Bringing together research and clinical care, two doctors at the VA Palo Alto Health Care System were recently recognized for their ground-breaking efforts in the care of veterans injured in the Iraq and Afghanistan wars. 

Dr. Gregory Goodrich, research psychologist, and Dr. Glenn Cockerham, chief of ophthalmology, were selected to receive the 2009 Olin E. Teague Award, a national award that recognizes contribution in an area of utmost importance to VA’s mission: the rehabilitation and improvement in the quality of life of war-injured veterans. 

The doctors’ research efforts began in 2004, when they noticed that soldiers and Marines who were exposed to combat blast also had visual disorders and eye injuries that often went undiagnosed by the Department of Defense (DoD ) and VA health care systems. These personnel usually had traumatic brain injury (TBI), a common aftermath of blast.  Modern body armor offers improved protection against blast, but the face remains relatively exposed.  Published scientific literature rarely addressed this population or discussed the visual system in patients with traumatic brain injury.

“As one example, a 25-year-old Army soldier was thrown through the air and lost consciousness following an IED blast in Iraq,” said Dr. Cockerham.  “When he regained consciousness, he was not aware of any damage to his eyes.  As an inpatient at our VA Polytrauma Center the soldier voiced no eye or vision complaints and his corrected vision was 20/20 in each eye.  However, after a thorough examination, we found he had a retinal detachment that if untreated could have led to vision loss.” 

The seminal research done at the VA in Palo Alto led to the development of improved eye and vision injury examination techniques, which were adopted as the standard of care in 2008 for inpatients with traumatic brain injury at all VA Polytrauma Centers.

“We have learned so much,” said Dr. Goodrich.  “We now know that with a thorough eye examination with emphasis on traumatic injury what might have formerly been thought to be anger expressed from PTSD, could be frustration in not seeing well and not understanding why.  Our blind rehabilitation specialists are working closely with our ophthalmologists to ensure veterans receive the training they need, which in the past was just not done.” 

Goodrich went on to give an example. An Army Captain, 22, sustained severe brain injury that left her with the loss of her left visual field, as well as reduced memory, motor and cognitive function. Her visual deficits included poor reading and mobility skills. 

Initially her mobility was impaired by both the field loss and by visual neglect (lack of awareness of the visual loss), as well as poor visual search skills that led to a number falls at curbs and on tripping hazards.  A multidisciplinary vision rehabilitation program, including the first use in the United States of the Neuro Vision Technology assessment and training program, was prescribed to improve her visual abilities. This therapy retrains visual scanning and perceptual awareness. 

Through this comprehensive rehabilitation effort the Captain was able to overcome her visual loss and neglect and regain her ability to travel safely and effectively.  She also was able to dramatically improve her reading ability and to once again carry out a full range of daily activities. She now lives independently and is pursuing additional education that will allow her to return to work.

Visual impairment needlessly results in social isolation, depression, unemployment, and reduced independence among other factors reducing quality of life,” said Dr. Goodrich.  “If we can be a model for other facilities, we can help improve the lives of the many thousand Americans who experience a traumatic brain injury each year, whether from stroke, motor vehicle accidents, falls, assaults, gunshot wounds, and other causes.” 

Dr. Cockerham added, “Visual damage and ocular injury in combat have been recognized by Congress as an important area of research with the creation of the Vision Center of Excellence, a joint collaboration between DoD and VA.  This agency will manage an Eye Injury Registry to allow tracking of war injuries, coordinate clinical guidelines and fund and supervise research.  It is rewarding to know that we played a key role in this effort and in future efforts to   improve the lives of our war-injured veterans through prevention and rehabilitation.”

Through a comprehensive rehabilitation effort the Captain was able to overcome her visual loss and neglect and regain her ability to travel safely and effectively.  She also was able to dramatically improve her reading ability and to once again carry out a full range of daily activities. She now lives independently and is pursuing additional education that will allow her to return to work.

“Visual impairment needlessly results in social isolation, depression, unemployment, and reduced independence among other factors reducing quality of life,” said Dr. Goodrich.  “If we can be a model for other facilities, we can help improve the lives of the many thousand Americans who experience a traumatic brain injury each year, whether from stroke, motor vehicle accidents, falls, assaults, gunshot wounds, and other causes.” 

 Dr. Cockerham added, “Visual damage and ocular injury in combat have been recognized by Congress as an important area of research with the creation of the Vision Center of Excellence, a joint collaboration between DoD and VA.  This agency will manage an Eye Injury Registry to allow tracking of war injuries, coordinate clinical guidelines and fund and supervise research.  It is rewarding to know that we played a key role in this effort and in future efforts to  improve the lives of our war-injured veterans through prevention and rehabilitation.”