LRMC ophthalmology, optometry keep future clearly in sight

by Sgt. Tina Villalobos
Landstuhl Regional Medical Center

People who do not require vision correction rarely experience the inconvenience of diminished sight except, perhaps, when having their eyes dilated during an examination. The immediate and disorienting effect of diminished vision makes us recognize the importance of our eyesight.

According to the Centers for Disease Control and Prevention, vision loss is common in adults and prevalence increases with advancing age. Approximately 13 percent of individuals 65 or older and 28 percent of those over 85 report some degree of visual impairment.

In children, refractive errors are the most common vision disorders, occurring in 20 percent by age 16. More than 90 percent of older people require the use of corrective lenses at some time. Visual disorders in older adults frequently lead to trauma from falls, automobile crashes and other types of unintentional injuries. Many adults are unaware of decreases in their visual acuity, and up to 25 percent may have incorrect corrective lens prescriptions.

While the difference between ophthalmology and optometry is blurred for most of us, Dr. (Col.) Richard H. Birdsong, chief of Ophthalmology Service at Landstuhl Regional Medical Center, brings it into focus.

Ophthalmologists are physicians who, after college, complete medical or osteopathic school, then medical internship and residency training in ophthalmology, Birdsong said. Optometrists are eye care professionals who, after college, complete optometry school with some optional one-year residencies. Optometrists’ primary roles are eye health and refractive care. Ophthalmologists perform all types of surgeries in addition to eye health and refractive care.
LRMC Ophthalmology’s role is two-fold: to provide state-of-the-art comprehensive ophthalmic care to service members, their families and other eligible beneficiaries, and to provide laser refractive surgery to active duty members under the
Warfighter Refractive Eye Surgery Program in order to make them less reliant on glasses for sharp distant vision.

“When Soldiers elect to wear contact lenses downrange (which is a punishable as an Article 15 offense), the eye can become very infected and vision loss can result,” said Maj. James Hartley, assistant director for WREP at LRMC.

“Downrange is not a good, clean environment to be wearing contact lenses. Sometimes people don’t take them out and clean them like they should because they cannot wash their hands and so forth. This can result in having to be evacuated to LRMC for treatment.

“We are doing the refractive surgery here to make a better warfighter,” Hartley continued. “Refractive surgery helps our warfighters by improving their overall vision, allowing them to see well without wearing cumbersome glasses that can slide down their noses or fog up — or if lost or broken can render a warfighter visually impaired. Refractive surgery eliminates the chance of a warfighter choosing to wear contact lenses against regulation, thereby eliminating all of the eye health problems associated with the wear of contact lenses downrange.”

The ophthalmology and optometry department play a key role in the LRMC wartime mission, treating the more than 66,000 wounded warriors medically evacuated from Afghanistan and Iraq the past 10 years. LRMC serves as the sole link between downrange care and subsequent care in the U.S. and in other coalition nations. As a result, LRMC is often referred to as a prism or center of the hourglass, receiving a daily mix of patients and diagnoses that LRMC then treats and triages to appropriate destinations around the world.

Deployed Eye Protection
The danger of eye damage or injury for military members are much greater than most civilian occupations and require appropriate precautions, including the use of eye protection. Many people take their glasses for granted or even find them annoying, yet there are others who have never known the luxury of clear sight. For those blessed with sight, protecting it is paramount.

“It is very important to wear your eye protection to protect against flying debris,” Hartley said. “The most common injury downrange is caused by flying debris from explosions, such as IEDs. Sometimes it is a little piece of metal that goes in, and sometimes it is a huge piece that blows the eye apart. There was a guy who came to LRMC not long ago with blast injuries, and because he wore his eye protection his vision was saved.”

According to the Tri-Service Vision Conservation and Readiness program, eye injuries account for more than 15 percent of combat-related injuries, with the most common causes being explosives or environmental, thus making eye armor an essential element of every warrior’s battle gear. Deployed service members in need of glasses, mask inserts, or military combat eye protection can order their prescription through the Internet without going to a clinic, by visiting

“I saw someone with an IED blast and it really touched me and gave me a sense of purpose and refocus in my job here at LRMC,” said Anthony Hodges, supervisor of LRMC ophthalmology services. “I have been working in this field for 20 years. Typically, we would get cases of cataracts, glaucoma and such, but I had never encountered a patient wounded from an IED blast before joining the LRMC team.”

Eye Health, Exams
Getting regular vision checks, eye pressure checks and periodic eye exams by an optometrist or ophthalmologist are important steps in eye health, Birdsong said.
Fortunately, LRMC has a team of experts on hand to provide regular eye exams and treatment when necessary.

LRMC’s ophthalmologists have a total of more than 75 years of combined experience and the optometrists have more than 50 years combined experience. The LRMC ophthalmology department consists of 10 service members and 13 civilians. The staff stays busy.

“We did about 1,000 laser refractive surgeries in our clinic last year and about 240 other types of eye surgery up in the main operating room,” Birdsong said.

Eye Conditions
The leading causes of blindness (although primarily age related) are age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma. Some of these conditions are thought to be related to behavioral choices over time. This translates directly into making appropriate, healthy choices during youthful years in order to help prevent certain negative consequences later on in life. Age-related macular degeneration is associated primarily in those over 50 and among smokers. A greater number of Anglos suffer from AMD than do other races. The National Eye Institute and Prevent Blindness America report that research also suggests long-term diets low in certain antioxidant nutrients may increase the risk of AMD.

Cataracts, according to the National Eye Institute and Prevent Blindness America, may be the result of a lifetime of exposure to ultraviolet radiation contained in sunlight, or may be related to other lifestyle factors such as cigarette smoking, diet and alcohol consumption. Cataract is the leading cause of blindness, according to the World Health Organization.

Diabetic retinopathy is particularly concerning, given the epidemic of childhood obesity in America and its associated elevation in cases of juvenile onset diabetes. The National Eye Institute and Prevent Blindness America state that eventually, almost everyone with juvenile-onset diabetes will develop some signs of diabetic retinopathy because the longer someone has diabetes, the greater the risk of its related retinopathy. The CDC estimates that 10.3 million Americans have diagnosed diabetes and another 5.4 million have the disease but have not been diagnosed.

Glaucoma is an eye disease that gradually degenerates cells of the optic nerve. Once vision is lost to glaucoma, it cannot be restored. Up to half of people with glaucoma are unaware they are afflicted. The disease cannot be prevented, but with the help of your ophthalmologist there are steps that can be taken to manage and control its progression.

Age and race play a role in the onset of glaucoma. It is more prevalent among aging African Americans and Hispanics. Long-term use of steroids, eye trauma and diabetes may also contribute to developing glaucoma.

“I find my profession most gratifying when I can make a dramatic improvement in a patient’s vision, particularly older folks, when they come in with poor vision and after surgery their vision is 20/20,” Hartley said.

According to a report by the National Eye Institute and Prevent Blindness America, the annual cost of adult vision problems in the U.S. comes to approximately $51.4 billion.

We can all take steps to improve the long-term health of our vision while contributing in a very real way to the economic health of our nation, keeping the future clearly in sight.

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