For the VA, that level of follow-up care, given the rapid growth in the number of veterans, as well as vision problems stemming from an aging veteran population, is difficult – if not impossible – to maintain for all patients due to both budget constraints and a shortage of available medical specialists.

TATRC is among the DoD research centers pursuing a multifaceted R&D effort on eye trauma in support of VCE. Current TATRC projects include corneal wound healing, low vision, clinical trials for orphan retinal regenerative diseases, ophthalmology education and training, vision augmentation/substitution, and a virtual mentor cataract surgery trainer.

According to its Vision Portfolio, TATRC’s “goal is to foster innovative, military-relevant research based on areas of research focus in the following areas: Visual Dysfunction after Concussive Injury/TBI; Protection against Environmental Hazards (Ballistic Eyewear, Transition lenses and Laser Eye Protection); Modulating Ocular Response to Injury (Alter Cornea Injury Response, Minimizing Retinal Laser Injury, Surgical Wound Healing and Orphan Retinal Diseases); Modulating Ocular Response to Disease (Orphan Retinal Diseases and Anterior Segment Dry Eye Studies); Ocular and Visual Restoration (Artificial Retina, Cortical Stimulation for Vision, Optic Nerve Restoration and Corneal Rehabilitation); Tele-Robotics and Simulation (email Tele-Consultation, Tele-Diagnosis, Tele-Surgery and Mentoring); Refractive Surgery; and Education and Training (Simulation and Distance Education).”

According to a 2010 report on combat vision trauma by the Naval Health Research Center’s Department of Medical Modeling, Simulation and Mission Support, an analysis of 2,254 U.S. service members with combat vision injuries showed 37.1 percent suffered a blast-related TBI and 62.9 percent had other blast-related injuries, with 8.9 percent diagnosed with an ocular or visual disorder within 12 months after blast injury.

“Compared with service members with other injuries, odds of ocular/visual disorder were significantly higher for service members with moderate TBI,” the report concluded. “Blast-related TBI is strongly associated with visual dysfunction within one year after injury and the odds of disorder appears to increase with severity of brain injury. Comprehensive vision examinations following TBI in theater may be necessary.”

In his report, Singman agreed, concluding that eye trauma should be included in TBI-related diagnosis and treatment protocols, thus closely tying combat vision impairment to one of the current war’s “signature” injuries.

“Comprehensive vision examinations after TBI in theater may be necessary in order to identify undiagnosed cases of ocular/visual disorder. For veterans with undiagnosed TBI, post-deployment health assessments, which contain questions about exposure to blasts and brain injury experience (e.g., losing consciousness), may be used to identify service members who may require vision assessments and/or rehabilitation,” he wrote. “Future research should include population-based studies and screening among returning service members to elucidate specific ocular and visual conditions associated with blast-related TBI in order to develop appropriate rehabilitation guidelines.”

Zampieri said the problem with current levels of research and treatment is funding, with Congress allocating defense spending on programs such as autism – which receive strong support from other government agencies and the private sector, but have little or no relation to the military – while failing to increase spending on eye trauma, even when also supported by the Pentagon and their own committees.

In March 2012, Zampieri said the assistant secretary of defense for health said eye trauma is a top priority and urged Congress to increase funding to $15 million. The House Appropriations Committee only approved one-third of that, but a floor amendment in July doubled it to $10 million. However, although a Senate subcommittee also requested $10 million, the subject never reached the floor of the Senate before Congress opted for a continuing resolution (CR).

“Normally, conferees would be working out the differences between the House and Senate bills by now, but because of the CR and the Senate never actually voting on the 2013 appropriations bill, I really don’t know what is going to happen,” Zampieri said as the 2013 fiscal year began. “Some have said they may do a yearlong CR, leaving funding at the 2012 level, which would be devastating for eye trauma research. I’ve also been told TATRC could not fund 26 vision research grants that scored very high in peer reviews because of a lack of funds this year.

“There are no private, nonprofit philanthropic organizations doing high-velocity eye trauma R&D. The only place you see the kind of combat-related injuries we’re dealing with is in DoD, so those groups have no incentive to deal with those. This lack of congressional funding severely impacts our ability to care for our wounded warfighters, whose lives have been saved at a far higher rate than any previous war.”

This story was first published in The Year in Veterans Affairs & Military Medicine: 2012-2013 Edition.