the data that’s built up using different registries to find that out. And when a proposal that comes up that matches almost completely where we know the gap is, it’s like a perfect fit.

One of the most challenging areas is vision restoration. Once you get to the point where the injury has stabilized, it’s either speeding that recovery or trying to push the recovery beyond what we could get to before, so that an injured Service member is not left with decreased vision and there’s nothing more that we can do about it, but trying to push that on, so that we can increase the rehabilitation possibilities for injured Service members and give them back vision that they may not have gotten back before we had the VRP.

I would say, for potential PIs writing grants is, even though there may seem like a lot has been done along military injuries, the spectrum is very wide open. And even though the injuries might not have exact correlates in the civilian world, the severity of the injuries makes it an important topic to keep pursuing, and novel ideas are always welcome. The VRP is looking at different models, different treatments to be used, completely different approaches in different areas of medicine, and seeing how that would apply to ocular injuries and vision threatening conditions.

I think that the DoD Vision Research Program is a vital resource, as we’re trying to deal with vision threatening conditions, not only so we can keep our Force ready to do their mission, but also so that we can do whatever possible to rehabilitate them and get them back to—to the highest level of functioning possible if they happen to get an injury along the way.