A retrospective study reviewed medical records of military personnel who had participated in a vision readiness study the previous year. The review evaluated (1) the number of personnel who returned for an eye examination (as recommended), (2) the number of dilated eye examinations, (3) the number of optical devices ordered, (4) the number of patients requiring continuing treatment, (5) the types of eye disease in personnel who were classified as nondeployable in the original study, and (6) the relationship between patient vision complaints and the need for spectacles. Analyses revealed 44% of military personnel have never had a comprehensive eye examination. Of these personnel who never had an eye examination, 15% to 26% could improve their vision with spectacles. Finally, even though having an eye examination is important, whether or not the individual has had a comprehensive eye examination should not be a significant criterion for deployment.
Introduction
As the military downsizes and increases the operations tempo, relentless readiness is critical to the success of military operations. With the increase in vision demand on the front line from night vision goggles, lasers, video display terminals, etc., military operations require an active vision readiness program. Even though vision plays an increasingly important role on the modern battlefield, data from vision readiness studies reveal shortcomings in the vision readiness of our forces.
Vision readiness studies reveal a significant problem in deploying personnel. During Operation Desert Shield/Desert Storm, nearly 23% of deploying Army personnel required eye examinations before deployment. In addition, 44% of deploying Army personnel did not have the required optical devices. This shortcoming in visual and optical readiness required the fabrication of over 1,000,000 pair of optical devices to prepare war-fighters for the war.1
Further studies revealed no improvement in the vision readiness of military personnel. In 1992, Major Andrew Erneston conducted a vision readiness study of aircrew members at Seymour Johnson Air Force Base. He found 75% had not had a comprehensive eye examination in the previous 2 years, 25% were not optically ready for deployment, 22% did not meet minimum visual acuity standards, and 4% had previously undiagnosed ocular disease.2 Two years later, Major Erneston repeated the vision readiness study at Seymour Johnson Air Force Base, expanding it to include all Air Force personnel. He discovered that 54% of personnel had not had a comprehensive eye examination in the previous 2 years, 24% were not optically ready for deployment, 3% did not meet minimum visual acuity standards, and 3% had previously undiagnosed ocular disease.3
The 5503rd U.S. Army Hospital conducted, in the summer of 1996 and 1997, a vision readiness screening at Fort McCoy to assess the vision readiness of Army National Guard and Army Reserve units. Of the 1,947 individuals screened, 545 (28%) failed to achieve 20/20 visual acuity and were given refractions.4 At nearly the same time in 1997, Major Amy Walker conducted a vision readiness study of a deploying fighter squadron at Seymour Johnson Air Force Base. Of the personnel who wore spectacles, 75% were not optically ready to deploy.5
With the above vision readiness problems, the Tri-Service Vision Conservation and Readiness Program, U.S. Army Center for Health Promotion and Preventive Medicine, conducted a study of visual acuity, optical, and eye health readiness at 13 Department of Defense sites from September through December 1997. This study investigated if personnel (1) had an eye examination in their medical record, (2) had any visual complaints, (3) were required to wear spectacles, (4) met their visual acuity requirement for deployment, (5) met their optical requirement for deployment, and (6) were eye health ready. Of the 4,825 active duty personnel who were screened, 10.4% were not visually ready for deployment, 25.9% were not optically ready for deployment, 73.8% were not eye health ready. A large number of personnel were not eye health ready because 54.3% did not have an eye examination in their health record.6 All personnel who did not have an eye examination in their medical record were referred for a comprehensive eye examination.
With such a large number failing the eye health readiness portion of the study, a medical record review follow-up study was implemented to evaluate (1) the number of personnel who did come back for an eye examination (as recommended), (2) the number of dilated eye examinations, (3) the number of optical devices ordered, (4) the number of patients requiring continuing treatment, (5) the types of eye disease in personnel who were classified as nondeployable in the original study, and (6) the relationship between patient vision complaints and the need for spectacles.
Methods
In September 1998, 1 year after the initial Vision Health Readiness study, a retrospective review of medical records was conducted at 6 of the 13 initial sites. These six sites were: Fort Jackson, South Carolina; Langley Air Force Base, Virginia; Maxwell Air Force Base, Alabama; Seymour Johnson Air Force Base, South Carolina; Naval Air Station Jacksonville, Florida; and Naval Submarine Base Kings Bay; Georgia. At the above six sites, 1,735 personnel were screened in the initial study. Medical records belonging to 486 of the 1,735 were available for follow-up review.
Table I lists the questions for which the medical records were reviewed. To further analyze the information, the answers to these questions were compared with the results of the initial study.
Results
Of the 486 personnel records reviewed, 413 (84.9%) were men and 73 (15.1%) were women; 427 (87.9%) were enlisted and 59 (12.1%) were officers; and 75 (15.5%) were Army personnel, 294 (60.5%) were Air Force personnel, 108 (22.2%) were Navy personnel, and 9 (1.8%) were Marine Corps personnel. Table II displays the count and percentage for the first four questions.
