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Kodali S, He CH, Patel S, Tao A, Szlechter M, Parsikia A, Mbekeani JN. Characteristics of ocular injuries associated with mortality in patients admitted with major trauma. BMC Ophthalmol 2024; 24:125. [PMID: 38504178 PMCID: PMC10949718 DOI: 10.1186/s12886-024-03392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries. METHODS A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05. RESULTS Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity. CONCLUSIONS Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.
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Affiliation(s)
- Sruthi Kodali
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Catherine H He
- Department of Ophthalmology & Visual Sciences, Yale School of Medicine, New Haven, Conn, USA
| | - Sheel Patel
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Alice Tao
- Department of Ophthalmology, Jamaica Hospital Medical Center, New York Medical College, Queens, NY, USA
| | - Moshe Szlechter
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA
| | - Afshin Parsikia
- Department of Research Services, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce N Mbekeani
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA.
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA.
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Buonfiglio F, Böhm EW, Pfeiffer N, Gericke A. Oxidative Stress: A Suitable Therapeutic Target for Optic Nerve Diseases? Antioxidants (Basel) 2023; 12:1465. [PMID: 37508003 PMCID: PMC10376185 DOI: 10.3390/antiox12071465] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Optic nerve disorders encompass a wide spectrum of conditions characterized by the loss of retinal ganglion cells (RGCs) and subsequent degeneration of the optic nerve. The etiology of these disorders can vary significantly, but emerging research highlights the crucial role of oxidative stress, an imbalance in the redox status characterized by an excess of reactive oxygen species (ROS), in driving cell death through apoptosis, autophagy, and inflammation. This review provides an overview of ROS-related processes underlying four extensively studied optic nerve diseases: glaucoma, Leber's hereditary optic neuropathy (LHON), anterior ischemic optic neuropathy (AION), and optic neuritis (ON). Furthermore, we present preclinical findings on antioxidants, with the objective of evaluating the potential therapeutic benefits of targeting oxidative stress in the treatment of optic neuropathies.
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Affiliation(s)
- Francesco Buonfiglio
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (E.W.B.); (N.P.)
| | | | | | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (E.W.B.); (N.P.)
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Moe MC, Özmert E, Baudouin C, Binadra A, Crafoord S, Jo Y, Kiratli H, Moore M, Pitsiladis YP, Rolle U, Tan B, Yanik Ö, Budgett R, Erdener U, Steffen K, Engbretsen L. International Olympic Committee (IOC) consensus paper on sports-related ophthalmology issues in elite sports. BMJ Open Sport Exerc Med 2023; 9:e001644. [PMID: 37485004 PMCID: PMC10357794 DOI: 10.1136/bmjsem-2023-001644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Vision plays an important role in an athletes' success. In sports, nearly 80% of perceptual input is visual, and eye health and sports medicine are closely intertwined fields of utmost importance to athletes. The physical nature of sports activities renders individuals more prone to various eye injuries than the general population. Ocular trauma can lead to lifelong sequelae, and impaired vision requires careful follow-up and management. Apart from injuries, athletes may also experience vision problems that can hamper their performance, including blurred vision, double vision, and light sensitivity. The interdisciplinary nature of sports medicine necessitates collaboration between sports medicine professionals and ophthalmologists. Through such collaborations, athletes can receive appropriate eye care, education on proper eye protection and guidance on adopting good eye health practices. If any inconspicuous symptoms are not detected and treated promptly, athletes may acquire systemic injuries because of defective vision, preventing them from achieving high level athletic performance in competitions. The protection of the elite athlete is the responsibility of all of us in sports medicine. To advance a more unified, evidence-informed approach to ophthalmic health assessment and management in athletes and as relevant for sports medicine physicians, the International Olympic Committee Consensus Group aims for a critical evaluation of the current state of the science and practice of ophthalmologic issues and illness in high-level sports, and present recommendations for a unified approach to this important issue.
