Original Investigation | Clinical Sciences

Visual Quality of Life in Veterans With Blast-Induced Traumatic Brain Injury

Sonne Lemke, PhD1; Glenn C. Cockerham, MD2,3,4; Catherine Glynn-Milley, RN3; Kimberly P. Cockerham, MD3,4
[+] Author Affiliations
1Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California
2Department of Pathology, Stanford University School of Medicine, Palo Alto, California
3Ophthalmology Service, VA Palo Alto Health Care System, Palo Alto, California
4Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
JAMA Ophthalmol. 2013;131(12):1602-1609. doi:10.1001/jamaophthalmol.2013.5028.
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Importance  Traumatic brain injury (TBI) is an important cause of morbidity worldwide, with increasing awareness of the role of blast exposure in military and civilian casualties. Visual problems have been reported in TBI and may affect functioning and quality of life.

Objective  To evaluate the 25-item National Eye Institute Visual Functioning Questionnaire and Neuro-Ophthalmic Supplement for utility in assessing the effect of blast exposure on perceived visual functioning among veterans with TBI.

Design, Setting, and Participants  Observational cohort study from a tertiary care Veterans Health Administration hospital. Reported visual quality of life was compared with existing norms, and relationships between perceived visual quality and ocular injury, diplopia, visual performance, and blast exposure characteristics were examined. Participants included inpatients with blast-induced TBI who underwent baseline examination between December 7, 2006, and January 11, 2012, at a multiple-trauma rehabilitation center and who had at least 1 intact eye and were able to undergo psychometric testing and ocular examination. Among 64 sequentially eligible patients, 60 completed visual quality testing, 1 declined study participation, and 3 were evaluated prior to inclusion of visual quality testing in the protocol. Thirty-nine patients returned for outpatient follow-up, with a median test-retest interval of 11 months.

Exposure  Combat blast exposure with documented TBI.

Main Outcomes and Measures  Composite and subscale scores on the 25-item National Eye Institute Visual Functioning Questionnaire and Neuro-Ophthalmic Supplement.

Results  Both tests had high test-retest reliability. Blast-exposed veterans reported significantly poorer visual quality compared with healthy samples and some patient samples with known eye disease. Scores tended to be worse for participants with identified visual performance deficits (poorer visual acuity or spatial contrast sensitivity, visual field depression or defects). Scores were not related to the extent of ocular injury or to blast exposure characteristics such as use of protective eyewear or TBI severity level.

Conclusions and Relevance  Individuals with blast-induced TBI reliably completed both tests and reported significant decrements in their subjective visual experiences. Measures of subjective visual quality may be useful to identify patients needing additional visual or neurologic evaluation and to monitor the effect of visual rehabilitation on patients with blast-related visual disabilities.

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Composite Scores on the 25-Item National Eye Institute Visual Functioning Questionnaire by Traumatic Brain Injury Severity

TBI indicates traumatic brain injury; VFQ-25, 25-item National Eye Institute Visual Functioning Questionnaire.

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