The University of Newcastle, Australia

Since 2000, the Defense and Veterans Brain Injury Center, USA has identified more than 280,000 cases of traumatic brain injury (TBI) in US service members, many resulting from combat blast exposure.

During blast exposure, blast waves and acceleration forces can produce brain injury; these same forces can affect the eyes, orbital tissues, and ocular adnexa. Assessing vision in military personnel has the potential to improve outcomes from eye injury associated with blast exposure (e.g.: penetrating eye injury, retinal detachment) but also has the possibility of assessing and monitoring longitudinal recovery from blast-related TBI.

Competitive advantage

  • We study the vision and ocular control in retired athletes who have been exposed to a high incidence of repetitive mild traumatic brain injury (mTBI)
  • A collaborative team conduct clinics assessing vision and ocular control (eg: visual acuity, optical coherence tomography, convergency) on research participants
  • Several ADF personnel have been referred for clinical management of vision disorders following exposure to blast events, so we have traction within this space

Successful applications of research

  • The recent conflicts in Afghanistan and Iraq have been notable for the extensive use of explosive weaponry, and the resulting blast injuries are, for the most part, unique to the military. Traumatic brain injury has been referred to as the “signature wound” of the Afghanistan and Iraq wars. Blast-related TBI is hypothesized to have diffuse effect on the brain, and thus incorporating visual and oculomotor assessments has the potential to diagnose, and monitor, the effects of TBI in military personnel. These assessment tools additionally have the advantage of being mobile and conducted in a relatively short amount of time, i.e.: close to the conflict zone

Partners

  • University of Sydney
  • Save Sight Institute, Sydney Eye Hospital

Impact

  • Six of the 12 cranial nerves pertain to vision and visual/ocular functions. In addition, the areas of the brain that are most likely to be injured during a TBI (frontal, occipital, temporal, and parietal lobes, as well as the long axonal fibers connecting the midbrain to the cortex) are vision related. Visual performance can be impaired through damage to cortical, brainstem, cranial nerve, or ocular structures. Thus, significant brain injury is hypothesized to impair vision and/or oculomotor control
  • Recently, vision-based tests have been integrated into evaluation and assessment of concussion, especially on athletic sidelines, where they may be easily and efficiently performed for concussion detection. In addition, vision and eye movement testing may assist with detection, monitoring, and treatment of concussion in the outpatient setting. Such data will ultimately provide insight into the long-term sequelae of concussion, repetitive head impacts and TBI

Capabilities and facilities

  • Team member, Dr Fraser is a neuro-ophthalmologist (University of Sydney) with experience in treating patients with neurodegenerative conditions and vision related conditions
  • Clinics are held with retired athletes and have access to personnel (medical students, trainees, registrars, orthoptists) and equipment (optical coherence tomography)
  • Access to Magnetic Resonance Imaging (MRI) equipment and expertise in the use of MRI equipment