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For veterans returning from war in Iraq and Afghanistan, vision problems caused by traumatic brain injury are a growing concern. These veterans have better body armor than soldiers in the past, but they are more likely to be severely shaken by a blast from a homemade explosive device.
About 16% of soldiers who fought in Iraq have returned with vision problems, often due to a traumatic brain injury. In comparison, 9% of Vietnam soldiers and 6% of World War II soldiers had eye injuries.
The New Ocular Trauma: Closed-Eye Injuries
Blunt force can hurt the eye without piercing it. These ''closed-eye injuries'' are difficult to diagnose because there's no obvious injury to the outside of the eye. But inside, blunt force can damage the cornea, retina, lens, and optic nerves. Sometimes, vision problems from ocular trauma don't show up for one to three years after the blast. As a result, veterans may not know that they have eye damage until they have an eye exam or start having vision problems after they've left military service.
Symptoms of Ocular Trauma
Blast-related ocular trauma may start as color blindness and become more severe. Other symptoms of vision problems include:
Problems with depth perception
Phantom Vision With Ocular Trauma
About 20% of people with ocular trauma also have Charles Bonnet syndrome or "phantom vision" in which they see hallucinations. People may be afraid to mention that they see visions, so doctors and family members should ask about them.
Sometimes it can be difficult to separate hallucinations from physical reality. These detailed visions can include seeing:
Strangers or familiar people sitting at home
Animals in the closet
Realistic objects that are out of place, such as a double-decker bus
Visions tend to lessen after a year or 18 months. In the meantime, antiseizure drugs may ease phantom visions for some veterans. If the visions are particularly upsetting, anti-anxiety medicines may help. Veterans who also have depression may find relief through mental health counseling and medications such as antidepressants.
Other veterans learn eye exercises and other activities to help them ignore the visions. Visions often occur when it is quiet, so staying active, keeping rooms bright, and playing music may help limit visions.
Screening for Vision Loss
A simple eye chart test cannot always diagnose ocular trauma. Veterans may still be able to see well, although they have other visual symptoms. More thorough vision screenings are needed for veterans with traumatic brain injury. All soldiers at Walter Reed Army Medical Center who have had traumatic brain injury within two years now have screenings for vision loss. The Center's staff found that 64% of these soldiers have vision problems.
Other veteran rehabilitation centers are also screening for low vision in soldiers who have had a traumatic brain injury. (Low vision is sight impairment that eyeglasses, contact lenses, surgery, or medicine can't fix.) Tests revealed that these soldiers had mild to severe vision problems. And 2% of them were legally blind.