QUERI – Quality Enhancement Research Initiative

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SHP 08-142
 
 
Visual Dysfunction in MTBI: A Comparison Group Study
Gregory L Goodrich PhD
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: May 2008 - March 2009

BACKGROUND/RATIONALE:
The current study sought to determine the rate of binocular/occulomotor dysfunction in a population of veterans and active duty troops served by the VA Palo Alto Health Care System (PAHCS). Knowledge of the baseline rate of binocular/occulomotor dysfunction will provide a better understanding of the occurrence of these dysfunction in troops and veterans returning from combat with mild traumatic brain injury and binocular/occulomotor dysfunction.

OBJECTIVE(S):
The primary objective of this study was to determine if the types and rates of binocular dysfunction seen in the on-going MTBI study were unique to that population or whether they are also present in a population diagnosed with PTSD but not MTBI.

METHODS:
The current projectwas a prospective clinical research pilot study. Prospective participants were recruited from the patient population served by the PAHCS Polytrauma Network Site clinic, optometry clinic, flyers posted at both the Menlo Park and Palo Alto Divisions of PAHCS, and through requests for referrals from all members of the PAHCS psychology service via emails and in-person meetings. The inclusion criteria included participants between 19 and 39 years of age with no prior history of concussion or diagnosed brain injury. Binocular/occulomotor examinations were provided in the PAHCS Polytrauma Network Sit clinic, optometry clinic, and/or the optometry clinic within the Western Blind Rehabilitation Center. Participants were paid with gas cards to offset time and travel.

FINDINGS/RESULTS:
During the study period binocular examination were completed on 78 patients. Four participants were identified who met the inclusion criteria of the study and who were willing to sign the consent form to enroll in the project. None of the four participants had clinical binocular vision findings, however the sample was too small to permit statistical analysis. Participants with mild traumatic brain injury were examined concurrently with this study. The results of binocular/occulomotor dysfunction examinations in those participants was consistent with findings we have previously published.

IMPACT:
Establishing a control population to provide baseline rates of binocular/oculomotor dysfunction in a population comparable to that seen in mTBI patients served by the VA remains a needed area of research. The current study highlighted the difficulty in recruiting patients from within the VA system. Recruiting problems were: reluctance of prospective participants to make a weekday appointment (requiring time-off from work, school, or other activities), identifying prospective participants with no prior history of concussion or mTBI diagnosis, and travel time and distance from home to the medical center. Also, many prospective participants were engaged in other therapy activities (often at the Menlo Park Division of PAHCS, which is some eight miles distant from PAHCS) and reluctant to schedule a visit to PAHCS. Thus, the experience gained in the current study highlights some of the difficulties in recruiting a control population for binocular/occulomotor dysfunction studies.

PUBLICATIONS:

Conference Presentations

  1. Goodrich GL, Arditi A, Rubin G, Keeffe J, Legge G. The low vision timeline: An interactive history. Paper presented at: International Society for Low Vision Research and Rehabilitation International Conference on Low-Vision; 2008 Jul 9; Montréal, Canada.
  2. Brahm K, Shen M, Goodrich G, Katsaros J, Kirby J, Wilgenburg H. Low vision eccentric viewing training: Computer vs. CCTV model. Paper presented at: International Society for Low Vision Research and Rehabilitation International Conference on Low-Vision; 2008 Jul 7; Montréal, Canada.
  3. Goodrich GL. Low vision services: Evolution in a time of revolution? Paper presented at: International Society for Low Vision Research and Rehabilitation International Conference on Low-Vision; 2008 Jul 7; Montréal, Canada.
  4. Goodrich GL. Blasts, Brain Injury, and Vision. Paper presented at: International Society for Low Vision Research and Rehabilitation International Conference on Low-Vision; 2008 Jul 7; Montréal, Canada.
  5. Wilgenburg HM, Goodrich G, Brahm K, Kirby J, Ingalla S. Visual findings associated with traumatic brain injury in military personnel. Paper presented at: International Society for Low Vision Research and Rehabilitation International Conference on Low-Vision; 2008 Jul 7; Montréal, Canada.


DRA: Sensory Loss, Military and Environmental Exposures
DRE: none
Keywords: PTSD, Traumatic Brain Injury
MeSH Terms: none