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.
  6. 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 Dec. 2015. Accessed 28 Aug. 2019.
  7. 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 Jan. 2017.
  8. 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 Nov. 2015. Accessed 05 Aug. 2019.
  9. 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 Aug. 2019.
  10. 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 Dec. 2016. Accessed 05 Aug. 2019.
  11. 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.
  12. 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...

Viral hepatitis C, active component, U.S. Armed Forces, 2011–2020

Article
10/1/2022
1

This study reports updated numbers and incidence rates of hepatitis C virus (HCV) infection among active component members of the U.S. military using a revised case definition during a 10-year surveillance period between 2011 and 2020.

Recommended Content:

Medical Surveillance Monthly Report

Update: Contraception Among Active Component Service Women, U.S. Armed Forces, 2017–2021

Article
10/1/2022
2

This report summarizes the annual prevalence of permanent sterilization, as well as use of long- and short-acting reversible contraceptives (LARCs and SARCs, respectively), contraceptive counseling services, and use of emergency contraceptives from 2017 through 2021 among active component U.S. service women.

Recommended Content:

Medical Surveillance Monthly Report

MSMR Vol. 29 No. 10 - October 2022

Report
10/1/2022

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

Update: Routine Screening for Antibodies to Human Immunodeficiency Virus, U.S. Armed Forces, Active and Reserve Components, January 2017–June 2022

Article
9/1/2022
Cover 1

This report provides an update through June 2022 of routine screening results for antibodies to the human immunodeficiency virus (HIV) among members of the active and reserve components of the U.S. Armed Forces. During the full 5 and 1/2-year surveillance period, the HIV seropositivity rates for active component service members were 0.21 positives per 1,000 members of the Army, 0.24 for the Navy, 0.16 for the Marine Corps, and 0.14 for the Air Force.

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Menstrual Suppression Among U.S. Female Service Members in the Millennium Cohort Study

Article
9/1/2022
Cover 4

Menstrual suppression allows for the control or complete suppression of menstrual periods through hormonal contraceptive methods. In addition to preventing pregnancy, suppression can alleviate medical conditions and symptoms associated with menstruation such as iron deficiency anemia,1 eliminate logistical hygiene-related challenges, and improve quality of life.

Recommended Content:

Medical Surveillance Monthly Report

Letter to the Editor: Clarification of Hepatitis C Virus Screening with Case Definitions and Prevalence Among Trainees

Article
9/1/2022
Cover 3

We read with interest the brief report regarding the prevalence of Hepatitis C Virus (HCV) infection in basic military trainee blood donors by Kasper and colleagues in the November 2021 issue of the Medical Surveillance Monthly Report (MSMR),1 an update of a previous similar report

Recommended Content:

Medical Surveillance Monthly Report

Evaluation of the MSMR Surveillance Case Definition for Incident Cases of Hepatitis C

Article
9/1/2022
Cover 2

The validity of military hepatitis C virus (HCV) surveillance data is uncertain due to the potential for misclassification introduced when using administrative databases for surveillance purposes. The objectives of this study were to assess the validity of the surveillance case definition used by the Medical Surveillance Monthly Report (MSMR) for HCV, the over and underestimation of cases from surveillance data, and the true burden of HCV disease in the U.S. military.

Recommended Content:

Medical Surveillance Monthly Report

MSMR Vol. 29 No. 09 - September 2022

Report
9/1/2022

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: Pain and Post-Traumatic Stress Disorder Screening Outcomes Among Military Personnel Injured During Combat Deployment.

Article
8/1/2022
03_Pain and PTSD

The post-9/11 U.S. military conflicts in Iraq and Afghanistan lasted over a decade and yielded the most combat casualties since the Vietnam War. While patient survivability increased to the high­est level in history, a changing epidemiology of combat injuries emerged whereby focus shifted to addressing an array of long-term sequelae, including physical, psychologi­cal, and neurological issues.

Recommended Content:

Medical Surveillance Monthly Report

Prevalence and Distribution of Refractive Errors Among Members of the U.S. Armed Forces and the U.S. Coast Guard, 2019.

Article
8/1/2022
02_Refractive Errors

During calendar year 2019, the estimated prevalence of myopia, hyperopia, and astigmatism were 17.5%, 2.1%, and 11.2% in the active component of the U.S. Armed Forces and 10.1%, 1.2%, and 6.1% of the U.S. Coast Guard, respectively.

Recommended Content:

Medical Surveillance Monthly Report

Musculoskeletal Injuries During U.S. Air Force Special Warfare Training Assessment and Selection, Fiscal Years 2019–2021.

Article
8/1/2022
01_Musculoskeletal Injuries

Musculoskeletal (MSK) injuries are costly and the leading cause of medical visits and disability in the U.S. military.1,2 Within training envi­ronments, MSK injuries may lead to a loss of training, deferment to a future class, or voluntary disenrollment from a training pipeline, all of which are impediments to maintaining full levels of manpower and resources for the Department of Defense.

Recommended Content:

Medical Surveillance Monthly Report

MSMR Vol. 29 No. 08 - August 2022

Report
8/1/2022

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:

Medical Surveillance Monthly Report

Interview with the SEAC: TBI from a Joint Perspective

Video
7/18/2022
Picking Your Brian Podcast. Interview with the SEAC: TBI from a Joint Staff 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 | TBI Patient and Family Resources | TBI Educators | Centers 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

Surveillance Trends for SARS-CoV-2 and Other Respiratory Pathogens Among U.S. Military Health System Beneficiaries, 27 September 2020–2 October 2021.

Article
7/1/2022
1_COVID-19 testing beneficiaries

Respiratory pathogens, such as influenza and adenovirus, have been the main focus of the Department of Defense Global Respiratory Pathogen Surveillance Program (DoDGRPSP) since 1976.1. However, DoDGRPSP also began focusing on SARS-CoV-2 when COVID-19 was declared a pandemic illness in early March 2020.2. Following this declaration, the DOD quickly adapted and organized its respiratory surveillance program, housed at the U.S. Air Force School of Aerospace Medicine (USAFSAM), in response to this emergent virus.

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 16 - 30 Page 2 of 17
Refine your search
Last Updated: October 31, 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