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Marissa L. Weber, Dal Chun, Marcus Colyer, Michael Mines; Visual Field Defects in the Setting of Traumatic Brain Injury and Combat Ocular Trauma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4216.
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To examine the visual field defects (VFD) found in association with Traumatic Brain Injury (TBI) and Combat Ocular Trauma (COT) resulting from Operations Iraqi and Enduring Freedom.
Retrospective, observational case series of soldiers injured during Operations Iraqi and Enduring Freedom who had visual field (VF) testing at Walter Reed Army Medical Center (WRAMC) between 2003 and 2009. Humphrey and Goldmann VF were obtained from clinic charts. VFD were classified as scotoma, enlarged blind spot (EBS), quadrantopsia, hemianopsia, or constricted field/generalized depression (CF/GD). Diagnoses of TBI and COT were taken from outpatient and electronic medical records. TBI was classified as penetrating (PTBI) or non-penetrating (NPTBI). COT was subdivided according to mechanism (penetrating or nonpenetrating) and anatomic structures involved (retina or optic nerve).
Seventy-two subjects [70 male (97%) and 2 female (3%)] treated at WRAMC were included. The average age was 27 years. Fifty-six subjects (78%) had been injured in battle. The remaining 16 (22%) were treated for disease or non-battle injuries. VF were normal in 30 battle injured subjects (54%). VFD was present in 26 battle injured subjects (46%). Twenty (77%) had TBI. Fourteen of those with TBI (70%) did not have any ocular injury. Six subjects (30%) had PTBI with the following VFD: hemianopsia (3), quadrantopsia (1), scotoma (1), and CF/GD (1). The 14 subjects (70%) with NPTBI had scotoma (6), CF/GD (3), hemianopsia (2), quadrantopsia (2), or EBS (1). Fifteen battle injured subjects with VFD (58%) had ocular trauma. Penetrating ocular injury occurred in ten (67%) with VFD of scotoma (6) and CF/GD (4). VFD found in the 6 subjects (40%) with nonpenetrating ocular trauma included: scotoma (3), CF/GD (2), and quadrantopsia (1). Ten of those with ocular injury (67%) had retinal injuries. The VFD in those were: CF/GD (5) and scotoma (5). In the 5 subjects (33%) with optic nerve injury, VFD included: CF/GD (2), EBS (1), hemianopsia (1), and scotoma (1).
The majority of patients with TBI had VFD that could be attributed to their TBI. PTBI resulted in more neurologic VFD, while NPTBI resulted most frequently in a scotoma. The VFD most commonly associated with ocular injury, either penetrating or nonpenetrating, was a scotoma. Both CF/GD and scotoma were seen in subjects with retinal injury. A variety of VFD was seen in those with optic nerve injury. Further study is needed to elucidate the degree of VFD that results from TBI versus ocular trauma in those subjects who have both conditions.
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