Optometrist has eye on vets’ vision problems

By Rachael Scarborough King
Nov. 28, 2007

GUILFORD — For many Americans, the image of a visually impaired soldier returning from war is of a person with bandages wrapped around his injured eyes.

But people with traumatic brain injuries may score perfectly reading an eye chart and still have double vision or see words moving on a page. These problems, which doctors can have difficulty diagnosing and treating, have life-altering effects.

One local optometrist, William Padula, has spent a career researching the links between traumatic brain injuries and vision problems. Now, he is seeing some of his work parlayed into federal legislation that aims to help soldiers returning from war with vision problems.

Padula, who runs the Padula Institute of Vision and has treated soldiers and veterans from across the region, called traumatic brain injuries “the signature injury coming back from Iraq and Afghanistan.” They occur when roadside bombs or mortars explode, sending out shock waves that can cause neurological problems, even if there are no outward signs of injury.

“Even though there are eye injuries coming back from Iraq and Afghanistan, the majority of the soldiers don’t have eye injuries, they have traumatic brain injuries that are causing these brain-processing problems in the visual area,” he said. “To look at them, they look normal, but the visual processing area has become dysfunctional, and it can affect how they talk, how they behave, how they move.”

Since the start of the war, 13 percent of the 9,000 seriously wounded soldiers evacuated from Iraq and Afghanistan have suffered physical injuries to their eyes, according to the Blinded Veterans Association.

At the same time, R. Cameron VanRoekel, an optometrist at Walter Reed Army Medical Center in Washington, D.C., said almost one-third of all the soldiers treated at the hospital had traumatic brain injuries. He estimated that, of that group, 50 percent to 70 percent had problems seeing and reading.

About two years ago, Padula visited Walter Reed to talk with the eye doctors there about the vision problems they were encountering in injured soldiers. He and two other doctors then applied for a grant that made its way to the Blinded Veterans Association, a Washington-based advocacy group, and to the office of Sen. John F. Kerry, D-Mass.

In August, Kerry sponsored the Neuro-Optometric Center of Excellence bill, which would provide $5 million for the Department of Defense to set up a “center of excellence in prevention, diagnosis, mitigation, treatment and rehabilitation of military eye injuries.”

The legislation calls for creation of a registry that would track the diagnosis and treatment of combat-related eye injuries, and specifically would set up research at Walter Reed into the screening and diagnosis of “visual dysfunction related to traumatic brain injury.”

The Kerry-sponsored legislation passed the Senate as an amendment to the Department of Defense authorization bill in October.

The bill has a House counterpart, whose chief sponsor is Rep. John Boozman, R-Ark., an optometrist. That legislation, known as the Military Eye Trauma Treatment Act, has not come to the floor of the House and could also wind up as part of the next Defense authorization bill, according to Boozman’s office.

Tom Zampieri, director of government relations for the Blinded Veterans Association, said his organization was “alarmed” that it could not find a firm number for how many soldiers have suffered eye injuries in Iraq and Afghanistan. He approached Kerry’s office with the idea of creating a way to track them.

“The blast injuries for these service members who are protected by the body armor in this war — they survive, but they sustain severe extremity injuries and facial injuries,” Zampieri said. “The soldiers wear protective eyewear goggles, but these explosions are so powerful that they rip vehicles apart, so you’re not going to be able to protect the eyes.”

While his organization deals mainly with soldiers and veterans with eye injuries, Zampieri said a second part of the bill addresses the growing awareness of the relationship between traumatic brain injury and poor vision.

Col. Francis McVeigh, chief of the optometry service at Walter Reed, said that starting in summer 2005, doctors at the Department of Veterans Affairs identified some of the traumatic brain injury-related problems, including blurry vision, difficulty concentrating and a perceived shift in the visual midline. McVeigh decided to investigate further and started talking with a group of optometrists from across the country, including Padula.

“The problem was identified, we sought help from the experts in the field (and) we listened to them,” McVeigh said. “Our egos are small — our priority is taking care of the patient.”

He added that there are about 2 million traumatic brain injuries nationally every year — from causes like car accidents and falls — but before the start of the war Walter Reed had not dealt with many of them.

Padula said that, with his own patients, he has identified and researched two syndromes related to traumatic brain injury, post-traumatic vision syndrome and visual midline shift syndrome. Both can be treated by the patient wearing special types of lenses and prisms that eventually can correct the problem, he added.

“Many will be rehabilitated, (but) it’s not a cure — it’s not like taking an aspirin and your headache goes away,” he said. “It becomes a part of the multi-disciplinary team treating the person with the head injury.”

Rehabilitation for people with traumatic brain injury should include a variety of health professionals, such as physical therapists, occupational therapists, orthopedists, psychologists and optometrists, Padula said.

“My hope is that these bills will create services for our courageous men and women (in the armed forces), but that it’s also going to raise the awareness of the millions of people in the U.S. who have traumatic brain injuries,” he said. “The two bills will create a very comprehensive approach to treating all eye injuries.”

Doctors at Walter Reed have already begun implementing similar practices. VanRoekel said he talks to almost all the hospital’s patients with traumatic brain injuries, blast injuries or amputations to see if they have undiagnosed visual complications. He added that the legislation’s passage would help him continue and expand some of the screening and training he has started.

Padula said he was gratified to be included in the work, to which several doctors contributed, and to see some of his research make its way to Congress. McVeigh added that many people have worked with Walter Reed at their own expense to try to address the problem.

“I guess that’s one of the bright shining lights that make you proud of your profession and your colleagues,” McVeigh said. “When push comes to shove and you raise that flag, they were there for us, and it brought tears to my eyes.”