Skip to main content

Military Health System

Editorial: The Department of Defense/Veterans Affairs Vision Center of Excellence

Image of U.S. Army Spc. Angel Gomez, right, assigned to Charlie Company, 173rd Brigade Support Battalion, wraps the eye of a fellow Soldier with a simulated injury, for a training exercise as part of exercise Saber Junction 16 at the U.S. Army’s Joint Multinational Readiness Center in Hohenfels, Germany, April 5, 2016. Saber Junction is a U.S. Army Europe-led exercise designed to prepare U.S., NATO and international partner forces for unified land operations. The exercise was conducted March 31-April 24. (U.S. Army photo by Pfc. Joshua Morris). U.S. Army Spc. Angel Gomez, right, assigned to Charlie Company, 173rd Brigade Support Battalion, wraps the eye of a fellow Soldier with a simulated injury, for a training exercise as part of exercise Saber Junction 16 at the U.S. Army’s Joint Multinational Readiness Center in Hohenfels, Germany, April 5, 2016. Saber Junction is a U.S. Army Europe-led exercise designed to prepare U.S., NATO and international partner forces for unified land operations. The exercise was conducted March 31-April 24. (U.S. Army photo by Pfc. Joshua Morris)

Recommended Content:

Medical Surveillance Monthly Report | Centers of Excellence

Vision and visual function are essential for performance across multiple activities. When vision is compromised, it can negatively affect behavioral health, social functioning, and overall quality of life.1 Studies have also linked decreased visual function to increased mortality.2 In military populations, optimal visual function is required for demanding tasks ranging from effective weapons utilization3 to aircraft-based flight operations.4

Ocular injuries present a particular problem for service members and the providers charged with their care. These injuries are associated with a substantial cost in terms of resources, rehabilitation, and training.5 In response to the need for increased focus on ocular injuries and their treatment across the continuum of care, the Department of Defense (DOD)/Veterans Affairs (VA) Vision Center of Excellence (VCE) was established by congressional mandate in 2008 under the National Defense Authorization Act (Public Law 110-181, Section 1623) as a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of military eye injuries, including visual dysfunction related to traumatic brain injury (TBI).6 Consistent with the requirement of all Defense Centers of Excellence to provide expertise across the entire clinical spectrum of care for a patient, the VCE addresses the full scope of vision care, from the prevention of diseases and treatment of clinical conditions through rehabilitation and transition to civilian life.7

The VCE continually executes initiatives in support of the 2008 mandate. In 2015, the VCE collaborated with the Joint Trauma System (JTS), the Committee on Tactical Combat Casualty Care (TC3), and the Defense Health Agency’s Medical Logistics Division to increase the availability of rigid eye shields in the individual first aid kit. These eye shields are essential for preventing further damage to a traumatized eye until definitive treatment is available. This effort to increase the availability of rigid eye shields resulted in changes to the TC3 card (DD Form 1380) to allow for documentation of eye shield use (check boxes for eye shield use).8 In further collaboration with the JTS, the VCE has initiated and/or contributed to multiple clinical practice guidelines (CPGs) designed to provide best care practices across the spectrum of ocular injuries. For example, the “Ocular Injuries and Vision-Threatening Conditions in Prolonged Field Care” CPG is currently available at https://jts.amedd.army.mil/index.cfm/PI_CPGs/cpgs, and the “Evaluation and Disposition of Temporary Visual Interference and Ocular Injury after Suspected Ocular Laser Exposure” CPG is pending publication on the JTS website.

A specific area of focus mandated to the VCE is visual dysfunction following TBI. To address this complex set of conditions, the VCE, in collaboration with a panel of experts in vision, rehabilitation, and TBI across the DOD, VA, and the civilian sector’s diverse group of subject matter experts, including the Defense and Veterans Brain Injury Center, oversaw the production of clinical recommendations and associated clinical support tools for the care of visual dysfunction after TBI. These aids to clinical care include “Eye and Vision Care Following Blast Exposure and/or Possible Traumatic Brain Injury,” “Care of Visual Field Loss Associated with Traumatic Brain Injury,” and “Care of Oculomotor Dysfunctions Associated with TBI.”9–11 In coordination with the Uniformed Services University of the Health Sciences, the VCE is conducting a review of current visual dysfunction documentation, intervention options, and best practices. The article on visual dysfunction following TBI in this issue of the MSMR was developed to provide additional information on this diverse set of conditions, update current recommendations, and inform future clinical and research efforts.12

The VCE established the World Wide Ocular Trauma and Readiness Curriculum Teleconference to engage international, multiagency, and cross-specialty attendees spanning multiple sites in review of vision cases and identification of clinical process improvements. The monthly calls serve as a key platform for providing feedback and follow-up to deployed providers and for developing and disseminating best practices and clinical lessons learned.

