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DOD Funded Researchers Address Diagnosis of Visual Disorders from TBI

Left to right: Joint DOD/Veterans Affairs (VA) Vision Center of Excellence (VCE) Director Colonel Donald Gagliano, M.D., with Stacey Choi, Ph.D. (New England College of Optometry) and Randy Kardon, M.D., Ph.D. (University of Iowa)
Left to right: Joint DOD/Veterans Affairs (VA) Vision Center of Excellence (VCE) Director Colonel Donald Gagliano, M.D., with Stacey Choi, Ph.D. (New England College of Optometry) and Randy Kardon, M.D., Ph.D. (University of Iowa)
On February 22, AEVR’s Decade of Vision 2010-2020 Initiative hosted a briefing entitled Vision Research Meeting Battlefield Needs: Diagnosing Vision Problems Resulting from Traumatic Brain Injury (TBI). Featured speakers Randy Kardon, M.D., Ph.D. (University of Iowa) and Stacey Choi, Ph.D. (New England College of Optometry, NECO) were among twelve researchers who received a total of $11 million in Vision Research Program (VRP) grants from the Department of Defense’s (DOD) Telemedicine and Advanced Technology Research Center (TATRC) in the combined Fiscal Year (FY) 2009/2010 cycle. TATRC manages the Peer Reviewed Medical Research-Vision (PRMR-Vision) line in defense appropriations, which is a dedicated funding source for extramural vision research into immediate battlefield needs which is not conducted by the Department of Veterans Affairs (VA), the DOD, or the National Eye Institute (NEI).

Colonel Donald Gagliano, M.D., who directs the joint DOD/VA Vision Center of Excellence (VCE), introduced the speakers. He stressed that, while the VCE has neither extramural or intramural research funding, the Defense and Veterans Eye Injury and Vision Registry (DVEIVR) it is developing to track traumatic eye injuries will assist in further identifying vision research gaps already identified by the DOD. As co-chair of the TATRC Programmatic Committee that managed the awards process, he noted that the program has attracted the best and brightest of researchers to tackle these problems. He has visited several VRP awardees and has observed that the grant has fostered additional projects to address related problems, many of which are funded through other sources. “The PRMR-Vision line, and the VRP awards it funds, is money well spent,” he stated, adding that, “And we need to remember that every day, someone on the battlefield is experiencing a visual problem associated with TBI from blast injuries. These include loss of field of vision in one or both eyes, light sensitivity (photophobia), and uncoordinated eye movements (e.g., double vision), with one or more of these conditions occurring short- or long-term in upwards of 70% of soldiers with TBI.”

Dr. Kardon, who is funded by the VA, DOD, NEI, and private funding organizations, emphasized that, without PRMR-Vision line funding, he likely would not be conducting research in that arena. However, he has applied aspects of his larger research portfolio to the problem-better diagnosing TBI-related vision problems-through his research into using the brain’s natural reflexes to visual stimuli. These include the pupil’s light reflex (contractions of the pupil based on amount of light sensed by the eye), natural eye tracking of visual targets, and the activation of eyelid muscles in response to light. One goal is to develop a portable, hand-held device-perhaps even through a smart phone application-to quickly and inexpensively analyze the pupil’s reaction to light. “Since about 70 percent of the brain’s nerve connections are engaged in visual processing, a soldier could technically have 20/20 vision yet have visual disorders since the processing is perturbed. Studying the body’s natural reflexes provides one way of determining the extent of the problem.”

Dr. Choi acknowledged that the VRP award is her first major grant, as well as the first DOD award for NECO. Her research involves in vivo retinal imaging to detect microscopic changes in the retina-the photosensitive tissue at the back of the eye-to diagnose TBI and facilitate earlier intervention to improve visual outcomes. Dr. Choi is using Adaptive Optics (AO) technology that was initially developed for the military use and was then applied to the space program. AO corrects for distortions in optical imaging systems and essentially “supercharges” it, so in combination with current retinal imaging systems such as Optical Coherence Tomography (OCT) and Scanning Laser Ophthalmoscope (SLO), it can detect changes down to the cellular level. Due to its sensitivity, AO retinal imaging may be especially valuable as a diagnostic tool in cases of mild TBI or in situations where a blast was too weak to cause damage detectable by standard screening standards, yet visual symptoms exist. As with Dr. Kardon’s research, Dr. Choi’s ultimate aim is to develop a compact battlefield-ready instrument that can diagnose TBI in-theatre. “Once validated, this system could also find applications diagnosing civilian TBI from various injuries, as well as several retinal and optic nerve diseases,” stated Dr. Choi.

AEVR Executive Director James Jorkasky concluded the event by echoing Dr. Gagliano’s comment about the defense vision research’s value. “PRMR-Vision line funded research addressing DOD-identified research gaps will result in instruments to diagnose and treat eye injuries on the battlefield, which can also have potential civilian applications.”

Left to right: Dr. Kardon, AEVR Executive Director James Jorkasky, and Tom Zampieri, Ph.D., of Blinded Veterans Association (BVA)
Left to right: Dr. Kardon, AEVR Executive Director James Jorkasky, and Tom Zampieri, Ph.D., of Blinded Veterans Association (BVA)
Left to right: Francis McVeigh, O.D., F.A.A.O. from the DOD’s Telemedicine and Advanced Technology Research Center (TATRC) with Dr. Choi and David Danielson from the American Optometric Association
Left to right: Francis McVeigh, O.D., F.A.A.O. from the DOD’s Telemedicine and Advanced Technology Research Center (TATRC) with Dr. Choi and David Danielson from the American Optometric Association
Left to right: AEVR Director of Education David Epstein with Mary Lawrence, M.D., Deputy Director of the VCE
Left to right: AEVR Director of Education David Epstein with Mary Lawrence, M.D., Deputy Director of the VCE
Dr. Choi answers questions from Christian Lyons, a Defense Fellow in the office of Cong. Michael McCaul (R-TX)
Dr. Choi answers questions from Christian Lyons, a Defense Fellow in the office of Cong. Michael McCaul (R-TX)
 
Dr. Kardon made visits with the Iowa delegation, including (left) Tom Buttry in the office of Senator Tom Harkin (D-IA), who serves on the Senate Defense Appropriations Subcommittee, and (right) with Meagan Linn, office of Cong. Dave Loebsack (D-IA), in whose district the University of Iowa is located and serves on the
Armed Services Committee