Logo for the Journal of Rehab R and D

Volume 46 Number 6, 2009
   Pages 811 — 818

Abstract — Eye and visual function in traumatic brain injury

Glenn C. Cockerham, MD;1-2* Gregory L. Goodrich, PhD;3 LTC Eric D. Weichel, MD;4 James C. Orcutt, MD, PhD;5-6 Joseph F. Rizzo, MD;7-8 COL Kraig S. Bower, MD;4,9 Ronald A. Schuchard, PhD10-11

1Ophthalmology Section, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA; 2Department of Ophthalmology, Stanford University, Stanford, CA; 3Psychology Service, VA Palo Alto Health Care System, Palo Alto, CA; 4Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC; 5Ophthalmology Section, VA Puget Sound Health Care System, Seattle, WA; 6Department of Ophthalmology, University of Washington, Seattle, WA; 7Center for Innovative Visual Restoration, VA Jamaica Plain, Boston, MA; 8Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA; 9Uniformed Services University of the Health Sciences, Bethesda, MD; 10Research and Development Center of Excellence, Atlanta VA Medical Center, Atlanta, GA; 11Department of
Neurology, Emory University, Atlanta, GA

Abstract —  Combat blast is an important cause of traumatic brain injury (TBI) in the Department of Veterans Affairs polytrauma population, whereas common causes of TBI in the civilian sector include motor vehicle accidents and falls. Known visual consequences of civilian TBI include compromised visual acuity, visual fields, and oculomotor function. The visual consequences of TBI related to blast remain largely unknown. Blast injury may include open globe (eye) injury, which is usually detected and managed early in the rehabilitation journey. The incidence, locations, and types of ocular damage in eyes without open globe injury after exposure to powerful blast have not been systematically studied. Initial reports and preliminary data suggest that binocular function, visual fields, and other aspects of visual function may be impaired after blast-related TBI, despite relatively normal visual acuity. Damage to the ocular tissues may occur from blunt trauma without rupture or penetration (closed globe injury). Possible areas for research are development of common taxonomy and assessment tools across services, surgical management, and outcomes for blast-related eye injury; the incidence, locations, and natural history of closed globe injury; binocular and visual function impairment; quality of life in affected servicemembers; pharmacological and visual therapies; and practice patterns for screening, management, and rehabilitation.

Key words: blast injury, blindness, eye trauma, oculomotor, quality of life, rehabilitation, traumatic brain injury, vision, visual disturbance, visual field.

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