Background: Due to the highly visual nature of military activities, eyes are frequently exposed to potential injury in military training and combat scenarios. Even the partial loss of vision in one eye could result in the medical retirement of Service members following seemingly innocuous injuries. The eye is a highly organized structure, derived from neural ectoderm and neural crest cells, and there is no capability to restore function to damaged retinal or optic nerve tissue. Additionally, dysfunction in other ocular structures may lead to chronic loss of vision following injury without careful observation. The Principal Investigator has the largest and most detailed database of mission-related eye injuries, totaling 654 Service members, injured in Iraq and Afghanistan between 2001 and 2011. This dataset is large, unique, and unrepeatable. We believe that eye injuries sustained in combat are a surrogate to eye injuries sustained in training, and meaningful information can be extracted. Moreover, over 50% of patients sustaining eye injuries had concomitant traumatic brain injury (TBI) in one review of casualty data from the Global War on Terror. Given that recovery from TBI requires a multidisciplinary approach, it is unknown to what degree TBI impacts visual recovery and to what degree ocular injury impacts TBI recovery.

Objective/Hypothesis: Our objective is to, first, report on the impact of visual dysfunction in the United States Military population following the wars in Iraq and Afghanistan. Second, it is our objective to conduct preliminary work assessing the quality of life impact of eye injuries on TBI patients and the impact of TBI on the quality of life of eye injured patients. Lastly, it is our objective to publish 8-10 manuscripts related to this.

Specific Aims: We seek to answer the question of what is the impact of eye injury on TBI recovery, what is the impact of TBI on eye injury recovery from a quality of life perspective. Additionally, we seek to publish between 8-10 manuscripts related to our retrospective dataset to help provide guidance to the Defense Health Programs in funding eye injury research.

Study Design: We will conduct a retrospective analysis of already existing Institutional Review Board (IRB)-approved dataset of eye injured patients to identify and report on trends related to the objectives. Second, we will conduct prospective assessments of quality of life outcomes for Service members through an already existing IRB-approved protocol.

Impact: The impact of this analysis will be significant as it relates to military Service members and eye injury recovery. Currently, military ophthalmologists treat eye injuries separately and distinct from the multidisciplinary TBI recovery process. This analysis may help direct more or fewer resources to recovery. Further, it will offer further data regarding the complex relationship between vision and TBI. Lastly, it will enable longer-term assessment of US Service members who sustained eye injuries. In general, we monitor patients for 1 to 2 years post-injury. This project will enable us, through existing IRB-approved protocols, to contact patients remote from injury and gather data regarding outcomes post-injury.