An epic battle, for no reason: Undiagnosed vision problems in returning Iraq veterans

Army Staff Sergeant Brian Pearce came home from Iraq with 20/20 vision – and a diagnosis of legal blindness. It has taken him much of the lat 18 months, since he arrived home on a stretcher with severe injuries from the blast of an improvised explosive device, to make sense of that paradox.

Dr. Kara Gagnon, director of low vision optometry at the West Haven, Connecticut veterans hospital, explained that "your eyes are healing. It's your brain that won't allow your eyes to work the right way." Shrapnel had penetrated his skull and jarred his brain, damaging his optic nerves.

Since a binocular dysfunction keeps his eyes from working in unison, Brian had been straining his upper body to compensate, and was bothered by headaches and neck pain.

When the brain is jostled by a blast, the force can disrupt the circuitry that allows the eyes to work in unison or to process the entire visual field. Double vision, trouble focusing, and poor spatial orientation can result from TBI. Some can be fixed easily with corrective lenses or other adaptive devices; others can require extensive therapy to retrain the brain and eye muscles.

Through six weeks of intensive therapy in her clinic, Brian learned how to navigate a disjointed visual field and to compensate for the permanent loss of his peripheral vision. The therapy and special prism glasses have eased his problems.

But Brian is the exception; most veterans with his condition are not diagnosed appropriately. In their recent report, Government Accounting Office investigators wrote that only one of the nine VA facilities they reviewed was referring all veterans with traumatic brain injury (TBI) to a vision specialist.

There are many veterans like Brian. Last week, a study by RAND Corporation found that about 320,000 service members have likely experienced a traumatic brain injury during their deployment. Last November, doctors at the VA hospital in Palo Alto, California reported that 74% of veterans they studied with TBI and other traumatic injuries reported vision problems. This implies that up to 80,000 veterans have undiagnosed vision problems.

Meanwhile, the Defense Department has taken only the first steps to set up a center of excellence. Though Congress authorized an affiliated eye center, plans for it are in limbo. "This has turned into an epic battle, for no reason," says Thomas Zampieri, director of government relations for the Blinded Veterans Association.

Advice to families of returning Iraq veterans: Ask their primary care physician to ask the veteran about headaches, double vision and trouble reading.

Read another Iraq veteran’s TBI story.

Thanks to Lisa Chedekel for the source story in the Hartford Courant of April 20.