In order to ensure continuity of care from injury through rehabilitation, the VCE developed a collection of reference guides that include vision resources across the DOD and VA as well as at the state and national level. The “Vision Care Coordination Reference Guide” expands network capabilities between stakeholders, increases partnerships, and enables care coordinators to assist in a rapid and thorough response to the patient population requiring trauma and vision care specialties. In addition, the VCE produces fact sheets to educate the care community to assist with engaging a visually impaired patient.

With continued emphasis on military readiness, the VCE is expanding focus beyond combat-related traumatic conditions to include disease and non-battle injuries. Ocular and vision-related conditions can have great impact on readiness and retention. The first article in this issue characterizes the burden of ocular and vision conditions and was developed to provide a broad overview of these conditions.13 This information will provide key information to guide further initiatives and programs across the Military Health System.

The VCE was tasked with implementing and managing a registry of information to track diagnoses, interventions/treatments, and follow-up for each case of significant eye injury sustained by a member of the Armed Forces while serving on active duty. The Defense Vision and Eye Injury and Vision Registry (DVEIVR) was developed to address this requirement. Registry data are available to ophthalmological and optometric personnel of the DOD and VA for purposes of encouraging and facilitating the conduct of research and the development of best practices and clinical education on eye injuries incurred by members of the Armed Forces in combat. Registry data have been used by DOD and academic institutions to better characterize the complex field of ocular trauma. DVEIVR data are also shared with the VA Blind Rehabilitation Service to maximize continuity of care. The VCE is currently incorporating DVEIVR data along with other data sources focused on providing evidence-based care recommendations.

The VCE continually strives to improve the recognition and management of ocular injuries and vision-threatening conditions across military and veteran populations. Such efforts supporting improved care and coordination of care are essential for maintaining the visual performance of U.S. service members and veterans. Additional information on the VCE and its products is available at https://vce.health.mil/. Further inquiries can be sent via email to dha.ncr.dod-va.mbx.vce@mail.mil.

References

1. Nyman SR, Gosney MA, Victor CR. Psychosocial impact of visual impairment in working-age adults. Br J Ophthalmol. 2010;94(11):1427–1431.

2. Taylor HR, McCarty CA, Nanjan MB. Vision impairment predicts five-year mortality. Trans Am Ophthalmol Soc. 2000;98;91–99.

3. Hatch BC, Hilber DJ, Elledge JB, Stout JW, Lee RB. The effects of visual acuity on target discrimination and shooting performance. Optom Vis Sci. 2009;86(12):e1359–e1367.

4. Tanzer DJ, Brunstetter T, Zeber R, et al. Laser in situ keratomileusis in United States Naval aviators. J Cataract Refract Surg. 2013;39(7):1047–1058.

5. Frick KD, Singman EL. Cost of military eye injury and vision impairment related to traumatic brain injury: 2001–2017. Mil Med. 2019;184(5–6):e338–e343.6. National Defense Authorization Act for Fiscal Year 2008, Public Law 110–181, section 1623. 2008.

7. United States Government Accountability Office. GAO-16-54, Centers of Excellence: DOD and VA Need Better Documentation of Oversight Procedures. https://www.gao.gov/assets/680/673936.pdf. Published 2 December 2015. Accessed 28 August 2019.

8. Defense Health Agency. Procedural Instruction 6040.01. Implementation Guidance for the Utilization of DD Form 1380, Tactical Combat Casualty Care (TCCC) Card, June 2014. 20 January 2017.

9. Department of Defense/Veterans Affairs Vision Center of Excellence. Clinical Recommendations for the Eye Care Provider. Eye and Vision Care Following Blast Exposure and/or Possible Traumatic Brain Injury. https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations/Eye-Care-and-TBI. Revised 24 November 2015. Accessed 05 August 2019.

10. Department of Defense/Veterans Affairs Vision Center of Excellence. Clinical Recommendation for the Eye Care Provider and Rehabilitation Specialists. Rehabilitation of Patients with Visual Field Loss Associated with Traumatic or Acquired Brain Injury. https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations/VFL. Revised 27 April 2016. Accessed 05 August 2019.

