{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:09:04Z","timestamp":1792188544989,"version":"4.4.0"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"7-8","funder":[{"DOI":"10.13039\/100014055","name":"U.S. Army Medical Research and Acquisition","doi-asserted-by":"crossref","award":["W81XWH-17-2-0007"],"award-info":[{"award-number":["W81XWH-17-2-0007"]}],"id":[{"id":"10.13039\/100014055","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,22]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Traumatic brain injury (TBI) remains a significant source of disability for active duty service members in both deployed and training settings as well as those who have left active service. Service members with ocular trauma are at risk for a TBI and should be screened appropriately. Early detection results in treatment to minimize long-term sequelae which can often be debilitating. This study is the first to evaluate different combat-related ocular injuries and their associations with TBI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>A secondary analysis of existing data was conducted from a prospective study of patients who sustained combat ocular trauma (COT) during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) between 2006 and 2020. Clinical data of a total of 88 participants were gathered and each case reviewed, including patient demographics, injury-related factors, history of TBI, and treatments rendered. All cases were then categorized to compare COT (n\u2009=\u200913) versus COT-T (Combat Ocular Trauma associated with TBI; n\u2009=\u200975). The Fisher\u2019s exact test was completed for each category to assess for predictive factors of TBI within the ophthalmic trauma cohort. Odds ratios were calculated with their 95% CI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>When compared to COT, COT-T was significantly associated with closed globe injuries (56%; OR 4.24, 95% CI 1.08-16.67), blast injuries (89.3%; OR 3.72, 95% CI 0.93-14.9), multiple surgeries (89%; OR 2.51, 95% CI 0.57-11.08), anterior segment injuries (69.3%; OR 1.41, 95% CI 0.42-4.79), optic nerve injuries (24%; OR 1.05, 95% CI 0.26-4.25), orbital fractures (48%; OR 2.08, 95% CI 0.59-7.34), enucleation (17.3%; OR 2.52, 95% CI 0.300-21.08), the use of eye protection (68.6%; OR 2.18, 95% CI 0.57-8.32), and the need to undergo plastic surgery (78.7%; OR 2.30, 95% CI 0.66-8.02). Significant factors associated with COT included penetrating injury (30.8%; OR 0.027, 95% CI 0.07-1.08), posterior segment injuries (92%; OR 0.264, 95% CI 0.032-2.17), bilateral injuries (76.9%; OR 0.678, 95% CI 0.17-2.69), and bilateral blindness (7.7%; OR 0.857, 95% CI 0.092-7.99).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patients who have sustained combat-related ocular injuries, specifically blast injury, anterior segment injury, or an orbital fracture, were noted to be more likely to have also sustained a TBI. However, of the evaluated variables in predicting the co-occurrence of TBI, only closed globe injury was identified as statistically significant. Service members with injuries requiring multiple surgical procedures, reconstructive plastic surgery, or enucleation of an eye were also more likely to be diagnosed with a TBI, but these variables were not found to be predictive of TBI among ocular trauma patients. The presence of eye protection was not protective against TBI. Further studies are needed to find significant predictors of TBI in combat ocular trauma patients to assist in the early and accurate detection of TBI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usac010","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T07:37:37Z","timestamp":1646811457000},"page":"e1729-e1733","source":"Crossref","is-referenced-by-count":6,"title":["Correlative Factors for Traumatic Brain Injury in Combat Ocular Trauma"],"prefix":"10.1093","volume":"188","author":[{"given":"Remigio","family":"Flor","sequence":"first","affiliation":[{"name":"Carl R. Darnall Army Medical Center , Fort Hood, TX 76544, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boonkit","family":"Purt","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"},{"name":"Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, MD 20889, USA"},{"name":"Department of Ophthalmology, Fort Belvoir Community Hospital , Fort Belvoir, VA 22060, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose K","family":"Sia","sequence":"additional","affiliation":[{"name":"Warfighter Refractive Eye Surgery Program and Research Center , Fort Belvoir, VA 22060, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. , Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise S","family":"Ryan","sequence":"additional","affiliation":[{"name":"Warfighter Refractive Eye Surgery Program and Research Center , Fort Belvoir, VA 22060, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. , Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice M","family":"Kagemann","sequence":"additional","affiliation":[{"name":"Warfighter Refractive Eye Surgery Program and Research Center , Fort Belvoir, VA 22060, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. , Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany