The Relationship Between Severe Visual Acuity Loss, Traumatic Brain Injuries, and Ocular Injuries in American Service Members From 2001 to 2015
The Relationship Between Severe Visual Acuity Loss, Traumatic Brain Injuries, and Ocular Injuries in American Service Members From 2001 to 2015
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DOI：
10.1093/milmed/usaa154
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发表时间：
2020-09-01
影响因子：
1.2
通讯作者：
Singman, Eric
中科院分区：
文献类型：
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作者：
Flanagan, Gerald;Velez, Tom;Singman, Eric
尽管创伤性脑损伤可导致多种视力问题，但其严重视力丧失程度与其严重程度之间的关系尚未得到广泛的研究。在这项回顾分析中，结合了来自国防部/退伍军人事务部眼损伤和脑损伤资料库的信息，评估了2001至2015年间服役的美国军人的慢性创伤、脑外伤、眼损伤和相关眼后遗症之间的关系。材料和方法国防和退伍军人眼部眼损伤和视力登记(DVEIVR)是由国防部和退伍军人事务部领导的一项倡议，由国防部和退伍军人事务部自2001年以来一直在战区服役的军人的临床和相关数据组成。国防和退伍军人脑损伤中心(DVBIC)是国防部跟踪军队脑损伤数据的办公室，自2000年以来一直维护着患有脑损伤诊断的现役军人的数据。通过对2001年2月至2015年10月这两个资料来源的纵向资料进行分析，在Logistic回归模型中调整开放眼球损伤(OGI)、眼前段紊乱和后段紊乱等眼部协变量，以了解SWAL和TBI之间的关系。DVEIVR中的脑损伤病例使用DVBIC数据进行识别，并根据DVBIC建立的国际疾病统计分类标准进行分类。头部创伤和其他开放性头部创伤(OOHW)也包括在内。根据国际疾病统计分类的盲和低视力标准以及DVEIVR中记录的视力测试数据确定DVEIVR中的SVAL病例。结果从2001年2月到2015年11月，DVEIVR中共记录了25,193例患者，88,996次遭遇。在这些患者中，7217例脑外伤和1367例低视力患者被确认，638名患者同时经历了这两种情况。在一个完整的Logistic模型中，尽管眼部损伤(眼前段病变、后段病变和OGI)和OOHW显著，但UTBI和分化型TBI(即轻度、中度、重度、穿透性或未分类)都不是SVAL的重要危险因素。结论任何直接损伤眼或头部都有SVAL的危险，但部位和严重程度会改变这种风险。在调整了OGIS、OOHW及其后遗症后，在DVEIVR中记录的患者中，TBI被发现不是Sval的显著危险因素。还需要进一步的研究来探索脑外伤是否与更中度的视力丧失有关。
IntroductionAlthough traumatic brain injury (TBI) is known to cause many visual problems, the correlation between the extent of severe visual acuity loss (SVAL) and severity of TBI has not been widely explored. In this retrospective analysis, combined information from Department of Defense (DoD)/Veterans Affairs ocular injury and TBI repositories were used to evaluate the relationship between chronic SVAL, TBI, ocular injuries, and associated ocular sequelae for U.S. service members serving between 2001 and 2015.Materials and MethodsThe Defense and Veterans Eye Injury and Vision Registry (DVEIVR) is an initiative led by the DoD and Veterans Affairs that consists of clinical and related data for service members serving in theater since 2001. The Defense and Veterans Brain Injury Center (DVBIC) is the DoD's office for tracking TBI data in the military and maintains data on active-duty service members with a TBI diagnosis since 2000. Longitudinal data from these 2 resources for encounters between February 2001 and October 2015 were analyzed to understand the relation between SVAL, and TBI while adjusting for ocular covariates such as open globe injury (OGI), disorders of the anterior segment and disorders of the posterior segment in a logistic regression model. TBI cases in DVEIVR were identified using DVBIC data and classified according to International Statistical Classification of Diseases criteria established by DVBIC. Head trauma and other open head wounds (OOHW) were also included. SVAL cases in DVEIVR were identified using both International Statistical Classification of Diseases criteria for blindness and low vision as well as visual acuity test data recorded in DVEIVR.ResultsData for a total of 25,193 unique patients with 88,996 encounters were recorded in DVEIVR from February, 2001 to November, 2015. Of these, 7,217 TBI and 1,367 low vision cases were identified, with 638 patients experiencing both. In a full logistic model, neither UTBI nor differentiated TBI (DTBI, ie, mild, moderate, severe, penetrating, or unclassified) were significant risk factors for SVAL although ocular injuries (disorders of the anterior segment, disorders of the posterior segment, and OGI) and OOHW were significant.ConclusionAny direct injury to the eye or head risks SVAL but the location and severity will modify that risk. After adjusting for OGIs, OOHW and their sequelae, TBI was found to not be a significant risk factor for SVAL in patients recorded in DVEIVR. Further research is needed to explore whether TBI is associated with more moderate levels of vision acuity loss.