Vision problems resulting from head and brain injuries - what we can learn from the way the US Army uses vision therapy

Recently an interview appeared between Dr. Kathy Freeman and Dr. Randall Beatty, an assistant professor in ophthalmology at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania, about his experience treating combat eye injuries.

Dr. Beatty served as a colonel in the US Air Force Reserve Medical Service in Irag and Afghanistan, where he treated American service members and Iraqi and Afghan military and police personnel, as well as civilians, who experienced traumatic eye injuries during the course of the wars.

Below is the portion of the interview where the doctors talk about vision problems that arise from brain injuries. Dr. Freeman specifically mentions vision training (vision therapy) as a treatment. There is tons of evidence on the effectiveness of vision therapy in treating vision problems that result form brain injuries.  We have had considerable success in our Vancouver eye clinic treating vision problems that result form brain injuries sustained in car accidents, sports and falls.

Dr. Freeman: What are your thoughts on the traumatic brain injury that might be associated with these injuries?

Dr. Beatty: Well, traumatic brain injury was one of the things that kept us busy. A recent review of the VA literature reports that over 250,000 US service people have been diagnosed with some form of traumatic brain injury.2 The symptoms of those patients who have suffered traumatic brain injury are very similar to those associated with migraine headache—visual distortion, headaches, and extreme photosensitivity, not only to sunlight but even to lights inside. Some patients are very sensitive to the flickering of fluorescent lights. These are some visual disturbances that you won’t pick up just by having someone read an eye chart. The symptoms may be episodic, depending on how the patient is recovering from the post-concussive events, which can take quite a while; some may not really ever recover.

Dr. Freeman: How do you think eye care practitioners can best serve these veterans?

Dr. Beatty: I think that, overall, anyone who has been in a combat zone, and especially anybody who has had a concussion or suffered a concussive force by a nearby IED, will need to have very complete eye examinations on an ongoing basis. Dr. Glen Cockerham, at the VA Hospital in Palo Alto, California, did a study of returning veterans3 and, although the number was small, he found that a very high percentage of those veterans had some sort of ocular abnormality that could be attributable to their time in the combat zone. And that’s where we think that there may be problems with late-onset glaucoma as the years go by and as these veterans get older. In summary, very careful and complete eye examinations are necessary, and the emphasis cannot only be on detecting ocular pathology. It is essential to talk with these patients to determine what bothers them about their visual system—for example, do they experience photophobia or double vision? And, then, institute not only medical treatment but nonmedical as well—such as different types of eyewear that have tints, prism; low-vision devices that address the visual impairment; non-optical aids that can help with the distortion. In addition, there may be some need for different types of visual training. There should be attention to visual field analysis, detecting areas where there may be scotomas or blind spots.
And all of these things may be complicated by the fact that these patients also have cognition problems, deficits of short-term and long-term memory, which impacts their ability to handle low vision devices. Some of them have lost limbs or have other limitations that make it difficult to hold things and that complicate their visual rehabilitation. We’re now saving people on the battlefield with brain injuries and other types of trauma who, in the past, did not make it back to the trauma centers, and they are surviving and undergoing rehabilitation. This will result in more challenging long-term rehabilitative care, which is going to involve extensive physical and occupational therapy. And, in addition to those therapies, there should be visual rehabilitation.

The US army uses doctors of optometry to provide vision therapy to soldiers who have sustained brain injuries.  Here is a video:

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