An article that appeared in the April 27, edition of the European magazine Stars and Stripes brings home the very real dangers our soldiers face with their eyes. EYE CARE CHECKLIST FOR MILITARY PERSONNEL
The article, titled Eye Injuries Devastate Troops In Iraq, But Can Be Prevented, recounts the case of a 20-year-old sniper poised on a Fallujah rooftop. While the sniper looked through his riflescope, a chunk of metal from a grenade shot through his cheek, tore through his eye and lodged there.
Optometrists must help ensure that military personnel have eye protection.
Stars and Stripes also reports that last year, hospital surgeons actually removed 40 eyes and worked to repair 100 lacerated eyesmostly as a result of roadside bombs.
Finally, the article states that the percentage of eye injuries may be going upaccounting for 10% of combat injuriespartly due to an increased number and decreased size of fragments.
My point? As optometrists, we can help prevent such injuries by asking our military patients questions about their lifestyles and using their answers to provide appropriate eye protection.
O.D. Basic Training
Even if you practice in an area with no military bases nearby, a number of your patients may serve as consultants (engineers, members of security and police forces, farmers, construction personnel, etc.) or in other non- or paramilitary positions. Like soldiers, they may be required to venture into foreign environments that may be hazardous to their vision.
Such environments can be likened to the desert areas of Southern California, Arizona, New Mexico, Texas and Nevada. There is extreme heat, and tiny particles of dirt and dust invade their eyes, ears, mouth, clothes and equipment. Facing this environment is a lot like facing a blast furnace while wearing helmets, heavy clothing (long pants and long sleeves) and carrying a fair amount of gear, including weapons and ammunition.
But sticky, scorching and exhausting only begins to describe the everyday life experiences of many of these men and women. They are also pummeled with artillery and debris from explosions. As optometrists, we have a very real duty to
inquire about the lifestyle issues of every member of the military before he or she ships out or is reassigned. I have found that the best questions to ask are:
1. All personnel must have copies of their most recent spectacle and contact lens prescriptions.
2. Personnel who are deployed to inhospitable climates may need to discontinue contact lens use.
3. All personnel must have two pairs of glasses in their current prescription.
4. Basic eye hygiene and emergency eye care should be discussed prior to deployment.
5. Patients must know how to flush the eye if needed and how to handle an injury until skilled medical personnel can take over.
6. All personnel must understand the risks and benefits of polycarbonate lenses. Special consideration should be given to frames as well, with possible side and brow protection.
7. UV protection is a necessity, and lenses should be made of high impact-resistant materials.
8. All patients must be counseled regarding the importance of eye protection and safety.
9. Dont forget to document this discussion in your records.
What do you do for a living? We need to know if these patients will be on the front lines, in hospital environments, or working with calibrations, tools, gauges, etc.
Does your job involve out-of-country consulting or travel?
If so, where do you expect to travel?
If he or she works on a computer, for instance, this patient may not necessarily be at the typical computer-at-a-desk set-up. The computer may be a field-type set-up. But, if we do not ask, we cannot expect to be told.
On the other hand, these patients may answer some questions evasively due to security concerns. In such cases, make certain these patients are educated about the im-portance of carrying additional pairs of glasses and prescriptions. Ensure that they are armed with safety eyewear and the knowledge needed to handle an ocular emergency.
We have a very real duty to these special patients. That is why we can and must do our part to educate and protect them. And, under the Theory of Respondeat Superior (the employer is responsible for all acts or ommissions to act within the scope of the employees job responsibilities) our staff also needs to be informed about these patients needs so that they can appropriately care for them and reinforce our instructions and prescriptions.
Be Part of the Mission
Lt. Col. Clifton Slade, an ophthalmologist at the 31st Combat Support Hospital in Baghdad, is on a mission to get troops to wear protective polycarbonate sunglasses. Any soldier in a vehicle should wear eye protection, he says.
The problem is that although the polycarbonate sunglasses have been issued to some units, no one is making certain the sunglasses are enforced or provided to all the units.
But, we can help Lt. Col. Slade by committing ourselves to asking these men and women questions about their lifestyles and then using their answers to educate and protect them from potential ocular injuries.
Protective eyewear is a medical necessity, and our professional role may make the very real difference in whether these patients can live full and rewarding lives. Further, if you do not inquire about these patients total lifestyle needs, you are seriously underserving them. The basic rule is this: If you knew or should have known that these patients were at risk, but you did not meet your legal duty in advising them about ocular protection and they become injured, you may have increased your liability. In simple terms, your patient may have a cause of action for negligence, although as a rule, doctors in the United States cannot be held liable for injuries incurred during war.
I have had military patients who have experienced an array of near-devastating eye accidents. But, because I took the time to determine their needs and then made certain they were adequately protected, these same patients thanked me for literally saving their vision and their eyes. Skin can be grafted and wounds heal, but an eye is irreplaceable.