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Affiliation(s)
- Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Emin Özmert
- Ophthalmology, Ankara University Faculty of Medicine, Ankara, Türkiye
- Department of Ophthalmology, Vehbi Koç Eye Hospital, Ankara, Türkiye
| | - Christophe Baudouin
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital & Vision Institute, Paris, France
| | - Abhinav Binadra
- Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
| | - Sven Crafoord
- Faculty of Medicine and Health, Department of Ophthalmology, Örebro University Hospital, Orebro, Sweden
| | - Young Jo
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, South Korea
| | - Hayyam Kiratli
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Melita Moore
- Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, California, USA
| | - Yannis P Pitsiladis
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Udo Rolle
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/M, Germany
| | - Ben Tan
- SingHealth Duke-NUS Sport & Exercise Medicine Centre, Singapore
| | - Özge Yanik
- Ophthalmology, Ankara University Faculty of Medicine, Ankara, Türkiye
- Department of Ophthalmology, Vehbi Koç Eye Hospital, Ankara, Türkiye
| | - Richard Budgett
- Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
| | - Ugur Erdener
- Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Türkiye
- World Archery, Lausanne, Switzerland
| | - Kathrin Steffen
- Oslo Sports Trauma Center, Institute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lars Engbretsen
- Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
- Oslo Sports Trauma Center, Institute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopaedic Surgery, University of Oslo Faculty of Medicine, Oslo, Norway
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4
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Harper MM, Gramlich OW, Elwood BW, Boehme NA, Dutca LM, Kuehn MH. Immune responses in mice after blast-mediated traumatic brain injury TBI autonomously contribute to retinal ganglion cell dysfunction and death. Exp Eye Res 2022; 225:109272. [PMID: 36209837 DOI: 10.1016/j.exer.2022.109272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to examine the role of the immune system and its influence on chronic retinal ganglion cell (RGC) dysfunction following blast-mediated traumatic brain injury (bTBI). METHODS C57BL/6J and B6.129S7-Rag1tm1Mom/J (Rag-/-) mice were exposed to one blast injury of 140 kPa. A separate cohort of C57BL/6J mice was exposed to sham-blast. Four weeks following bTBI mice were euthanized, and splenocytes were collected. Adoptive transfer (AT) of splenocytes into naïve C57BL/6J recipient mice was accomplished via tail vein injection. Three groups of mice were analyzed: those receiving AT of splenocytes from C57BL/6J mice exposed to blast (AT-TBI), those receiving AT of splenocytes from C57BL/6J mice exposed to sham (AT-Sham), and those receiving AT of splenocytes from Rag-/- mice exposed to blast (AT-Rag-/-). The visual function of recipient mice was analyzed with the pattern electroretinogram (PERG), and the optomotor response (OMR). The structure of the retina was evaluated using optical coherence tomography (OCT), and histologically using BRN3A-antibody staining. RESULTS Analysis of the PERG showed a decreased amplitude two months post-AT that persisted for the duration of the study in AT-TBI mice. We also observed a significant decrease in the retinal thickness of AT-TBI mice two months post-AT compared to sham, but not at four or six months post-AT. The OMR response was significantly decreased in AT-TBI mice 5- and 6-months post-AT. BRN3A staining showed a loss of RGCs in AT-TBI and AT-Rag-/- mice. CONCLUSION These results suggest that the immune system contributes to chronic RGC dysfunction following bTBI.
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Affiliation(s)
- Matthew M Harper
- Departments of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA; Departments of Biology, And Pharmacology, The University of Iowa, Iowa City, IA, USA; Veterans Administration Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, IA, USA.
| | - Oliver W Gramlich
- Departments of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA; Departments of Neuroscience and Pharmacology, The University of Iowa, Iowa City, IA, USA; Veterans Administration Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Benjamin W Elwood
- Departments of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA; Veterans Administration Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Nickolas A Boehme
- Departments of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA; Veterans Administration Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Laura M Dutca
- Departments of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA; Veterans Administration Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Markus H Kuehn
- Departments of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA; Veterans Administration Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, IA, USA
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Kaldenberg J, Newman R, Jimenez C, Walker M. Vision Therapy Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020). Am J Occup Ther 2022; 76:23917. [PMID: 36165888 DOI: 10.5014/ajot.2022/76s2006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.