E","family":"Powell","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Fort Belvoir Community Hospital , Fort Belvoir, VA 22060, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis M","family":"French","sequence":"additional","affiliation":[{"name":"National Intrepid Center of Excellence, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hind","family":"Beydoun","sequence":"additional","affiliation":[{"name":"Department of Research Programs, Fort Belvoir Community Hospital , Fort Belvoir, VA 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant A","family":"Justin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"},{"name":"Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus H","family":"Colyer","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"},{"name":"Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, MD 20889, USA"},{"name":"Department of Ophthalmology, Madigan Army Medical Center , Tacoma, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,9]]},"reference":[{"issue":"3","key":"2023072301091362200_R1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1080\/09286580600665886","article-title":"Epidemiology of blinding trauma in the United States Eye Injury Registry","volume":"13","author":"Kuhn","year":"2006","journal-title":"Ophthalmic Epidemiol"},{"issue":"3","key":"2023072301091362200_R2","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1076\/opep.5.3.143.8364","article-title":"The global impact of eye injuries","volume":"5","author":"N\u00e9grel","year":"1998","journal-title":"Ophthalmic Epidemiol"},{"issue":"1348","key":"2023072301091362200_R3","first-page":"61","article-title":"Ocular trauma epidemiology: 10-year retrospective study","volume":"125","author":"Pandita","year":"2012","journal-title":"N Z Med J"},{"key":"2023072301091362200_R4","article-title":"TBI-related emergency department visits, hospitalizations, and deaths (EDHDs)","author":"Centers for Disease Control and Prevention"},{"issue":"1","key":"2023072301091362200_R5","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/HTR.0b013e3181956ffd","article-title":"Traumatic brain injury associated with combat ocular trauma","volume":"24","author":"Weichel","year":"2009","journal-title":"J Head Trauma Rehabil"},{"issue":"12","key":"2023072301091362200_R6","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1016\/j.ophtha.2008.08.033","article-title":"Combat ocular trauma visual outcomes during operations Iraqi and enduring freedom","volume":"115","author":"Weichel","year":"2008","journal-title":"Ophthalmology"},{"issue":"6","key":"2023072301091362200_R7","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1682\/JRRD.2008.08.0109","article-title":"Eye and visual function in traumatic brain injury","volume":"46","author":"Cockerham","year":"2009","journal-title":"J Rehabil Res Dev"},{"key":"2023072301091362200_R8","article-title":"Traumatic brain injury: updated definition and reporting","author":"Department of Defense","year":"2015"},{"key":"2023072301091362200_R9","article-title":"VA\/DoD clinical practice guideline for the management of concussion-mild traumatic brain injury","author":"Department of Veterans Affairs and Department of Defense","year":"2016"},{"issue":"1","key":"2023072301091362200_R10","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ophtha.2005.07.018","article-title":"Ocular war injuries of the Iraqi Insurgency,January-September 2004","volume":"113","author":"Mader","year":"2006","journal-title":"Ophthalmology"},{"key":"2023072301091362200_R11","article-title":"DoD TBI worldwide numbers","author":"Defense and Veterans Brain Injury Center (DVBIC)","year":"2021"},{"issue":"12","key":"2023072301091362200_R12","first-page":"135","article-title":"Evolution of military combat eye protection","volume":"3","author":"Auvil","year":"2016","journal-title":"US Army Med Dep J"},{"issue":"12","key":"2023072301091362200_R13","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.30824","article-title":"Association of optical coherence tomography with longitudinal neurodegeneration in veterans with chronic mild traumatic brain injury","volume":"3","author":"Gilmore","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"15","key":"2023072301091362200_R14","article-title":"Prevalence of structural abnormalities of the Retinal Nerve Fiber Layer (RNFL) and Ganglion Cell Layer Complex (GCLC) by OCT in veterans with Traumatic Brain Injury (TBI)","volume":"54","author":"Kardon","year":"2013","journal-title":"Invest Ophthalmol Vis Sci"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/7-8\/e1729\/50937193\/usac010.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/7-8\/e1729\/50937193\/usac010.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,23]],"date-time":"2023-07-23T01:11:41Z","timestamp":1690074701000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/188\/7-8\/e1729\/6545132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,9]]},"references-count":14,"journal-issue":{"issue":"7-8","published-online":{"date-parts":[[2022,3,9]]},"published-print":{"date-parts":[[2023,7,22]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usac010","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,7,1]]},"published":{"date-parts":[[2022,3,9]]}}}