Head Injuries Have Vision and Eye Complications

Vision and eye problems from traumatic head injury have become a central topic in recent years with both field injuries in the military (Traumatic Brain Injury—TBI) and head injuries and concussion being discussed increasingly in sports. Some have proposed that the eye and vision impacts of head injury can actually be among the earliest signs of important brain injury, particularly in sports. And certainly the eye and vision consequences of TBI are quite evident; upwards of 75% of all troops with a TBI diagnosis have experienced short- or long-term vision disorders, such as double vision, light sensitivity, inability to read print, and other cognitive and perceptual impairments. Although there is much media attention on the head injuries and the eye and vision consequences, there has been much less attention to the research aspects of these relationships, with the exception of the over 60 research awards for a total of almost $50 million since 2009 from the US Department of Defense. Optometry and Vision Science (OVS) believes it is time to bring ongoing research efforts to publication in this feature theme issue that informs and advances thinking on the topic for researchers and clinicians alike. Consequently, Optometry and Vision Science (OVS) assembled a team of international experts as Guest Editors for this theme issue. OVS now brings recent study results and clinical perspectives together in a single publication this month, with this esteemed team of guest editors (Felix Barker, OD, PhD, FAAO, Glenn Cockerham, MD, Andrew Hartwick, OD, MSc, PhD, FAAO, Randy Kardon, MD, PhD, Andrew Mick, OD, FAAO, Mark Swanson, OD, MSPH, FAAO, with Gregory Goodrich, PhD, FAAO, as the lead guest editor who, with the OVS editors, coordinated all submitted manuscripts). We know there will be great interest in this publication among clinicians and basic and clinical scientists. I thoroughly recommend readers carefully read the Guest Editorial by this team. It is an “eye-opener” preview of the manuscripts and their contributions to detection, diagnosis, management, and prognosis. You will not be disappointed. As they note, “Public awareness of brain injury has been heightened by two seemingly unrelated factors: brain injury in military personnel during the recent wars in Afghanistan and Iraq and sports-related concussions. The former has resulted in over 340,000 military personnel sustaining a brain injury and the latter some 170,000 head injuries per year from sports participation in children age 19 and younger.” Yet they take pains to make the case that the sequelae and vision implications can be remarkably similar; so much so that in their call for further research they make the case that we already have learned a great deal from research studies funded for TBI, including the need for further research funding. In that context, they also point to specific research areas of need, including, “The growing concern about concussions in student athletes has led to the development of widely accepted ‘return-to-play’ criteria. These criteria are useful in guiding parents, coaches, trainers, and others in limiting a player’s return-to-play so as to maximize the body’s ability to heal from a concussive event. ‘Return-to-learn’ criteria, focusing on readiness to return to school after a concussive event, are widely acknowledged as needed.”Gregory L. Goodrich, PhD, FAAOOur lead Guest Editor, Gregory Goodrich, PhD, FAAO, has a stellar record of research with the US Veterans Hospitals looking at specific consequences for military personnel with TBI. He has published a good deal in this area, including with his VA colleague Douglas Cockerham, MD, who heads the National Ophthalmology Service in the US Veterans Administration. Greg deserves special credit for his leadership on this Feature Issue; he made numerous decisions that significantly strengthened the final product and he assembled the team of Guest Editors. Greg received his PhD from Washington State University. He is a Fellow of the American Academy of Optometry and its first Research Diplomate of the Low Vision Section. His research spans more than 40 years with broad interests in vision rehabilitation and visual loss and dysfunction after brain injury. In 2009, he and collaborator Glenn Cockerham, MD, received the Olin E. Teague award, the highest Veterans Affairs Award for achievements that have been extraordinarily beneficial to the rehabilitation of war-injured veterans, for their work on visual function after traumatic brain injury in service members of the wars in Afghanistan and Iraq.Felix M. Barker, OD, MS, FAAOFelix Barker, OD, MS, FAAO, is