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VCE examines low vision with detection and care

military health personnel wearing a mask and performing an eye exam Navy Hospital Corpsman 3rd Class Jordan Belthrop (right) administers an eye exam on Navy Hospitalman Caleb Newbill at the Naval Support Activity Souda Bay’s, Branch Health Clinic on the island of Crete, Greece in Aug. 2020. (U.S. Navy photo by Joel Diller)

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“There are many types of low vision, ranging from small to life-changing issues,” explained Dr. David Eliason, associate chief of the Department of Defense/Department of Veterans Affairs’ Vision Center of Excellence.

With February designated as Low Vision Awareness Month, Eliason, the VCE and other eye specialists within the Defense Health Agency are focused on the variety of causes and cases of low vision within the military.

“People also become low vision for a variety of reasons,” said Eliason. “Because needs and treatments are as varied as the cases, the DOD is in the unique position of having the greatest variety of low vision patients compared with other medical systems.”

Causes of low vision range from hereditary to environmental factors, but what exactly is “low vision?”

“A broad definition of ‘low vision,’ in the past, may have been anyone with vision worse than a particular level. For example, they don’t see any better than 20/70 or 20/80 in both eyes,” said Eliason. “However, most low vision specialists prefer a practical approach to defining low vision as simply a loss of vision that has resulted in a decrease in desired visual function or ability for that person.”

This usually means a loss of visual function in both eyes, added Eliason.

“We tend to be able to perform fairly well if we lose vision in just one eye, but still have normal vision in the other eye,” Eliason said.

Low vision, said Eliason, disproportionately affects older populations.

“The impacts of low vision can be felt across the patient spectrum within the DOD, from active-duty service members to retirees and dependents,” said Eliason. “Naturally, though, the majority of low vision patients are dependents and retirees simply because the demographics of the active-duty population is going to put them within the healthiest groups of the general population. That’s also not factoring in the fact that they are remaining on active duty because they obviously don’t have a disability that is limiting their function.”

But the number of service members dealing with low vision is significant. Many times, individuals find themselves continuing to serve in some capacity, even as they are separating or retiring because of low vision.

“The process may be long enough that their vision loss requires attention prior to their separation,” Eliason said. “Even though they may be in the process of leaving the DOD, that doesn’t mean that things can be put off or not addressed until they separate.”

In other cases, he said, low vision may be just one of many combat-related injuries that a patient is dealing with.

Eliason said a plan should be in place for their post-separation eyecare, whether that be with the Department of Veterans Affairs or out in the community.

Military personnel wearing a mask performing an eye exam
Air Force Airman 1st Class Hannah Schaeffer (right) performs an eye exam on fellow 911th Aeromedical Staging Squadron Medical Technician Air Force Airman 1st Class Alexis Workman at the Pittsburgh International Airport Air Reserve Station in Pennsylvania in Dec. 2020. (U.S. Air Force photo by Senior Airman James Fritz)

“The VCE [Vision Center of Excellence] was designed to evaluate the continuum of care that a DOD patient would undergo with a significant eye injury, starting at prevention and going all the way through to detection, diagnosis, mitigation, and treatment of an eye injury and what results afterward, including vision rehabilitation,” Eliason said.

Part of the mission of the VCE is also to bridge the gap between active-duty and post active-duty vision care, specifically with the VA.

VCE connects the DOD and the VA because the DOD does not traditionally offer long-term rehabilitation.

“It’s understandable why,” Eliason said. The priority of the DOD is the readiness of its fighting force, and the medical force that supports that.”

Additionally, Eliason said, in cases where low vision may be caused by damage from hazards encountered as part of one’s job, safety and prevention are key.

“Prevention measures are command- and occupation-specific,” said Eliason. “But for cases that are based on hereditary factors, some cases aren’t preventable or predictable and may surface in younger service members unannounced. Our mission is to be looking at what factors lead to eye injuries, as well as short-term and long-term impacts of vision injuries and vision rehabilitation.”

With the VA taking on responsibilities for rehabilitation, it allows military medical treatment facilities to focus on more traditional aspects of vision care like routine care, testing, and surgeries.

“The VA has a large, nationwide, robust vision rehabilitation program, and a memorandum of understanding is in place that allows the VA to see active-duty personnel for vision rehabilitation,” said Eliason. “That gives the DOD a chance to focus on other aspects of vision care.”

As a one of several centers of excellence within of the Defense Health Agency, the VCE leads and advocates for programs and initiatives with the inter-related goals of improving vision health, optimizing readiness, and enhancing the quality of life for service members and veterans. VCE promotes collaboration, facilitates integration, and serves as an advocate for vision across the DOD and VA healthcare systems. VCE also collaborates with other federal health care organizations, academia, and private sector organizations.

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