11. Department of Defense/Veterans Affairs Vision Center of Excellence. Clinical Recommendation for the Eye Care Provider. Assessment and Management of Oculomotor Dysfunctions Associated with Traumatic Brain Injury. https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations/Oculomotor. Revised 13 December 2016. Accessed 05 August 2019.

12. Reynolds ME, Barker II FM, Merezhinskaya N, Oh G, Stahlman S. Incidence and temporal presentation of visual dysfunction following diagnosis of traumatic brain injury, active component, U.S. Armed Forces, 2006-2017. MSMR. 2019;26(9):13–24.

13. Reynolds ME, Williams VF, Taubman SB, Stahlman S. Absolute and relative morbidity burdens attributable to ocular and vision-related conditions, active component, U.S. Armed Forces, 2018. MSMR. 2019;26(9): 4–11.

You also may be interested in...

Interview with the SEAC: TBI from a Joint Perspective

Video
7/18/2022
Interview with the SEAC: TBI from a Joint Perspective

In this episode of Picking Your Brain, Traumatic Brain Injury Center of Excellence Branch Chief Capt. Scott Cota and clinical moderator Amanda Gano interview the Senior Enlisted Advisor to the Chairman of the Joint Chiefs of Staff (SEAC), Ramón Colón-López. The discussion covers the health impacts of TBI and blast-related concussion stemming from the demands of combat and training. The SEAC also addresses the importance of maintaining medical readiness through education and military leadership. Listen to more Picking Your Brain episodes at www.health.mil/TBIPodcasts, on DVIDS, or wherever you listen to podcasts.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Podcasts | TBI Provider Resources | Patient and Family Resources | TBI Educators | Centers of Excellence | Traumatic Brain Injury Center of Excellence

MSMR Vol. 29 No. 07 - July 2022

Report
7/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Health Readiness & Combat Support | Public Health | Medical Surveillance Monthly Report

Brief Report: Phase I Results Using the Virtual Pooled Registry Cancer Linkage System (VPR-CLS) for Military Cancer Surveillance

Article
7/1/2022
A patient at Naval Hospital Pensacola prepares to have a low-dose computed tomography test done to screen for lung cancer. Lung cancer is the leading cause of cancer-related deaths among men and women. Early detection can lower the risk of dying from this disease. (U.S. Navy photo by Jason Bortz)

The Armed Forces Health Surveillance Division, as part of its surveillance mission, periodically conducts studies of cancer incidence among U.S. military service members. However, service members are likely lost to follow-up from the Department of Defense cancer registry and Military Health System data sets after leaving service and during periods of time not on active duty.

Recommended Content:

Medical Surveillance Monthly Report

Protecting Your Hearing and Vision is a Personal Readiness Mission

Article
6/14/2022
Aviation Ordnanceman 3rd Class Dominique Campbell drives a forklift on the flight deck of the Nimitz-class aircraft carrier USS Harry S. Truman (CVN 75) during a vertical replenishment. She is wearing proper hearing and vision protection.

Experts from the Centers of Excellence help advance research to diagnose and treat diseases and conditions that affect military personnel and their families.

Recommended Content:

Centers of Excellence

Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2021

Article
6/1/2022
Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2021

As in previous years, among service members deployed during 2021, injury/poisoning, musculoskeletal diseases and signs/symptoms accounted for more than half of the total health care burden during deployment. Compared to garrison disease burden, deployed service members had relatively higher proportions of encounters for respiratory infections, skin diseases, and infectious and parasitic diseases. The recent marked increase in the percentage of total medical encounters attributable to the ICD diagnostic category "other" (23.0% in 2017 to 44.4% in 2021) is likely due to increases in diagnostic testing and immunization associated with the response to the COVID-19 pandemic.

