Development of a mild traumatic brain injury-specific vision screening protocol: a Delphi study.

Although traumatic brain injury (TBI) can happen to anyone at any time, the wars in Iraq and Afghanistan have brought it renewed attention. Fortunately, most cases of TBI from the recent conflicts are mild TBI (mTBI). Still, many physical, psychological, and social problems are associated with mTBI. Among the difficulties encountered are oculomotor and vision problems, many of which can impede daily activities such as reading. Therefore, correct diagnosis and treatment of these mTBI-related vision problems is an important part of patient recovery. Numerous eye care providers in the Department of Veterans Affairs, in military settings, and in civilian practices specialize and are proficient in examining patients who have a history of TBI. However, many do not have this level of experience working with and treating patients with mTBI. Recognizing this, we used a modified Delphi method to derive expert opinions from a panel of 16 optometrists concerning visual examination of the patient with mTBI. This process resulted in a clinical tool containing 17 history questions and 7 examination procedures. This tool provides a set of clinical guidelines that can be used as desired by any eye care provider either as a screening tool or adjunct to a full eye examination when seeing a patient with a history of mTBI. The goal of this process was to provide optimal and uniform vision care for the patient with mTBI.

Visual function in patients of a polytrauma rehabilitation center: A descriptive study.

Little is known about the visual function deficits associated with polytrauma injury. In this retrospective descriptive study, we examined the records of a clinic established to assess visual function in patients experiencing deployment-related polytrauma. We describe the clinical findings and present a vision examination protocol that may be useful for screening polytrauma patients in other settings. Data from our sample suggested that self-reported vision complaints were common (74%) and confirmed that visual impairment occurred in 38% of all cases. When examining the mechanism of injury, we found that polytrauma due to blast injuries appeared to more than double the risk of visual impairment compared with all other polytrauma causes (i.e., motor vehicle accidents, gunshot and/or shrapnel, assault, falls, or anoxia). The rate of visual impairment in blast-related injury was 52% compared with 20% for all other sources of injury. Visual complaints and impairments were common in the polytrauma patients studied. This finding suggests that comprehensive eye examinations should be routinely administered, particularly when the mechanism of injury involves a blast.