Associate Director of Research of the Rehabilitation and Reintegration Directorate of the VA/DoD Vision Center of Excellence (VCE). Dr. Barker is Emeritus Professor at Salus University, Adjunct Associate Professor of Pathology (Comparative Medicine) at Wake Forest University, and was the Dean of Research at Salus University. He is a clinical staff member at the Salisbury VAMC. In his VCE role, Dr. Barker works to facilitate the prioritization, development, and funding of vision rehabilitation research efforts within the VA, DoD, and non-Federal Communities.Glenn C. Cockerham, MDGlenn Cockerham is the Director of the National Ophthalmology Service in the Veterans Administration. He has published numerous articles on the effects of blast injury on the eye and visual system of Veterans. Dr. Cockerham is a corneal specialist and ophthalmic pathologist, and a former Colonel in the U.S. Air Force. He is located at the VA Palo Alto Medical Center in Palo Alto, California. As noted, he shared the prestigious Olin E. Teague award for his extraordinary work with veterans after their traumatic brain injury in the wars in Afghanistan and Iraq.Andrew T. E. Hartwick, OD, MSc, PhD, FAAOAndrew Hartwick, OD, MSc, PhD, FAAO, is an Associate Professor in the College of Optometry at Ohio State University. He trained at Dalhousie University (Halifax, Nova Scotia), where he received his PhD in Anatomy, and at the University of Waterloo, where he received both OD and MSc (in Vision Science) degrees. Andrew’s research, involving both basic laboratory and clinically applied studies, is directed towards understanding how a subset of retinal ganglion cells (RGCs) are able to capture light and convert it into an electrical signal, and determining whether RGC photoreception is affected in conditions such as traumatic brain injury and glaucoma.Randy H. Kardon, MD, PhDRandy Kardon, MD, PhD, is Professor of Ophthalmology and Director of the Neuro-Ophthalmology Service at the University of Iowa and Veterans Administration Hospitals. He holds the Pomerantz Family Chair in Ophthalmology and is Director of the Iowa City Veterans Administration Center for the Prevention and Treatment of Visual Loss. Dr. Kardon has published extensively and his research is funded from the Department of Veterans Affairs since 1990; he is principal investigator (PI) or co-PI on eight major grants from the Veterans Administration, NIH, and the Department of Defense, including funding as part of the Chronic Effects of Neurotrauma Consortium (CENC) for a prospective study entitled “Visual Sensory Impairments and Progression Following Mild Traumatic Brain Injury.” He did all of his training at the University of Iowa, Iowa City, Iowa, USA, and has been an ophthalmology faculty member there since1989. He serves on the editorial board for the Journal of Neuro-Ophthalmology. His current research interests include pupil physiology and clinical application, diagnosis and treatment of light sensitivity, traumatic brain injury and its treatment, therapeutic interventions for preserving vision in disorders of vision, and investigating structure-function relationships in the visual system using optical coherence tomography (OCT), ocular blood flow, image analysis, and MRI.Andrew B. Mick, OD, FAAOAndrew Mick, OD, FAAO, completed his OD degree at University of California Berkeley, then an optometric residency at the Bascom Palmer Eye Institute. He is currently an optometrist at the San Francisco VA Medical Center where he is the Coordinator of the residency program. He has an appointment as an Associate Clinical Professor at UC Berkeley School of Optometry and is a member of the clinical faculty of the UCSF Department of Ophthalmology. He is the Chair of the Scientific Program Committee of the American Academy of Optometry and is an Associate Editor and Editorial Board member for Optometry and Vision Science.Mark W. Swanson, OD, MSPH, FAAOMark Swanson, OD, MSPH, FAAO, is a Professor at the University of Alabama at Birmingham with a primary appointment in the Department of Optometry and Vision Science. He is a Senior Scientist in the University’s Comprehensive Center for Healthy Aging, the Center for Community Health, and the Vision Science Research Center. He serves as a member of the Executive Committee for the Vestibular Ocular Research Clinic at UAB. This multidisciplinary research and clinical collaborative is evaluating biomarkers of mild traumatic brain injury both in the examination room and on the sideline. The research concentrates on the interaction of the visual and vestibular systems. Tony Adams Associate Editor Optometry and Vision Science

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