BLINDED VETERANS ASSOCIATION FY 2020 Congressional Request $20 Million for DOD VISION RESEARCH PROGRAM (VRP)

Introduction

BVA, along with other VSOs and MSOs, once again requests your support for a programmatic request for the DOD Vision Research Program (VRP), a Peer Reviewed Medical Research Program (PRMR) for extramural translational battlefield vision research in the amount of $20 million in FY 2020. BVA appreciated the widespread bipartisan support our request of $20 million for FY 2019 received from the 115th Congress, and we request the $20 million to meet identified DOD Gaps in this area of battlefield vision trauma research.

The Peer Reviewed Vision Research Program (VRP) in the CDMRP appropriations funds critical extramural vision research into deployment-related vision trauma that is not currently conducted by VA, nor elsewhere within DOD (including the joint DoD/VA Vision Center of Excellence) or the National Eye Institute within the National Institutes of Health and no private foundations fund this type of blast eye trauma research. These agencies allocate less than 1% of their budgets and research resources to vision research. The Veteran Service Organizations Independent Budget (VSOIB) stand together with BVA urging Congress to fund the VRP at $20 million in FY 2020. 

Rationale

One consequence of today’s battlefield conditions is that 14.9 percent of those who are evacuated due to wounds resulting from Improvised Explosive Device (IED) blast forces have penetrating eye injuries and TBI-related visual system dysfunction. Upwards of 75 percent of all TBI patients experience short- or long-term visual disorders (double vision, light sensitivity, inability to read print, and other cognitive impairments). With the continued presence of the U.S. in Syria, Iraq, and Afghanistan, coupled with other global threats, such eye injuries will continue to be a challenge. The VHA Office of Public Health has reported that for the period October 2001 through June 30, 2015, the total number of OEF/OIF/OND veterans enrolled in VA with visual conditions was 211,350, including 21,513 retinal and choroid hemorrhage injuries (including retinal detachment), 5,293 optic nerve pathway disorders, 12,717 corneal conditions, and 27,880 with traumatic cataracts.[1]  The VA continues to see the increased enrollment of this generation with various eye and vision disorders resulting from complications from frequent blast-related injuries.

VHA data also reveals rising numbers of the total Post 9/11 veterans with TBI visually impaired ICD-10 Codes enrolled in VHA for vision care in FY 2013 was 39,908, for FY 2015 total 66,968 with symptoms of visual disturbances.[1] Based on recent estimates from reported TBI Defense Veterans Brain Injury Center (DVBIC) data, the incidence of TBI without eye injury with clinical visual impairment 2000-2017 is (estimated) to be at 76.900.[2]

VHA Blind Rehabilitation Services (BRS) provided data as of August 6, 2018, 3,439 unique OEF/OIF/OND patients have been seen by Vision Impairment Services Outpatient Rehabilitation (VISOR) programs, and 229 attended Blind Inpatient Rehab Centers. [4]

  • Research to effectively treat vision trauma and TBI-related visual disorders can have long-term implications for an individual’s vision health, productivity, and quality of life for the remainder of military service and into civilian life. John Hopkins Public Health study Oct 2001 to 2nd Q 2017 study using published data estimated that deployment-related eye injuries and blindness have cost the U.S. $45.5 billion, with $44.4 billion of that cost reflecting the present value of a lifetime of long-term benefits, lost wages, and family care[5].

In the combined FY 2013-2014 VRP funding cycle (in process), 275 pre-applications were received, and 151 were invited to submit full proposals. The number of applicants that can be awarded existing funds is flat, approximately 20 or fewer per year, despite the increased number of high-quality proposals received each year. The $20 million for FY 2020 would provide support for additional grants to bring new clinical care to frontline injured servicemembers.

VRP Funding Yields Deliverables 

VRP funds the research into mechanisms of corneal and retinal protection, corneal healing, and visual dysfunction resulting from TBI; and translational research, which facilitates development of critical diagnostics, treatments, and therapies− that can be employed on the battlefield to save vision. Research projects funded by the VRP funding cycles have resulted to-date in 153 published papers that are advancing knowledge about the diagnosis and treatment of blast eye trauma and TBI vision dysfunction. VRP funded-projects have also resulted in 15 patents or applications for patents.

  • The development of a portable, hand-held device to analyze the pupil’s reaction to light, enabling rapid diagnosis of TBI-related vision dysfunction.
  • A new “ocular patch,” which consists of nanotechnology-derived reversible glue that seals lacerations and perforations of the eye globe sustained on the battlefield
  • A computational model of the human eye globe to investigate injury mechanisms of a primary blast wave from an IED that account for 82 percent of the blast injuries in Iraq and Afghanistan.
  • The development of a new vision enhancement system that uses modern mobile computing and wireless technology, coupled with novel computer vision (object recognition programs) and human-computer interfacing strategies, to assist visually impaired veterans undergoing vision rehabilitation to navigate, and interact with people.

[1] VHA Office of Public Health OIF/OEF/OND Veterans Medical Encounters for Disorders Eye and Vision, FY 2002 to June 30, 2015 Enrollment Code data report.

[2] VHA Office of Public Health OIF/OEF/OND Veterans Medical Encounters for Disorders Eye and Vision, FY 2002 to June 30, 2015 Enrollment Code data report.

[3] 2018 study by the Alliance for Eye and Vision Research–published January 26, 2019 in Military Medicine journal Costs of Military Eye Injuries 2001 to 2017

[4] VHA BRS Data Source:  VSSC OEF/OIF/OND Input & Output Encounters Cube.

[5] 2018 Cost of Military Eye Injury and Blindness, study by the Alliance for Eye and Vision Research–Published January 26, 2019 in Military Medicine Journal by  Johns Hopkins Bloomberg School of Public Health