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