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Affiliation(s)
- Jennifer Kaldenberg
- Jennifer Kaldenberg, DrPH, MSA, OTR/L, SCLV, FAOTA, is Interim OTD Program DirectorClinical Associate Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Robin Newman
- Robin Newman, OTD, MA, OTR/L, CLT, FAOTA, is Clinical Assistant Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Christine Jimenez
- Christine Jimenez, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Mary Walker
- Mary Walker, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
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6
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Kaldenberg J, Newman R, Jimenez C, Walker M. Binasal Occlusion Intervention to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020). Am J Occup Ther 2022; 76:23918. [PMID: 36165889 DOI: 10.5014/ajot.2022/76s2005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of binasal occlusion interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.
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Affiliation(s)
- Jennifer Kaldenberg
- Jennifer Kaldenberg, DrPH, MSA, OTR/L, SCLV, FAOTA, is Interim OTD Program Director and Clinical Associate Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Robin Newman
- Robin Newman, OTD, MA, OTR/L, CLT, FAOTA, is Clinical Assistant Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Christine Jimenez
- Christine Jimenez, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Mary Walker
- Mary Walker, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
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7
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Kaldenberg J, Newman R, Jimenez C, Walker M. Vestibulo-Ocular Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020). Am J Occup Ther 2022; 76:23924. [PMID: 36166579 DOI: 10.5014/ajot.2022/76s2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of vestibulo-ocular interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.
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Affiliation(s)
- Jennifer Kaldenberg
- Jennifer Kaldenberg, DrPH, MSA, OTR/L, SCLV, FAOTA, is Interim OTD Program Director and Clinical Associate Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Robin Newman
- Robin Newman, OTD, MA, OTR/L, CLT, FAOTA, is Clinical Assistant Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Christine Jimenez
- Christine Jimenez, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Mary Walker
- Mary Walker, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
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8
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Kaldenberg J, Newman R, Jimenez C, Walker M. Filter Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020). Am J Occup Ther 2022; 76:23926. [PMID: 36166580 DOI: 10.5014/ajot.2022/76s2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of filter interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.
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Affiliation(s)
- Jennifer Kaldenberg
- Jennifer Kaldenberg, DrPH, MSA, OTR/L, SCLV, FAOTA, is Interim OTD Program Director and Clinical Associate Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Robin Newman
- Robin Newman, OTD, MA, OTR/L, CLT, FAOTA, is Clinical Assistant Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Christine Jimenez
- Christine Jimenez, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Mary Walker
- Mary Walker, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
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Abbas Farishta R, Farivar R. Montreal Brain Injury Vision Screening Test for General Practitioners. Front Hum Neurosci 2022; 16:858378. [PMID: 35911590 PMCID: PMC9330036 DOI: 10.3389/fnhum.2022.858378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Visual disturbances are amongst the most commonly reported symptoms after a traumatic brain injury (TBI) despite vision testing being uncommon at initial clinical evaluation. TBI patients consistently present a wide range of visual complaints, including photophobia, double vision, blurred vision, and loss of vision which can detrimentally affect reading abilities, postural balance, and mobility. In most cases, especially in rural areas, visual disturbances of TBI would have to be diagnosed and assessed by primary care physicians, who lack the specialized training of optometry. Given that TBI patients have a restricted set of visual concerns, an opportunity exists to develop a screening protocol for specialized evaluation by optometrists—one that a primary care physician could comfortably carry out and do so in a short time. Here, we designed a quick screening protocol that assesses the presence of core visual symptoms present post-TBI. The MOBIVIS (Montreal Brain Injury Vision Screening) protocol takes on average 5 min to perform and is composed of only “high-yield” tests that could be performed in the context of a primary care practice and questions most likely to reveal symptoms needing further vision care management. The composition of our proposed protocol and questionnaire are explained and discussed in light of existing protocols. Its potential impact and ability to shape a better collaboration and an integrative approach in the management of mild TBI (mTBI) patients is also discussed.
