New Treatments for Soldiers’ Traumatic Eye Injuries

March 9th, 2008 - by admin

Elizabeth Fernandez / San Franciscso Chronicle – 2008-03-09 22:13:48

SAN FRANCISCO (March 9, 2008) — Kara Wooten stared at the light panel, struggling to identify which colored bulbs were turned on. Seconds passed. Her eyes slowly, slowly moved. Then she spotted a bulb to the far left.

“Red,” she said.

When Wooten, 28, a senior Army medic, arrived a month ago at the Veterans Affairs hospital in Palo Alto, she couldn’t find that red light.

During two deployments to Iraq, Wooten was a victim of six IED blasts, one of them so strong it upended her humvee. Triggered by the massive pressure waves of the explosions, her ears would sometimes ring and her nose bled, but otherwise she was barely scratched. Then, two months after the last blast in July, Wooten started throwing up and teetering on her feet with crippling headaches. She fell into a stupor, couldn’t get out of bed, had a seizure.

Evacuated and rigorously tested, Wooten learned she had serious brain trauma that was significantly affecting her vision.

In a sign of the changing nature of warfare, ocular wounds have become among the most common — and devastating — form of battlefield injury. An estimated 10 to 13 percent of wounded Iraq war veterans have sustained direct, penetrating eye damage, typically as a result of modern weaponry that unleashes an explosive cascade of fragments.

Proportionately, more eye injuries are occurring in the Iraq war than in all previous wars, said Tom Zampieri, direct of government relations for the Blinded Veterans Association in Washington.

“In WWII, 6 percent of all the wounded had eye injuries,” he said. “In Vietnam, it was 9 percent. In this war, some eye doctors have told me they have never seen such horrific eye injuries.”
Difficult to recognize

But countless service members are, like Wooten, suffering from another, insidious form of visual impairment, one that is sometimes difficult to recognize and even more difficult to treat. These injuries stem from trauma in the brain affecting the visual neurological pathways. More than 4,000 veterans are reported to have traumatic brain injuries with an unknown number experiencing visual complications.

“With IEDs the level of injury is much higher,” said Col. Robert Mazzoli, an ophthalmologist and consultant to the Army surgeon general. “In any previous conflicts, these injuries would have been mortal.”

In late January, President Bush signed into law the Military Eye Trauma Treatment Act. The measure will establish a center to improve tracking, diagnosis and treatment of service members with eye injuries. Zampieri said the new federal eye trauma center will be a general registry and will coordinate research nationally — information that would also benefit the private sector.

The VA Palo Alto Health Care System, housing one of four specialized centers in the country that provide medical and rehabilitation of “polytrauma” injuries, and the only one with a fully comprehensive range of vision health and rehabilitation services, has several studies under way on visual wartime injuries.

In one, supervisory research psychologist Gregory Goodrich has found a range of visual impairments in some patients including headaches, vertigo, inability to focus, difficulty in tracking and blurred vision.

“Blasts cause twice as many severe visual impairments than do all the other kinds of injuries combined,” he said of his early study results. “Because of the changing face of war, we’re being challenged to develop new therapies — we’re dealing with people with severe vision injuries and severe brain injuries and severe physical injuries.”
Traumatic brain injury

In other Palo Alto VA research, Glenn Cockerham, chief of ophthalmology, is studying visual dysfunction related to traumatic brain injury.

“Our hypothesis was that a blast powerful enough to cause brain injury — with a helmet, skull and surrounding fluid as protection — could cause significant damage to the eye, eyelids and surrounding orbital tissues,” said the cornea specialist and ocular pathologist.

Among the 25 vets involved in the three-year study, five eyes were lost. But some eye injuries, not as readily apparent, could have potential lifelong implications such as retinal detachment, cataracts and corneal swelling, Cockerham said.

Army Spc. Wooten is part of Cockerham’s study.

“Due to her brain injury, she’s not as aware of what happens on her left side as on her right side,” said Paul Koons, a polytrauma vision rehabilitation specialist who is helping Wooten improve her ocular motor skills.

To Wooten, the early blasts she sustained were more limited in their propulsive power. “We called them popcorn,” she said with a wry smile. “But they got bigger. On Christmas Day 2003, an IED went off and flipped our humvee. We crawled out and thought, ‘You bastards didn’t get us.’ ”

A Kentucky native who joined the Army at 23, Wooten spent the last month at the Palo Alto VA undergoing extensive rehabilitation.

“My left eye does what it wants,” she said. “I’m not supposed to be the one who’s hurt, I’m the one who’s supposed to be fixing the other soldiers.”

In wars past, a badly damaged eye would simply have been removed — if the soldier survived in the first place. But with vastly improved field trauma care as well as microsurgical advances, some sight is being saved.

That was the case for Nick Popaditch, a Marine tank commander, after a rocket grenade in 2004 blew out one eye and left him with 8 percent vision in the other.

He arrived at the Palo Alto VA not being able to read a single word — months later he left reading 140 words a minute and fully mobile.

“I learned how to get my life back,” said Popaditch, 40, from his San Diego home.

Popaditch today has a few unorthodox prosthetic eyes. One bears the Marines insignia. The other a rifle crosshairs.

“It looks like something you’d aim at someone,” he said. “It really freaks people out. My wife hates it.”
Online resource

For further information about Palo Alto’s VA Health Care System:

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