Visual impairment in veterans with multiple
sclerosis, traumatic brain injury, spinal cord injury or stroke
Joseph H. Maino, OD; Gary Mancil, OD; Manoj K.
Sharma, MD; Ricki Mancil, MA; Julie Munday; Kristin Richwine, OD
VICTORS Low Vision Rehabilitation Research Laboratory;
Kansas City VA Medical Center; Vision Rehabilitation Research Laboratory;
Salisbury VA Medical Center
Objectives: The broad objective of this study
is to understand the nature and distribution of visual impairment in veterans
with multiple sclerosis (MS), spinal cord injury (SCI), Cerebral Vascular
Accident (CVA) or traumatic brain injury (TBI). Information from this
research will lay the foundation for a prospective study to determine
if vision rehabilitation enhances rehabilitation medicine outcomes, improves
quality of life and prevents secondary disabilities in veterans with these
conditions.
Methods: This pilot study obtained research
subjects from the Kansas City and Salisbury VAMC’s Rehabilitation Medicine
(RM) outpatient appointment schedule, SCI registry, and RM inpatient discharge
summaries. The pilot study was limited to CVA, SCI, TBI and MS patients
because veterans with these diagnoses are more likely to have an associated
visual impairment not correctable by surgery or standard glasses or because
VA has designated veterans with these diagnoses as a "special population."
Measures of best corrected visual acuity, contrast sensitivity, color
vision, and visual field loss were obtained.
Results: Currently 187 subjects have completed
the study. Subject’s age ranged from 28 to 89 with an average of 61 years.
Ninety-six percent of the subjects were male. Forty-eight percent (89/187)
had a diagnosis of CVA, 25% (47/187) SCI, 19% (36/187) MS and 8% (15/187)
TBI. Seventeen percent of the subjects had a best-corrected acuity of
20/50 or less (unable to read standard newsprint) while 6% were legally
blind. Common eye diagnoses (subjects could have more than one diagnosis)
included cataract (51), diabetic retinopathy (25), dry eye (41), age related
macular degeneration (25), glaucoma/glaucoma suspect (24), optic nerve
atrophy (24) and presbyopia (76). Fifty-six percent (101/179) of subjects
had abnormal contrast sensitivity findings, 23% (41/182) demonstrated
visual field loss and 22% had color vision abnormalities.
Conclusions: When veterans are faced with
catastrophic illnesses such as MS, SCI, CVA or TBI it is not uncommon
for other health concerns to go unaddressed. Our previous work (a retrospective
chart review of RM patients) revealed that almost 50% of RM patients did
not receive adequate eye or low vision rehabilitative care. This pilot
study has demonstrated that a large number of veterans with MS, CVA, TBI
or SCI experience significant vision impairment (17%) not only as a consequence
of their primary medical disorder, but also secondary to age related eye
diseases such as diabetic retinopathy, macular degeneration, cataract
and glaucoma. Our ongoing work includes evaluating the impact of the veteran’s
eye/vision disorders on their quality of life via several health surveys
including the VFQ-25 (eye/vision specific) and the SF-36V (general health)
questionnaires.
Funding Acknowledgment: This study was funded
by VA Rehabilitation Research and Development Service, project #E2026P