Vision Center of Excellence Promotes Eye-injury Research, Care

WASHINGTON, Jan. 9, 2012 — Next month will mark a major mile­stone in advanc­ing care for wound­ed war­riors suf­fer­ing debil­i­tat­ing eye injuries with a rib­bon-cut­ting at the Wal­ter Reed Nation­al Mil­i­tary Med­ical Cen­ter in Bethes­da, Md.

Army Pfc. Dou­glas K. Phillips a mem­ber of the 3rd Infantry Division’s Com­pa­ny A, 1st Bat­tal­ion, 15th Infantry Reg­i­ment, deployed to Durai-ya, Iraq, in May 2007, shows the dam­age to his face and his eye pro­tec­tion from a small-arms attack. Phillips cred­its eye pro­tec­tion with sav­ing his eye. The Depart­ment of Defense and Depart­ment of Vet­er­ans Affairs Vision Cen­ter of Excel­lence is explor­ing oth­er ways to pre­vent bat­tle­field eye injuries and to bet­ter treat those who suf­fer them. U.S. Army pho­to by Sgt. Natal­ie Loucks
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The Depart­ment of Defense/Department of Vet­er­ans Affairs Vision Cen­ter of Excel­lence will offi­cial­ly open its new head­quar­ters at the Wal­ter Reed facil­i­ty, pro­vid­ing an expand­ed phys­i­cal pres­ence for a grow­ing col­lab­o­ra­tion between the two agen­cies.

The goal, explained Army Dr. (Col.) Don­ald Gagliano, its exec­u­tive direc­tor, is to pro­mote research and ini­tia­tives to pre­vent eye injuries and bet­ter diag­nose and treat those suf­fer­ing from them.

Although often over­looked, eye injuries are one of the sig­na­ture wounds of the wars over the last decade, Gagliano not­ed.

Just how preva­lent these injuries are isn’t clear, he said, although offi­cials esti­mate that 13 to 22 per­cent of all casu­al­ties between 2002 and 2010 have suf­fered eye injuries or trau­ma.

These injuries often go under­re­port­ed on the bat­tle­field, par­tic­u­lar­ly when caused by explo­sions that inflict oth­er, high­ly vis­i­ble and fre­quent­ly life-threat­en­ing wounds. Gagliano esti­mat­ed that eye-injury rates soared as high as 29 per­cent among casu­al­ties before the mil­i­tary began man­dat­ing the use of bal­lis­tic glass­es for deployed troops.

“The real­i­ty is it is very dif­fi­cult for us to know exact­ly what the preva­lence of eye injury is, because it is often inter­twined with oth­er poly­trau­ma,” Gagliano said.

What is known is that the same fly­ing frag­ments and high-ener­gy waves that tear into body tis­sue and inflict trau­mat­ic brain injuries also take a severe toll on the eyes. Ser­vice mem­bers are suf­fer­ing eye injuries unlike those in civil­ian trau­ma cas­es, and more severe than those from past con­flicts, Gagliano said.

So one of the first goals of the Vision Cen­ter of Excel­lence, stood up under the 2008 Nation­al Defense Autho­riza­tion Act, is to estab­lish a reg­istry to deter­mine the preva­lence of eye injuries and track wound­ed war­riors’ care and reha­bil­i­ta­tion through both the DOD and VA sys­tems.

This, Gagliano said, will pro­vide an impor­tant start­ing point for advanc­ing eye pro­tec­tion and care through­out the force.

The law that estab­lished the cen­ter for­mal­ized a part­ner­ship already being forged between DOD and VA to pro­vide bet­ter care for wound­ed war­riors. Even its make­up — Gagliano and half of the staff are from DOD, and his deputy, Dr. Mary Lawrence, and the oth­er half of the staff from VA — pro­motes col­lab­o­ra­tion as they pool exper­tise and resources, he said.

“It is very unique in struc­ture, and that is what allows us to func­tion across both sys­tems as effec­tive­ly as we have,” Gagliano said. “It helps us bring togeth­er the entire vision-care team of both the Defense Depart­ment and the VA to func­tion effec­tive­ly as an inte­grat­ed team.”

In stand­ing up the cen­ter, its founders opt­ed to max­i­mize rather than replace exist­ing resources. “Ear­ly on, we elect­ed to be a cen­ter that would work with and through the exist­ing sys­tem rather than being a sin­gle place,” Gagliano explained.

As a result, the cen­ter has oper­at­ed with facil­i­ties and office space in Wash­ing­ton as well as at Madi­gan Army Med­ical Cen­ter near Seat­tle.

The open­ing of the new head­quar­ters next month will pro­vide an offi­cial home to the cen­ter, but Gagliano said it will con­tin­ue to draw on exist­ing capa­bil­i­ties through­out DOD and VA, includ­ing VA’s net­work of 13 blind reha­bil­i­ta­tion cen­ters.

To ensure these enti­ties oper­ate as effec­tive­ly as pos­si­ble, eye sur­geons and eye-care providers from both agen­cies come togeth­er each month for a world­wide ocu­lar trau­ma video­con­fer­ence, Lawrence said. Par­tic­i­pants — at for­ward oper­at­ing hos­pi­tals in Afghanistan, at Land­stuhl Region­al Med­ical Cen­ter in Ger­many, at mil­i­tary treat­ment facil­i­ties state­side and at VA poly­trau­ma cen­ters — come togeth­er to share expe­ri­ence and explore ways to improve the care they pro­vide, she explained.

“This is an amaz­ing world­wide group of providers,” she said. Based on their inputs, she added, “a lot of inter­est­ing process improve­ments ideas have sur­faced that can be put into good use imme­di­ate­ly.”

Anoth­er pri­or­i­ty for the Vision Cen­ter of Excel­lence is expand­ing the research base about eye trau­ma, Gagliano said. That’s crit­i­cal to improv­ing care, he explained, because civil­ian insti­tu­tions, includ­ing the Nation­al Eye Insti­tute, have lim­it­ed research about the types of eye injuries being seen in the com­bat the­ater.

Gagliano expressed hope that the center’s col­lab­o­ra­tion with col­leges, uni­ver­si­ties and research bod­ies world­wide ulti­mate­ly will improve the research, pre­ven­tion, diag­no­sis, treat­ment and reha­bil­i­ta­tion of mil­i­tary eye injuries.

At the Vision Cen­ter of Excel­lence, “we are lead­ing the nation in try­ing in try­ing to deter­mine the best ways to address these issues,” he said.

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)

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