Dec. 2, 2008 When soldiers sustain eye injuries on the battlefields of Iraq or Afghanistan, one of the first questions families ask military doctors is whether their loved ones will recover good vision. But until Eric D. Weichel, MD, and his colleagues at Walter Reed Army Medical Center (WRAMC) tackled the issue, there was no standard for predicting visual recovery.
Dr. Weichel's team studied patient records for 523 consecutive eye injuries sustained by 387 US soldiers treated at WRAMC between March 2003 and October 2006. The researchers wanted to know whether a system called the ocular trauma score (OTS), developed for use with non-combat eye trauma by Ferenc Kuhn, MD, was applicable to soldiers' eye injuries. The OTS enables the care provider to calculate the probability that a particular eye trauma patient will obtain a visual range by six months after the injury. This study concluded that the OTS is a valid system for predicting visual acuity outcomes following combat ocular trauma (COT).
"We can now answer many questions about visual prognosis for service members and their families," said Dr. Weichel. "The assessment, treatment, and counseling protocols we developed based on this and related COT studies have been integrated into all phases of eye injury care, from military surgical intensive care units through follow-up and rehabilitation in Veterans' Administration centers."
Dr. Weichel's team collected 201 eye injury-related variables for each soldier studied, as well as measurements of the soldier's best-corrected visual acuity (BCVA) taken as soon as possible after the injury and at six months post-injury. Initial BCVA measurements were not available for all subjects since severely injured soldiers (unconscious or intubated) were unable to communicate with doctors about their visual status. The data was then categorized using the OTS. A higher OTS score indicated a higher likelihood that good visual acuity would be recovered.
The visual recovery prognosis was worst for soldiers who sustained injuries to the globe of the eye combined with lacerations to the eyelids or fractures to the bones around the eye, and/or with injuries to the cranial nerves, visual nerves or brain structures. Thirty-three percent of the soldiers had worse than 20/200 vision in one eye, and globe injuries occurred in both of the patient's eyes in 36 percent of the 523 eyes studied. Many soldiers sustained other devastating injuries such as traumatic brain injury (66%) and severe arm/ leg injuries (44%).
The study appears in the Dec. 1 issue of Ophthalmology, the journal of the American Academy of Ophthalmology.
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