Vision health is critical to force readiness, so much so that eye problems can cut a military career short. A recently launched study could lead to better tracking of eye health over a service member’s career to prevent future eye conditions.

The Defense Health Agency’s Vision Center of Excellence is working with the RAND Army Research Division on a one-year study to determine whether a “comprehensive baseline military eye examination requirement should be established across the services to fill gaps in information and improve warfighter vision health,” VCE said.

The study began in July 2022 and is expected to be completed next autumn with a peer-reviewed report due then.

“Today’s modern warfighter has to be so technical in their visual skills, that we think there should be more done to follow eye health and ocular conditions,” said Dr. Michael Pattison, VCE’s program manager of readiness and operations optometry.

Currently, service members get an eye exam at their enlistment physical. However, according to Pattison, the RAND study is looking to determine the value of requiring service members to also receive a comprehensive eye exam, including a full ocular health assessment and a manifest refraction to see if visual correction is necessary. The latter procedure, which measures the degree to which light bends as it passes through the cornea and lens on to the back of the eye, is extremely important in determining if someone has a serious eye disease.

“My biggest issue is if I've got someone who's got a rifle in their hands, do I want that person to see ‘good enough’? Or, do I want them to see to the best of their ability?” Pattison said.

Pattison also noted that expanding current guidelines for routine eye care could be beneficial to determine if there has been a change from the initial eye exam due to combat-related or non-battle injuries and diseases, including sports-related and other off-duty ocular injuries.

Additionally, when service members separate from the military or retire, there is no routine method to determine whether an eye disorder has a service-related connection, he added.

This can prove to be a challenge for the Department of Veterans Affairs when it comes to caring for the vision of veterans, Pattison pointed out.

Having both a beginning point and an endpoint for eye health and vision could help resolve this gap in information, he said.

Vision Correction Surgery

The long-term results of vision correction surgery are another variable where comprehensive data would be useful, Pattison suggested.

Laser eye correction surgery is one way a service member can optimize their vision. “What it's not doing is catching the other people who are ‘getting by,’” Pattison said.

The RAND survey may determine if there should be periodic monitoring of those vision-corrected service members as well, he suggested.

Current Standards

Those seeking to serve in the military have their vision tested during their enlistment physical and receive eyeglasses if they need them. They must be able to see 20/40 or better using both eyes together at a distance.

Those who are deployed are fitted with better-than-ballistics-grade military combat eye protection and gas mask inserts that match their prescriptions. All deployed service members use Military Combat Eye Protection-approved lenses that are found on the Authorized Protective Eyewear List, known as APEL. MCEP standards are set by the Tri-Service Vision and Conservation Program.

During required periodic health assessments, medical personnel are required to ask if the service member has had a change in vision that:

• impacts daily performance
• resulted in being on any medical profile (noting functional limitations) or limited duty

Additionally, service members are asked if they wear corrective lenses, and, if so, how many pairs of glasses they have, whether they have prescription gas mask inserts, and are they current with their service-specific vision and eyewear standards.

“The RAND study will help us connect all the data for military vision health and readiness status to build a methodology that will better identify whether the strategies we have for the efficacy of eye care are working,” Pattison said.