Of the personnel who did not have an eye examination in their health record in the initial 1997 study (N = 205), 109 (53.1%) received an eye examination the following year. Of the personnel who did not have an eye examination in their health record in the initial 1997 study and received an examination the following year (N = 109), 72 (66.1%) had a dilated fundus examination.
Of the personnel who did not have an eye examination in their health record in the initial 1997 study and received an examination the following year (N = 109), 25 (22.9%) were ordered optical devices. Of the people who did not have an eye examination in their health record in the initial 1997 study and received an examination the following year (N = 109), 15 (13.8%) had eye health conditions noted in their records. Table III displays the eye health conditions.
Analysis of the records reviewed uncovered a number of personnel who had an eye examination after the initial study and subsequently had optical devices ordered. This group had a mixed variety of visual complaints, previous eye examinations, spectacle wear, and/or whether they met visual acuity requirements for the initial vision readiness study (Table IV).
Discussion
Table II reveals that only 56.2% of the personnel had a comprehensive eye examination in their medical record over their military career. The American Optometric Association's standard of care for this age group requires a comprehensive eye examination every 2 to 3 years. Only 32.7% of active duty personnel had a dilated fundus examination even though the American Academy of Ophthalmology recommends at least one comprehensive medical eye examination for 100% of this age group. Even though 205 personnel in this study were referred for a comprehensive eye examination, only 53.1% had an examination. Sadly, the active duty population is significantly underserviced in eye care. It should be mandatory for all active duty personnel to have, at minimum, a comprehensive eye examination upon entry into the military.
This study reveals whether personnel at a vision screening do not have vision complaints, do not require spectacles, or meet their visual acuity requirements, and then subsequently have a comprehensive eye examination; 15% to 26% of these personnel could improve their vision with spectacles. This adds emphasis to the fact that all active duty personnel should have a comprehensive eye examination.
Finally, this study reveals that not having a comprehensive eye examination in the medical record should not be a significant criterion for vision readiness deployment. Of the 109 personnel who had their first eye examination after the initial vision screening, 15 (13.7%) had eye health conditions noted in their medical record. None of these diagnoses was a significant reason for not deploying personnel.
Conclusion
A retrospective study of military medical records was conducted at six military sites. This study reviewed medical records of military personnel who had participated in a vision readiness study the previous year. The medical records were reviewed for (1) the number of personnel who, as recommended, came back for a comprehensive eye examination, (2) the number of dilated eye examinations given, (3) the number of optical devices ordered, (4) the number of patients requiring continuing treatment, (5) the types of eye disease in personnel who were classified as nondeployable in the original vision readiness study, and (6) the relationship between patient vision complaints and the need for spectacles. Analyses revealed many military personnel have never had a comprehensive eye examination. At minimum, all active duty personnel should have a comprehensive eye examination upon entry into the military. If these personnel did receive a comprehensive eye examination, 15% to 26% could improve their vision with spectacles. Finally, having a comprehensive eye examination should not be a significant criterion for deployment.
[Reference]
References
1. Pyle JF: Executive Summary, Desert Shield/Storm Oplomelry after Action Reports. Falls Church, VA, Office of the Surgeon General, Department of the Army, 1991.
2. Erneston AG, Murchland MR: Questioning vision readiness in the aviation community of the United States Air Force. Milit Med 1994; 159: 432-4.
3. Erneston AG, Tale TJ, Ricks MR, et al: Vision Readiness in the United States Air Force Revisited. Seymour Johnson Air Force Base, NC, 4th Medical Group, 1995.
4. Weaver JL, McAlister WH: Vision readiness of the reserve forces of the U. S. Army. Milit Med 2001; 166: 64-6.
5. Buckingham RS, Walker AL, Darville JA: Vision readiness at Seymour Johnson Air Force Base. Milit Med 2000; 165: 512-4.
6. Buckingham RS, Whitwell K, Cornforth L, Lee R: Visual acuity, optical and eye health readiness in the military. Milit Med 2003;168: 194-8.
[Author Affiliation]
Guarantor: Lt Col Robert S. Buckingham, BSC USAF (Ret.)
Contributors: Lt Col Robert S. Buckingham, BSC USAF (Ret.); LTC Don McDuffie, MSC USA; LCDR Kenneth Whitwell, MSC USN; Robyn B. Lee, MS
[Author Affiliation]
Michigan College of Optometry, Ferns State University, 1310 Cramer Circle, Big Rapids, MI 49307.
The views expressed in this article are those of the authors and do not reflect either the official policy or position of the Department of Defense or the U.S. government. This manuscript was received for review in June 2002 and accepted for publication in July 2002.
