One hurdle that keeps tripping us is Sean's limited vision. Many of the doctors, optometrists, and ophthalmologists Sean has seen do not know enough about the relationship between TBI and vision loss. Add to that the overlap between TBI and PTSD and Sean's case is even more puzzling, especially when seeing a new provider.
Dr. S, neuro ophthalmologist, explained Sean's vision difficulties like an electrical circuit. If an electrical circuit has a frayed wire, sometimes the wires will connect and the switch will work, and sometimes it will not. The same is true with the electrical pathways in the brain. Microscopic damage in the brain can cause the visual pathways to be disrupted.
One ER doctor at the VA told us that Sean's vision loss was not likely due to his TBI because the loss would have been sudden, not delayed by two years as, "it just doesn't work that way." However, this is not what we have learned through our interaction with veterans and professionals through the BVA. We have met with Colonel Donald A. Gagliano, M.D., Executive Director of the Vision Center of Excellence and heard him speak about the problems associated with TBI-related vision loss.
Dr. Gagliano said more research is needed to determine the cause and proper treatment of TBI. Also, he said that integrated treatment between the DOD and the VA at the Vision Center of Excellence could help TBI patients receive the most effective care.
TBI is a serious condition that often results from improvised explosive device injuries. The visual impact of TBI is sometimes not observed until weeks, months or even years after the blast. TBI can have a major impact on visual quality of life, according to Glenn C. Cockerham, MD.
“Blast injury is the most common cause of TBI in the war in Iraq and is increasingly common in Afghanistan,” he said. “Little has been reported in the scientific literature about blast effects on the human eye and vision.”
The following articles highlight difficulties in diagnosing and treating vision loss due to TBI.
New DoD/VA Center Tracks Increasing Eye Injuries To Improve Vision Research, Care
About 60-70 percent of severe and moderate TBI cases and 40 percent of mild TBI cases include some form of visual impairment, such as nerve damage from concussive events. VCE is looking at capturing reports from the Defense and Veterans Brain Injury Center, which collects intake information on visual issues caused by mild TBI. "Mild TBI is still an enigma," COL Gagliano advised. "We're looking at clinical symptoms and maybe some cognitive testing. Some of the blast exposure injuries are injuries to the globe. When a blast wave hits your eye, it causes tissue, retinal, nerve, and zonular injury and we don't understand it well. It's like two times the force of being punched. The eye is compressible, so we're looking at how to mitigate it."
Vision and Traumatic Brain Injury (TBI) from the Vision Center of Excellence