Barbara Boughton

October 29, 2009

October 29, 2009 (San Francisco, California) — Patients with vision loss from combat-related traumatic brain injury report a lower quality of life than those with diabetic retinopathy and visual difficulties related to multiple sclerosis. They also rate their visual dysfunction similar to that of glaucoma patients, according to a study reported here at the American Academy of Ophthalmology Joint Annual Meeting With the Pan-American Association of Ophthalmology.

"Combat blast injury is becoming an increasingly important public health problem in the United States, as are closed globe eye injuries from these blasts," said Glenn Cockerham, MD, from Stanford University in California, who was lead author of the study.

In 2008, the Rand Corporation found that 320,000 American combat troops (30%) had some degree of traumatic brain injury from combat blast exposure, but the quality of life of veterans with vision loss associated with these injuries has not been well studied. Dr. Cockerham and colleagues at the Veterans Administration Palo Alto Department of Ophthalmology assessed visual function and occult eye injuries in 42 veterans (mean age, 28 years) with 2 quality-of-life questionnaires. The Visual Function Questionnaire (VFQ)-25 assesses vision, ocular pain, the ability to participate in daily activities, as well as dependence and mental health related to vision loss. The Neuro-Ophthalmic Supplement (NOS) captures problems such as double vision and eye fatigue, eye movement abnormalities, and photosensitivity.

After administering both questionnaires, results were compared with a normal reference group and with results from published studies of patients with a variety of eye disorders. The researchers found that the veterans' scores on the VFQ-25 were significantly worse than those from patients with diabetic retinopathy and multiple sclerosis, and there was a trend toward scores similar to those from patients with cataracts and glaucoma. The veterans' scores on the NOS were similar to those from patients with neuro-ophthalmic disorders, such as ocular myasthenia, and worse than those from patients suffering from multiple-sclerosis-related vision disorders, Dr. Cockerham said.

Some of the veterans had monocular vision as a result of their blast injuries, but the researchers found that those with binocular vision were more dissatisfied with their quality of life. Worse visual acuity correlated with a lower score on the 2 instruments, although even those with 20/20 vision in at least 1 eye had low scores on the visual quality-of-life tests. The researchers also found that wearing protective eye wear (during the time of injury) had no correlation with visual outcome or quality of life as measured by the tests.

The researchers plan to continue recruiting veterans with traumatic brain injury for their study, and to analyze quality-of-life data with measures of visual performance and ocular injury.

"This is a timely informed topic. The study's strengths are its unique prospective cohort and the use of previously validated instruments," said Andrew Lee, MD, from Methodist Hospital in Houston, Texas. "The weakness of course is the relatively small numbers. But it shows us that there's an opportunity for good from something that is ultimately tragic," Dr. Lee said. He noted that previous research on vision loss and traumatic brain injury has been marked by poor methodology, and the study helps ophthalmologists understand the relation between quality-of-life measures and these injuries.

Dr. Lee hypothesized that problems with eye coordination could explain why veterans with monocular vision are more satisfied with their vision than those with binocular vision. "This finding, as well as others in the study, needs confirmation with larger studies," Dr. Lee said. "Unfortunately, we're going to have those bigger numbers downstream."

The study was supported by a grant from the Veterans Administration. Dr. Cockerham and Dr. Lee have disclosed no relevant financial relationships.

American Academy of Ophthalmology Joint Annual Meeting With the Pan-American Association of Ophthalmology (AAO-PAAO): Abstract PA097. Presented October 27, 2009.

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