Ocular Trauma in Operation Iraqi Freedom and Operation Enduring Freedom from 2001 to 2011: A Bayesian Network Analysis

ABSTRACT

Purpose

To update the epidemiology of ocular injuries in soldiers admitted to Walter Reed Army Medical Center (WRAMC) from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF).

Methods

Data were collected in the Walter Reed Ocular Trauma Database. A Bayesian Network Analysis was completed to better understand the relationships between different ocular demographic variables, injuries, surgeries, ocular trauma scores (OTS) and visual outcomes.

Results

There were 890 consecutive globe or adnexal combat injuries, or both, sustained by 652 United States soldiers treated at WRAMC between 2001 and 2011.The primary mechanism of injury was improvised explosive device (62.47%). Many patients (62.0%) had final visual acuity (VA) grades of 1–2 (20/15 – 20/200), while 29.9% of patients had final VA grades of 3–5 (less than 20/200), and 8.1% had unknown final VA grades. Bayesian Network Analysis revealed that the injury variables of Retina (47.9%), Lens (44.6%), Posterior Segment (43.7%) and Anterior Segment (40.3%), and the surgical variables of Enucleation (97.6%) and cataract extraction and posterior capsule intraocular lens placement (CEPCIOL; 43.3%) all had probabilities greater than 40% for a poor final VA, while all other variables were less than 40%.

Conclusion

Modern-day combat trauma results in complicated ocular injuries causing 30% of patients to be left legally blind in their injured eye. It is critical to maintain a wide variety of deployable, specialty trained ophthalmologists to ensure the best visual outcomes for wounded warriors and to maintain mission readiness.

KEYWORDS:

• Ocular Trauma
• Combat Injury
• Operation Iraqi Freedom
• Operation Enduring Freedom
• Bayesian Network

Acknowledgments

We would like to express appreciation to Ramesh Natarajan, PhD for editorial assistance during preparation of this manuscript.

Disclaimer

The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the Defense Health Agency, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government.

Disclosure statement

No conflicting relationship exists for any author

Ethics statement

Institutional Review Board approval at Walter Reed National Military Medical Center was obtained. The study adhered to the Declaration of Helsinki. Informed consent was not completed as a HIPAA waiver was granted due to deidentified collection.

Financial support

This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs under through the Broad Agency Announcement for Extramural Medical Research, BAA-16-R-BAA1 under Award No. W81XWH-17-2-0007.

Presentation

Portions of the abstract were presented at the Association for Research in Vision and Ophthalmology Annual Meeting, Vancouver, BC, CAN, 2019 and Military Health System Research Symposium, Kissimmee, FL, USA, 2019

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the Office of the United States Assistant Secretary of Defense [W81XWH-17-2-0007].