Recommended Content:

Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2021

Article
6/1/2022
Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2021

In 2021, mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups. Among adults aged 45–64 and those aged 65 or older, musculoskeletal diseases accounted for the most morbidity and health care burdens. As in previous years, this report documents a substantial majority of non-service member beneficiaries received care for current illness and injury from the Military Health System as outsourced services at non-military medical facilities.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance snapshot: Illness and injury burdens, reserve component, U.S. Armed Forces, 2021

Article
6/1/2022
Surveillance snapshot: Illness and injury burdens, reserve component, U.S. Armed Forces, 2021

Recommended Content:

Medical Surveillance Monthly Report

Hospitalizations, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022
Hospitalizations, Active Component, U.S. Armed Forces, 2021

The hospitalization rate in 2021 was 48.0 per 1,000 person-years (p-yrs), the second lowest rate of the most recent 10 years. For hospitalizations limited to military facilities, the rate in 2021 was the lowest for the entire period. As in prior years, the majority (71.2%) of hospitalizations were associated with diagnoses in the categories of mental health disorders, pregnancy-related conditions, injury/poisoning, and digestive system disorders.

Recommended Content:

Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022
Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2021

In 2021, as in prior years, the medical conditions associated with the most medical encounters, the largest number of affected service members, and the greatest number of hospital days were in the major categories of injuries, musculoskeletal disorders, and mental health disorders. Despite the pandemic, COVID-19 accounted for less than 2% of total medical encounters and bed days in active component service members.

Recommended Content:

Medical Surveillance Monthly Report

Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

Article
6/1/2022
Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

The proportions of evacuations out of USCENTCOM that were due to battle injuries declined substantially in 2021. For USCENTCOM, evacuations for mental health disorders were the most common, followed by non-battle injury and poisoning, and signs, symptoms, and ill-defined conditions. For USAFRICOM, evacuations for non-battle injury and poisoning were most common, followed by disorders of the digestive system and mental health disorders.

Recommended Content:

Medical Surveillance Monthly Report

Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022
Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

In 2021, the overall numbers and rates of active component service member ambulatory care visits were the highest of any of the last 10 years. Most categories of illness and injury showed modest increases in numbers and rates. The proportions of ambulatory care visits that were accomplished via telehealth encounters fell to under 15% in 2021, compared to 19% in 2020.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance snapshot: Illness and injury burdens, recruit trainees, U.S. Armed Forces, 2021

Article
6/1/2022
Surveillance snapshot: Illness and injury burdens, recruit trainees, U.S. Armed Forces, 2021

Recommended Content:

Medical Surveillance Monthly Report

Cancer Patients Discuss Experiences During DOD Moonshot 2 Initiative Roundtable

Article
5/17/2022
The Uniformed Services University of the Health Sciences (USU) hosted a Department of Defense Cancer Moonshot Roundtable, “A Conversation on Cancer Health Equity and Military-relevant Environmental Exposures,” on May 4. (Photo: Courtesy of Uniformed Services University of the Health Sciences)

On May 4, the Uniformed Services University of the Health Sciences (USU) hosted the Department of Defense Cancer Moonshot Roundtable as part of a day-long series of agency events sponsored by the White House Cancer Moonshot initiative.

Recommended Content:

Centers of Excellence | Cancer Moonshot

DOD Cancer Research Program Aims to 'End Cancer as We Know It Today'

Article
5/3/2022
Dr. Craig Shriver is leading a renewed DOD/DHA effort to significantly expand cancer research and save lives through personalized medical treatments using proteogenomics. Shriver is director of the John P. Murtha Cancer Center at Walter Reed National Military Medical Center in Bethesda, Maryland, and professor of surgery at the Uniformed Services University of Health Sciences. (Photo: Bernard Little, Walter Reed National Military Medical Center)

DOD/DHA to greatly expand Military Health System cancer research, with a roundtable on the effort slated for May 4.

Recommended Content:

Centers of Excellence | Cancer Moonshot

The Association Between Two Bogus Items, Demographics, and Military Characteristics in a 2019 Cross-sectional Survey of U.S. Army Soldiers

Article
5/1/2022
NIANTIC, CT, UNITED STATES 06.16.2022 U.S. Army Staff Sgt. John Young, an information technology specialist assigned to Joint Forces Headquarters, Connecticut Army National Guard, works on a computer at Camp Nett, Niantic, Connecticut, June 16, 2022. Young provided threat intelligence to cyber analysts that were part of his "Blue Team" during Cyber Yankee, a cyber training exercise meant to simulate a real world environment to train mission essential tasks for cyber professionals. (U.S. Army photo by Sgt. Matthew Lucibello)

Data from surveys may be used to make public health decisions at both the installation and the Department of the Army level. This study demonstrates that a vast majority of soldiers were likely sufficiently engaged and answered both bogus items correctly. Future surveys should continue to investigate careless responding to ensure data quality in military populations.

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 15
Refine your search
Last Updated: July 29, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery