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RRP 07-339 – QUERI Project

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RRP 07-339
Visual Dysfunction in PNS OIF/OEF Patients: A Pilot Study
Gregory L Goodrich PhD
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: February 2008 - August 2008

BACKGROUND/RATIONALE:
The current study began following an extensive pilot project of some 115 outpatients who completed a vision screen within the the Palo Alto Polytrauma Network Site (PNS) clinic. The pilot data suggested that binocular dysfunction was present in an unexpectedly high percentage of these patients. The current study was undertaken to expand upon these initial findings and to refine the vision screening protocol.

OBJECTIVE(S):
The project has two main objectives. The first is to refine the vision screening protocol developed at Palo Alto by adding a second PNS screening clinic (Tucson) to gain added patient information and clinical experience. The second objective was to determine if the rates of binocular dysfunction seen in the Palo Alto pilot study were unique to that population or whether the results could be replicated at another site.

METHODS:
The current study is a prospective clinical research trial. Patients are consented in accordance with current VA research and human subject policies prior to their participation. The project attempts to see all patients scheduled for screening in the Palo Alto and Tucson PNS clinics, up to a maximum of 100 subjects. The basic vision screening method has been previously described (Lew, H. L., Poole, J., Vanderploeg, R., Goodrich, G., Dekelboum, S., Guillory, S. B., et al. (2007). Program Development and Defining Characteristics of Returning Military in a VA Polytrauma Network Site. Journal of Rehabilitation Research & Development, 44(7), 1027-1034), however modifications have been made as warranted by additional experience at the two sites. The screening methodology has now been standardized.

FINDINGS/RESULTS:
Data collection has been completed with 47 cases from the Tucson site and 54 cases from Palo Alto. An analysis of the data is currently being conducted. Both sites report similar population demographics and similar rates of visual dysfunction, however final results will not be available until the data analysis is complete.

IMPACT:
Preliminary data analysis suggest that vision loss and visual dysfunction are prevalent in patients of Polytrauma Rehabilitation Centers. If the final data analysis confirms these trends the results suggest that screening for visual dysfunctions should be conducted on returning OIF/OEF troops who have had significant blast exposure. The findings will also be important in guiding future research efforts on vision status in mild traumatic brain injury.

PUBLICATIONS:

Journal Articles

  1. Hall Lueck A, Goodrich GL. Vision rehabilitation services at a crossroads. Journal of visual impairment & blindness. 2010 Oct 1; 104(10):593-597.
  2. Kingston J, Katsaros J, Vu Y, Goodrich GL. Neurological vision rehabilitation: Description and case study. Journal of visual impairment & blindness. 2010 Oct 1; 104(10):603-612.
  3. Goodrich G. Scanning training in neurological vision loss: Case Studies. Eye and Brain. 2010 May 1; 2010(2):47-55.
  4. Lew HL, Weihing J, Myers PJ, Pogoda TK, Goodrich GL. Dual sensory impairment (DSI) in traumatic brain injury (TBI)--An emerging interdisciplinary challenge. Neurorehabilitation. 2010 Jan 1; 26(3):213-22.
  5. Brahm KD, Wilgenburg HM, Kirby J, Ingalla S, Chang CY, Goodrich GL. Visual impairment and dysfunction in combat-injured servicemembers with traumatic brain injury. Optometry and vision science : official publication of the American Academy of Optometry. 2009 Jul 1; 86(7):817-25.
  6. Cockerham GC, Goodrich GL, Weichel ED, Orcutt JC, Rizzo JF, Bower KS, Schuchard RA. Eye and visual function in traumatic brain injury. Journal of rehabilitation research and development. 2009 Jan 1; 46(6):811-8.
  7. Lew HL, Garvert DW, Pogoda TK, Hsu PT, Devine JM, White DK, Myers PJ, Goodrich GL. Auditory and visual impairments in patients with blast-related traumatic brain injury: Effect of dual sensory impairment on Functional Independence Measure. Journal of rehabilitation research and development. 2009 Jan 1; 46(6):819-26.
Center Products

  1. Goodrich GL, Martinsen G. Delphi Vision screen for TBI visual dysfunction. Vision Center of Excellence Work Group on Clinical Practice Recommendations for Eye Care after TBI, Galveston, TX. 2012 Aug 20.
  2. Goodrich GL, Arditi A. Low Vision: The Reference (LVTR). [Website]. 2012 Feb 21.
  3. Goodrich GL. Function of the Brain in Acquired Sight Loss. Keynote presentation, West of England School and College Neurological Vision Impairment Conference. 2011 May 6.
Conference Presentations

  1. Goodrich GL. Blast, Crash, or Smash: The Visual Consequences of Traumatic Brain Injury. Keynote address of MacFarland Seminar. Presented at: Association for Education and Rehabilitation of the Blind and Visually Impaired International Conference; 2012 Jul 18; Bellevue, WA.
  2. Goodrich GL. Highlighting Low Vision: A View of the Future [Keynote address]. Presented at: New York State Association for the Education and Rehabilitation of the Blind and Visually Impaired Fall Conference; 2011 Nov 4; Rochester, NY.
  3. Goodrich GL. Functional vision loss following traumatic brain injury and its rehabilitation. Paper presented at: Federal Interagency Conference on Traumatic Brain Injury; 2011 Jun 14; Washington, DC.
  4. Harris OA, Cockerham GC, Goodrich GL, Schuchard RA. TBI And Vision Loss: A Continuum Of Care And Research. Presented at: Federal Interagency Conference on Traumatic Brain Injury; 2011 Jun 14; Washington, DC.
  5. Goodrich GL. Visual Impairment and Visual Dysfunction Following Traumatic Brain Injury (TBI). Presented at: Association for Education and Rehabilitation of the Blind and Visually Impaired New Jersey Chapter Annual Conference; 2011 May 9; Princeton, NJ.
  6. Goodrich G. Combat, traumatic brain injury, and vision. Paper presented at: Association for Education and Rehabilitation of the Blind and Visually Impaired International Conference; 2009 Jul 22; Chicago, IL.
  7. Goodrich G. Dual sensory impairment (DSI): One person two (or more?) challenges. Presented at: Association for Education and Rehabilitation of the Blind and Visually Impaired International Conference; 2009 Jul 22; Chicago, IL.
  8. Goodrich G. Combat deployment injury and vision loss and dysfunction: Learning from current conflicts. Paper presented at: Envision Annual Conference; 2009 Apr 23; San Antonio, TX.
  9. Rosenbloom AA, Goodrich G. Managing geriatric low vision patients: Myths, misconceptions and low vision rehabilitation for success. Paper presented at: Envision Annual Conference; 2009 Apr 23; San Antonio, TX.
  10. Goodrich G. Vision impairment and dysfunction associated with traumatic brain injury. Paper presented at: American Foundation for the Blind Josephine L. Taylor Leadership Institute Annual Conference; 2009 Mar 4; Washington, DC.
  11. Goodrich G. Rehabilitation research needs for adults. Paper presented at: American Foundation for the Blind Josephine L. Taylor Leadership Institute Annual Conference; 2009 Mar 4; Washington, DC.
  12. Goodrich G. Brain injury and vision: Military and civilian research needs. Paper presented at: American Academy of Optometry Annual Meeting; 2008 Oct 22; Anaheim, CA.
  13. Goodrich G. Traumatic brain injury in military personnel: Mechanisms of injury and visual findings. Paper presented at: American Academy of Optometry Annual Meeting; 2008 Oct 22; Anaheim, CA.


DRA: Military and Environmental Exposures, Sensory Loss
DRE: none
Keywords: Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms: none