Godbole NJ, Seefeldt ES, Raymond WR, Karesh JW, Morgenstern A, Egan JA, Colyer MH, Mazzoli RA
Mil Med. 2018 Mar 1;183(suppl_1):219-223
Objective: Initial visual acuity after ocular injury is an important measure, as it is an accurate predictor of final visual outcome and gives a rapid estimation of the overall severity of the injury, thereby aiding evacuation prioritization. We devised a simple method for rapidly assessing visual acuity in the field without having to rely on formal screening cards.
Methods: Using common objects, icons, and text found in the injury zone – for example, common military name tapes, rank insignias, patches, emblems, and helmet camouflage bands, which will be known collectively as the Army Combat Optotypes (ACOs) - a Snellen-equivalent method of assessing visual acuity was devised and correlated to the ocular trauma score (OTS).
Results: Ability to read the ACOs at 2, 3, and 5 ft correlates with acuities in the range from 20/20 to 20/400. Identification of ACOs with visual acuity of 20/50 and 20/200 approximates important inflection points of severity for the OTS.
Conclusion: Accurately assessing visual acuity in the field after ocular injury provides essential information but does not require sophisticated screening equipment. Pertinent and accurate acuities can be rapidly estimated using commonly available text or graphical icons such as standard name tapes, patches, and rank insignias.
Paz DA, Thomas KE, Primakov DG.
J Spec Oper Med. Spring 2018;18(1):77-80.
In support of Operation Enduring Freedom, American, North American Treaty Organization (NATO) Coalition, and Afghan forces worked together in training exercises and counterinsurgency operations. While serving at the NATO Role 3 Multinational Medical Unit, Kandahar, Afghanistan, numerous patients with explosive blast injuries (Coalition and Afghan security forces, and insurgents) were treated. A disparity was noted between the ocular injury patterns of US and Coalition forces in comparison with their Afghan counterparts, which were overwhelmingly influenced by the use, or lack thereof, of eye protection. Computed tomography imaging coupled, with a correlative clinical examination, demonstrated the spectrum of ocular injuries that can result from an explosive blast. Patient examination was performed by Navy radiologists and an ophthalmologist. A cultural analysis by was performed to understand why eye protection was not used, even if available to Afghan forces, by the injured patients in hope of bridging the gap between Afghan cultural differences and proper operational risk management of combat forces.