November 3, 2008
Kia B. Eldred, O.D., F.A.A.O., a Diplomate in low vision at the MEDVAMC Visual Impairment Services Center works through a prism adaptation therapy session with U.S. Marine veteran Steven Schulz, who was wounded in Iraq by an improvised explosive device. Photo by Bobbi Gruner.
DeBakey VA one of few health care facilities nationwide using cutting-edge technology.
Approximately 70 percent of veterans with traumatic brain injury suffer some type of visual disturbance.
HOUSTON – The Michael E. DeBakey VA Medical Center (MEDVAMC), a leader in the treatment and rehabilitation of veterans with traumatic brain injuries (TBI), is continuing to adapt its programs and offer cutting-edge technology to meet the needs of the men and women who have served in Operation Enduring Freedom in Afghanistan (OEF) and Operation Iraqi Freedom in Iraq (OIF). The latest breakthrough is the use of specialized prism eyeglasses that retrain the brain to treat hemispatial neglect.
Patients suffering from TBI may lose half of their vision in each eye. This type of vision loss is called hemianopsia. Patients who have hemianopsia are often aware of their vision loss and can be taught to scan their environment to compensate for the visual field loss. Patients with hemispatial neglect unintentionally ignore part of their vision because of a lesion in the visual processing section of the brain.
In the last year, Kia B. Eldred, O.D., F.A.A.O., a Diplomate in low vision at the MEDVAMC Visual Impairment Services Center began using prism adaptation therapy to treat veterans suffering from hemispatial neglect. Eldred is a member of the Visual Impairment Services Outpatient Rehabilitation (VISOR) program in the MEDVAMC Eye Care Line.
“Prism glasses are intended to shift the image to the right in order to retrain the visual and motor system to become aware of objects on the left side,” said Eldred.
Marine Cpl. Steven Schulz was serving his second tour in Iraq in April 2005 when an improvised explosive device left him blind in his right eye and suffering from TBI.
“The vision in my left eye isn’t that good. My brain forgets to look to the left so I bump into stuff,” said Schulz. “About a month ago, I began working with Dr. Eldred, Tonya who is a low vision therapist, and the prism glasses to retrain my brain. I do the exercises twice a day at home and have already noticed an improvement.”
Advances in armor and Kevlar helmets have reduced the number of fatal gunshot wounds but still leave the brain vulnerable to improvised explosive devices, land mines, and mortar attack. TBI, the signature injury of recent combat, can result when the brain ricochets inside the skull during the impact of an object or blast waves. A recent Rand Corporation report estimated that 320,000 of the 1.64 million troops deployed in Iraq and Afghanistan are affected by TBI. Of those, approximately 70 percent suffer some type of visual disturbance.
“Improving field of vision dramatically increases a veteran’s ability to respond to rehabilitation programs and function more independently,” said Tonya A. Mennem, OTR, SCLV, a low vision therapist at the MEDVAMC. "We want to maximize a veteran’s quality of life, reduce dependence on family and community, and address patient safety issues such as falls, burns, and medication errors.”
In anticipation of increased demand for visual impairment services by OEF/OIF veterans, the MEDVAMC continues to expand its rehabilitation programs for low vision and blind veterans. This past spring, the MEDVAMC opened a new, 2,900 square foot Visual Impairment Services Center to provide a wide variety of services, including an intermediate nine-day rehabilitation program offering skills training, orientation and mobility, and low vision therapy.
“Dr. Eldred and Ms. Mennem are working in an area that tends to be overlooked in many TBI patients. This is basically because health care providers concentrate on the life-threatening aspects first. However, these often ignored problems create much difficulty in the long-term health and function of these patients,” said Silvia Orengo-Nania, M.D., Eye Care Line Executive. “The work VISOR Director Bill Johnson and his team are doing for TBI patients is incredible and will make a huge difference in our veterans’ daily life. I am very proud of the work they do.”
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