Traumatic Brain Injury Vision Loss Severely Impacts Veterans

Quality of life worse for veterans with TBI vision loss than for comparable civilians

Many young veterans of the Iraq and Afghanistan wars suffer traumatic brain injury (TBI) from exposure to combat explosions. A study of TBI’s affect on visual function and quality of life in such veterans by Glenn C. Cockerham, MD, Stanford University, and colleagues at the Veterans Administration Palo Alto Department of Ophthalmology, found that most had severe vision problems and poorer quality of life than comparable civilian patients.

Dr. Cockerham, Sonne Lemke, PhD, Catherine Glynn-Milley, CRNO, and Kimberly Cockerham, MD, assessed visual function and occult (not readily detectable) eye injuries in 42 young veterans with blast-related TBI, then evaluated them using two standard quality of life tests, the National Eye Institute Visual Function Questionnaire (VFQ-25) and Neuro-Ophthalmic Supplement (NOS). The veterans’ VFQ-25 and NOS scores were compared with accepted norms for patients with similar visual disorders. On the VFQ-25, overall scores were significantly lower for veterans than the reference patient groups; for example, veterans scored lower than norms for patients with glaucoma, multiple sclerosis (MS) and diabetic eye disease. On the NOS the veterans’ scores were significantly lower than norms for patients with MS and disease-free adults and were similar to norms for comparable neuro-ophthalmic patients.

The eyes and related tissues are less protected than the head during explosions and are vulnerable to blast forces. A comprehensive eye exam and neuro-ophthalmic evaluation detect occult injuries that may include: structural damage that can lead to glaucoma, retinal and choroidal damage, optic nerve injury, double vision, visual field changes and other disorders.

"The young veterans in our study self-reported compromised visual function in many areas," Dr. Cockerham said. "We found the VFQ-25 and NOS were sensitive to vision loss issues in patients with blast-related TBI. Our future studies will correlate visual function with specific life challenges and determine how these change over time," he added. In September, 2009, the Veterans Administration honored Dr. Cockerham and his colleague Greg Goodrich, PhD, with the Olin Teague Award for improving disabled veterans’ quality of life.