title: Visual impairment and dysfunction in combat-injured servicemembers with traumatic brain injury.
abstract: OBJECTIVE
  The purpose of this study was to determine the frequencies of visual impairment and dysfunction among combat-injured Polytrauma Rehabilitation Center (PRC) inpatient and Polytrauma Network Site (PNS) outpatient military personnel with traumatic brain injury (TBI).
  
  
  METHODS
  A retrospective analysis of data from vision screenings of 68 PRC-inpatients with moderate to severe levels of TBI and 124 PNS-outpatients with mild TBI at the VA Palo Alto Health Care System was conducted.
  
  
  RESULTS
  Eighty-four percent of PRC-inpatients and 90% of PNS-outpatients had TBIs associated with a blast event. The majority of patients in both the PRC and PNS populations had visual acuities of 20/60 or better (77.8% PRC, 98.4% PNS). Visual dysfunctions (e.g., convergence, accommodative, and oculomotor dysfunction) were common in both PRC and PNS populations. In the PRC-inpatient population, acuity loss of 20/100 to no light perception (13%) and visual field defects (32.3%) were found. In the PNS-outpatient population, acuity loss of 20/100 to no light perception (1.6%) and visual field defects (3.2%) were infrequently found. In both the PRC and PNS populations, visual field defects were more often associated with blast than non-blast events.
  
  
  CONCLUSIONS
  Blast events were the most frequent mechanism of injury associated with TBI in combat-injured servicemembers. The vision findings suggest that combat troops exposed to blast with a resulting mild TBI are at risk for visual dysfunction, and combat troops with polytrauma injuries are at risk for visual dysfunction and/or visual impairment. The visual consequences of such injuries necessitate further study and support the need for appropriate evaluation and treatment in all severities of TBI.
authors.affiliation: Western Blind Rehabilitation Center, VA Palo Alto Health Care System, Palo Alto, California 94086, USA.
authors.forename: Karen D
authors.initials: KD
authors.lastname: Brahm
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Wilgenburg
authors.forename: Jennine
authors.initials: J
authors.lastname: Kirby
authors.forename: Shanida
authors.initials: S
authors.lastname: Ingalla
authors.forename: Chea-Yo
authors.initials: CY
authors.lastname: Chang
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Goodrich
mesh_terms: D000065:Accommodation, Ocular; D000328:Adult; D000346:Afghanistan; D001753:Blast Injuries / Q000150:complications / Q000453:epidemiology; D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D003290:Convergence, Ocular; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D007493:Iraq; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000534:rehabilitation; D009801:Oculomotor Muscles / Q000503:physiopathology; D010045:Outpatients / Q000706:statistics & numerical data; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014786:Vision Disorders / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D015354:Vision, Low / Q000209:etiology; D014792:Visual Acuity; D014794:Visual Fields; D014857:Warfare; D014947:Wounds and Injuries / Q000150:complications