By Lt. Cmdr. Manuel Zambrano Optometry Department,Naval Medical Center San Diego Public Affairs
SAN DIEGO - Naval Medical Center San Diego’s Optometry department has joined NMCSD’s Comprehensive Combat and Complex Casualty Care (C5) program to help service members who suffer from severe eye injuries associated with both mild and severe Traumatic Brain Injuries (TBI).
Since joining the C5 team in April 2011, the Optometry department has screened and treated more than 200 service members with eye injuries associated with TBI. A multidisciplinary holistic rehabilitative approach serves as the best model to address a wide range of combat-related TBI care. Optometry is just one component of this multidisciplinary rehabilitative team and provides invaluable input for proper assessment, management and disposition recommendations for wounded service members.
One of the least understood and most common forms of injuries deal with blast exposure from Improvised Explosive Device’s (IED) leading to the diagnosis of traumatic brain injury. Service members diagnosed with TBI due to blast exposure also complain of visual symptoms- most common are blurred eyesight, light sensitivity, difficulty reading and visual field loss.
In October 2007, NMCSD established C5, a multidisciplinary program of care that manages wounded, ill and injured service members from medical evacuation through inpatient care, outpatient rehabilitation, and eventual return to active duty or transition from the military.
The C5 model incorporates numerous specialties including psychiatry, neurology, vestibular and occupational therapy and most recently optometry. NMCSD’s Optometry department along with the support of C5 Director, Jennifer Town, created a C5 clinic to address the visual needs of wounded service members. Impaired vision can interfere with the rehabilitative process, but now wounded service members are referred for comprehensive, functional eye examinations and rehabilitative care using the latest up-to-date diagnostic instrumentation, evidence-based clinical protocols and rehabilitative methods.
This C5 optometric evaluation is uniquely tailored for TBI patients experiencing symptoms related to visual alignment, movement and focusing problems. In addition to the correction of refractive error with glasses or contact lenses, C5 Optometry provides consultative Ophthalmological referral services for refractive surgery, oculoplastics, cornea, retina and neuro-ophthalmology particularly when management of the C5 patient requires blood work, brain imaging, prescription medications or hospitalization.
“Primarily we treat patients with tinted prescription glasses for even mild but symptomatic refractive error and light sensitivity,” said Cmdr. Ken Uyesugi, chairman of Optometry department. “We have also prescribed prism lenses to address visual field loss (blindspots) and convergence insufficiency (difficulty maintaining gaze while reading or computer work). Our specialty contact lens clinic also fits prosthetic lenses on injured eyes for improved cosmetic and visual function.”
With the support of the Naval Ophthalmic Support and Training Activity (NOSTRA) located in Yorktown Va., C5 Optometry patients with light sensitivity can now order their frame of choice prescription glasses with photo chromic lenses. Photochromic or transition lenses change to a darker tint when exposed to sunlight then change back to clear lenses when indoors.
C5 optometrists are also specially trained to manage visual field defects using prism correction. They work closely with rehabilitative providers, such as vestibular and occupational therapists, to administer the appropriate therapy for better outcomes. One rehabilitative therapy C5 optometrists use is the Dynavision (D2)™ system.
The D2 system™, was originally designed to improve the visuomotor skills (hand eye coordination) of athletes, and is one of the devices adopted and modified by rehabilitation specialists to provide that same training benefit to TBI patients. C5 occupational therapists have used this device in brain injury rehabilitation to address visual, cognitive and motor impairment. For persons with motor impairment it is used to increase active upper extremity range of motion and coordination, muscular and physical endurance and motor planning. For C5 optometry and vestibular patients with visual and visuomotor impairment the apparatus is used to train compensatory search strategies, increase visual search speed and efficiency, improve oculomotor skills (efficiency of eye tracking and movement while looking at objects) such as localization, fixation, gaze shift, and tracking, increase peripheral visual awareness, visual attention and anticipation, and improve eye-hand coordination and visuomotor reaction time.
Since C5 Optometry’s inception, NMCSD Optometrists and C5 occupational therapists have received in-service training from local, private and VA brain injury providers.
“The field of vision rehabilitation is relatively new,” said Uyesugi. “Therefore, networking closely with experienced local, private and federal providers is an integral component towards providing top-notch latest care and create a seamless patient care handoff experience both clinically and administratively with the VA.”
For more information on NMCSD’s C5, visit: http://www.med.navy.mil/sites/nmcsd/Patients/Pages/c5.aspx