Advancements and new technology in military vision health care would not be possible without dedicated personnel who conduct research to improve the recognition and management of ocular injuries and vision-threatening conditions across military and veteran populations.

Within the Department of Defense and the Defense Health Agency, the Vision Center of Excellence supports research and innovation that lead to better treatment and cures for vision problems and injuries. This research fuels vision care to enhance the health and readiness of the warfighter.

“Vision is the most important modality in our understanding of the outside world,” says Natalya Merezhinskaya, health science specialist with VCE. “A large part of our brain activity is dedicated to processing visual information. Diseases and dysfunctions of the visual systems can have a profound effect not only on vision itself but on other aspects of our health, development, and social interactions. That’s why vision research is very important.”

The VCE has three main goals: Improve vision health, optimize readiness, and enhance the quality of life for service members and veterans, according to Mariia Viswanathan, vision care research and readiness section chief with VCE.

“Research plays a critical role in identifying and treating eye diseases, and in developing treatments and cures,” says Viswanathan.

“First, observational and descriptive studies help to identify problems in vision. Then, systematic studies on large groups of patients help clarify common features of the problems and provide information about possible causes of the diseases,” says Merezhinskaya. “Finally, clinical trials help to find new ways to prevent and/or treat eye disease.”

Research can impact all areas of vision health care.

Viswanathan explains, “Through research, we understand basic knowledge of eye anatomy, physiology of vision, and genetic and environmental influence on vision performance. Through trials, we are assessing applicability of prevention, stabilization, and treatment solutions. Data analysis shows us gaps and successes in vision care that we are using to develop clinical recommendations, guidelines, and treatment protocols.”

Data is Critical to Vision Research

Behind every research project, there must be data and other evidence to support it.

The establishment of the Defense and Veterans Eye Injury Vision Registry in 2008 helped to drive and support this research with much needed important data.

“The DVEIVR collects longitudinal data on eye injuries and helps to guide analysis on prevention, treatment, and rehabilitation of military eye injuries,” says Viswanathan.

Merezhinskaya used the DVEIVR to help support research focusing “on the visual consequences of traumatic brain injuries … to characterize the co-morbid conditions in the service members who acquired sensitivity to light after the head trauma.”

She noted that research is often the work of multiple agencies or medical professionals—working together and pooling resources to work on important topics.

“We are working with our colleagues from the Department of Veterans Affairs, Uniformed Services University, and academic experts on a multicenter observational study on the frequencies of vision dysfunction in service members after a mild TBI,” said Merezhinskaya. “This study will serve as the first step in establishing the foundational data and will allow to evaluate the effectiveness of rehabilitative approaches in future studies.”

Educational Opportunities and Trainings to Further Vision Research

The VCE supports researchers, students, and providers with a variety of resources and educational opportunities.

“The VCE facilitates a yearly ocular trauma lab for both attending providers, residents, and students to polish their clinical and research skills, and have service members participate in learning how to maintain their vision readiness,” says Viswanathan.

Staying abreast of the latest research and trends, the VCE also hosts an annual research and industry day meeting to highlight the intersection of military and industry vision research, and to identify current and potential future collaborations.

The VCE, in collaboration with the DOD and VA, also provides guidance to participants in their Residency Research Partnership Program, and to other ophthalmologists and optometrists conducting research projects.

Advancements Driven by Research

Research has led to many successful applications to advancements in eye care and injury prevention.

Merezhinskaya noted that research conducted by Dr. Steven Wilson and his team from the Cleveland Clinic demonstrated that the drug Losartan controls the scarring after trauma to the cornea—the clear frontal wall of the eye that transmits light. Corneal injuries caused by trauma, including military trauma, can cause vision loss or blindness. Development of treatments to reduce scarring associated with corneal trauma, chemical burns, and infections is very important for service members, according to Merezhinskaya. This research was funded by the DOD.

Research has also been instrumental in the development and use of safety equipment by service members across the MHS.

“One of the main ways to prevent eye injuries that significantly influence service members vision readiness is the use of military eye protection,” said Viswanathan.

“Through research and analysis, it was established that combat eye injuries make up to 15% of all injuries in the services, with an estimated 38% of those service members not wearing eye protection at the time of injury. Service members wearing eye protection were nine times less likely to sustain an eye injury than those without.”

Based off this research, military eye equipment was developed to provide protection from sun, wind, dust, lasers, and ballistic fragmentation and from possible chemical injuries.

Viswanathan says that “research is for anyone … there is no excuse not to ask questions and to conduct investigations to achieve the best results for prevention, treatment, and rehabilitation of service members to fulfill medical readiness, and to provide a high quality of life for them and their families.”