2019 VRP Vignette
Title: Advancing Research for Military Vision Trauma
CAPT Walter Steigleman, MD; Naval Medical Center Portsmouth

I’ve been in the Navy now almost 24 years. I came through USUHS and did some undersea medicine, diving medicine, before I went to ophthalmology. I did residency at Balboa and then served as a Comprehensive Ophthalmologist for a few years. And then I’ve been back in Virginia in the Naval Hospital there for most of the last 2 years except when I’ve been deployed on the Comfort—the USNS Comfort.

In my day-to-day life, I’m mostly a clinician seeing patients and doing surgery and, you know, being involved with the Vision Research Program allows me to see what the other side of medicine is doing, and I find it very fascinating. I mean, it’s easy to get discouraged sometimes—that it doesn’t seem like there’s a lot going right with things, but you read about all the developments, all the research that’s going into the future, and you realize that, you know, I think we’ll be okay.

Something that really spurred my interest was the Warfighter trauma focus. And there really aren't other avenues of research that are looking directly into this. And this was, I think, a big gap that we had in military medicine. You know, throughout OIF, OEF, we had a great number of folks that had horrific injuries and were—were basically without any hope to—to get satisfactory solutions for some of those.

There are—are devices that we use in the standard hospital clinic every day that just aren't small enough; they’re not robust enough to be deployed in a field setting. And so what may be applicable for something we could do in a hospital just isn't possible in a forward deployed environment. So some of the things that we evaluate are trying to treat trauma, but also trying to treat it as far forward as possible. It’s also a concern if an injured Service member can't be Medivac’d from a forward deployed area back to a—a hospital within hours or within the day. And if that’s true, we need to be able to put solutions as far forward as possible. And that’s definitely a focus of—of the protocols that we evaluate.

There’s been some recent concerns to address a big gap that we’ve got for focused energy trauma, you know, like laser injuries and—and whatnot.

And one of the things that we are really concerned about and don’t have some great answers now are repeated blast exposures. And what do low levels of blast trauma do to the eyes and ocular structures over time? There is some concern that low-level repeated concussions, basically, of the eye and ocular tissues can lead to dysfunction and damage that’s very difficult to detect right away, and it basically might accumulate over time.

And so having an avenue in order to pursue, you know, a glimmer of hope or pursue some solutions to some of those—those problems I think is fantastic.

I think that getting a group of folks like myself who have experience, been around, and treated a number of these patients—I think it gives us a better focus to come up with things that we think are important. These are things that we have seen firsthand that need to be addressed.

The consumer focus helps to ground us and keep us focused on the—the outcome and why, “Hey, this is why this matters. This would be great if we had this.”

It’s, I think, it’s a pretty powerful meeting of the minds. I think—I think it’s a great—a great process. It’s like laws and sausage. You know it—some things you don’t want to know how it happens. You just want the—the final result. But I think that there’s probably no better way to address a need like this. I find it fascinating.

One of the things that—that was fun to see is some of the early steps that were taken that have delivered publications that are now moving into the next stages and getting closer to the translational products. It’s also kind of fun to see other researchers from other institutions reference some of the earlier work in the current proposals. So it’s easy to see that the efforts are snowballing—that early efforts are starting to—to build a foundation for what more recent efforts are proposing to do and proposing to accomplish.

Unfortunately, with research, it’s a multi-year, multi-stage process, and to go from, you know, an idea to, you know, basic science to animal research to humans through FDA trials—a translational component is clearly a focus of the panel. But it’s difficult to get all the way from A to Z; just it’s a very long process.