Eye Injuries Increase In Veterans

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NPR's Michele Norris talks to retired Col. Robert Mazzoli, a former consultant in ophthalmology to the Army's Surgeon General, about the increase of eye injuries in veterans, and what's being done about it.

MICHELE NORRIS, host:

The battlefield has changed and so has battlefield medicine. Hundreds of millions of dollars have been spent on researching and building better-engineered mechanical limbs for soldiers injured in Afghanistan and Iraq. Post-Traumatic Stress Disorder among combat veterans has also been the focus of heavy investment by the military and the Department of Veterans Affairs. Less so in the case of eye injuries, which account for more than a 10th of all battlefield wounds.

Joining me is retired Colonel Robert Mazzoli. He's a former consultant in ophthalmology to the Army's Surgeon General. Welcome to the program.

Colonel ROBERT MAZZOLI (Former Ophthalmology Consultant, Surgeon General, U.S. Army): Thank you for having me.

NORRIS: Why do we se so many eye injuries and why has the number increased compared to previous conflicts?

Col. MAZZOLI: Well, I think the munitions of modern warfare are high explosive and they're fragmentary, and they create a fair number of very small shards and pieces of shrapnel that are particularly devastating to the eye. The eye is exposed in the modern combat environment because its - warfare is still a very visual requirement. And so, the eye - despite our advances in being able to protect the head, the body, torso, the trunk - the eye itself is very naked.

And the very, very small shards and pieces of shrapnel that would hit on the forehead and maybe cause a little cut or maybe a scar, if it hits the eye, that causes visual and ocular devastation.

NORRIS: Are lenses or goggles, or polycarbonate lenses, for instances, any of those things effective?

Col. MAZZOLI: They are. And in fact we've known about the protective effect of polycarbonates since the late stages of Vietnam. However, there were manufacturing problems with designing polycarbonate into an effective eye armor, where visually we were creating distortion.

Because of that reluctance to distort vision or reduce vision, then there is a natural reluctance to put anything in front of the eyes. Certainly at the beginning of this conflict, the global war on terrorism, we had that same reluctance and consequently, we also saw a dramatic spike in the percentage of eye injuries. But very quickly, the soldiers saw that the eye armor that we did have is effective.

NORRIS: Colonel Mazzoli, we hear plenty about research in prosthetics and research, and discussion about treatments for Post-Traumatic Stress Disorder. Why is there not more attention paid to eye injuries?

Col. MAZZOLI: Thats a very, very good question. One of the medical paradigms that we use in our triage, we typically talk about saving life, limb and sight. But if you were a patient who has lost vision, you would probably reprioritize that to life, sight and limb.

I've had a fair number of amputees whove lost vision who would say, you know, Doc, you can have my other arm if you could restore my vision. And it's not to say that research into prosthetic arms and orthopedic appliances is unneeded, but at this point, our vision rehabilitation is still left at the stage of, well, here's your white cane, get in line for the seeing eye dog. And that hasnt really changed in the last hundred years.

There are researchers out there in a variety of locations across the country that are actually getting the optic nerves to regenerate after trauma - thats Earth-shattering. But the level of funding is certainly lagging behind the devastating visual loss.

NORRIS: That's retired Colonel Robert Mazzoli. He's a former consultant in ophthalmology to the Army's Surgeon General. Colonel, thank you very much.

Col. MAZZOLI: Thank you very much.

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