“Veterans Health Administration is the first national health care system to completely and seamlessly integrate rehabilitation services for patients with visual impairments into its health benefits. This ensures that patients receive the finest medical and rehabilitation care, as well as cutting-edge assistive technology.”

The VA and DoD have a long-standing agreement to provide specialized care and rehabilitation for active-duty warfighters suffering eye trauma in combat. For example, every VA Medical Center has an Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) care management team to assist returning service members and veterans and help coordinate their care.

Unlike prosthetics, mental health, dental, and other areas of research and development (R&D) and treatment, neither combat eye trauma nor vision care overall have ever been line items in the VA budget, instead being incorporated in broader budget categories, such as rehabilitative care.

While praising the efforts of the VCE and other government groups, such as the Telemedicine & Advanced Technology Research Center (TATRC) and the VA Office of Research and Development, Zampieri – a retired Air National Guard flight surgeon who later lost his own eyesight to disease – remains highly critical of the level of funding devoted to military eye trauma.

“BVA has been campaigning Congress to increase funding for eye trauma research. In 2009, they approved $4 million, which dropped to $3.75 million in 2010, then rose back to $4 million in 2011 – but much to our shock, only $3.2 million in 2012, despite more than 100,000 service members with some kind of eye injury in the previous decade,” he said. “I find it atrocious that is the best Congress thinks they can do. You’re not supposed to compare injuries, but they fund TBI [traumatic brain injury] at $135 million and PTSD [post-traumatic stress disorder] at $155 million, which does not include millions the VA adds.

“And we are stuck at $3.2 million, going into the first six months of 2013, due to the continuing resolution, which froze funding at 2012 levels. Along with the American College of Ophthalmology and nine other large veterans service organizations, we have consistently told Congress we need a minimum of $10 million for vision trauma research. For whatever reason, we keep hitting a wall that really has been the single most frustrating thing I’ve dealt with since I became involved in this area.”

Researchers also have linked vision problems to blast injuries to the mouth and ears, as well as TBI.

“Visual problems following brain trauma are frequent and often complex,” Dr. Eric Singman, a subject-matter expert in neuro-ophthalmology, low vision, and vision rehabilitation at VCE, wrote in the report “Vision and Rehabilitation after Brain Trauma.” “Trauma to the brain often entails injury that can also shake or directly damage the eye along with the rest of the body … Direct head trauma can also cause the eye to move too quickly and/or too far relative to the fixed structures in the eye socket.”

The various traumas to the brain, face, and neck experienced by a large segment of warfighters injured in Southwest Asia can affect vision in a variety of ways, from “dry eye” that may lead to scarring and infection to a rapid elevation of pressure in the chest that is transmitted by the blood vessels to the retina, which also can result from damaged blood vessels in the neck associated with head trauma. Damage to eye muscles and nerves also are common to TBI and other blast injuries.

“Patients suffering traumatic brain injury might unfortunately experience depression, which can lead to neglect of medical problems and delay in diagnosis of associated medical conditions, including visual problems,” Singman wrote. “Brain trauma can also exacerbate or accelerate underlying cranial disease. It cannot be stressed enough that the team who helped the patient return to maximal medical improvement must also ensure that continuity of care for the patient is available.”