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Affiliation(s)
- Reza Abbas Farishta
- McGill Vision Research Unit, Department of Ophthalmology and Vision Sciences, McGill University, Montréal, QC, Canada
- *Correspondence: Reza Abbas Farishta
| | - Reza Farivar
- McGill Vision Research Unit, Department of Ophthalmology and Vision Sciences, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montréal, QC, Canada
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Flor R, Purt B, Sia RK, Ryan DS, Kagemann JM, Powell BE, French LM, Beydoun H, Justin GA, Colyer MH. Correlative Factors for Traumatic Brain Injury in Combat Ocular Trauma. Mil Med 2022; 188:usac010. [PMID: 35260903 DOI: 10.1093/milmed/usac010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/14/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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 = 13) versus COT-T (Combat Ocular Trauma associated with TBI; n = 75). The Fisher's 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Remigio Flor
- Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | - Boonkit Purt
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
- Department of Ophthalmology, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Rose K Sia
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, VA 22060, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, VA 22060, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Janice M Kagemann
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, VA 22060, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Brittany E Powell
- Department of Ophthalmology, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Hind Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA 20889, USA
| | - Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Marcus H Colyer
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, USA
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Honig MG, Del Mar NA, Henderson DL, O'Neal D, Yammanur M, Cox R, Li C, Perry AM, Moore BM, Reiner A. Raloxifene, a cannabinoid type-2 receptor inverse agonist, mitigates visual deficits and pathology and modulates microglia after ocular blast. Exp Eye Res 2022; 218:108966. [PMID: 35143834 DOI: 10.1016/j.exer.2022.108966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
Visual deficits after ocular blast injury (OBI) are common, but pharmacological approaches to improve long-term outcomes have not been identified. Blast forces frequently damage the retina and optic nerves, and work on experimental animals has shown the pro-inflammatory actions of microglia can further exacerbate such injuries. Cannabinoid type-2 receptor (CB2) inverse agonists specifically target activated microglia, biasing them away from the harmful pro-inflammatory M1 state toward the helpful reparative M2 state. We previously found that treating mice with CB2 inverse agonists after traumatic brain injury, produced by either focal cranial air blast or dorsal cranial impact, greatly attenuated the visual deficits and pathology that otherwise resulted. Here we examined the consequences of single and repeat OBI and the benefit provided by raloxifene, an FDA-approved estrogen receptor drug that possesses noteworthy CB2 inverse agonism. After single OBI, although the amplitudes of the A- and B-waves of the electroretinogram and pupil light response appeared to be normal, the mice showed hints of deficits in contrast sensitivity and visual acuity, a trend toward optic nerve axon loss, and significantly increased light aversion, which were reversed by 2 weeks of daily treatment with raloxifene. Mice subjected to repeat OBI (5 blasts spaced 1 min apart), exhibited more severe visual deficits, including decreases in contrast sensitivity, visual acuity, the amplitudes of the A- and B-waves of the electroretinogram, light aversion, and resting pupil diameter (i.e. hyperconstriction), accompanied by the loss of photoreceptor cells and optic nerve axons, nearly all of which were mitigated by raloxifene. Interestingly, optic nerve axon abundance was strongly correlated with contrast sensitivity and visual acuity across all groups of experimental mice in the repeat OBI study, suggesting optic nerve axon loss with rOBI and its attenuation with raloxifene are associated with the extent of these two deficits while photoreceptor abundance was highly correlated with A-wave amplitude and resting pupil size, suggesting a prominent role for photoreceptors in these two deficits. Quantitative PCR (qPCR) showed levels of M1-type microglial markers (e.g. iNOS, IL1β, TNFα, and CD32) in retina, optic nerve, and thalamus were increased 3 days after repeat OBI. With raloxifene treatment, the overall expression of M1 markers was more similar to that in sham mice. Raloxifene treatment was also associated with the elevation of IL10 transcripts in all three tissues compared to repeat OBI alone, but the results for the three other M2 microglial markers we examined were more varied. Taken together, the qPCR results suggest that raloxifene benefit for visual function and pathology was associated with a lessening of the pro-inflammatory actions of microglia. The benefit we find for raloxifene following OBI provides a strong basis for phase-2 efficacy testing in human clinical trials for treating ocular injury.
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Affiliation(s)
- Marcia G Honig
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Nobel A Del Mar
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Desmond L Henderson
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Dylan O'Neal
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Meghna Yammanur
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Rachel Cox
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Chunyan Li
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Aaron M Perry
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Bob M Moore
- Department of Pharmaceutical Sciences, The University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Anton Reiner
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA; Department of Ophthalmology, The University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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12
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Kempuraj D, Mohan RR. Autophagy in Extracellular Matrix and Wound Healing Modulation in the Cornea. Biomedicines 2022; 10:biomedicines10020339. [PMID: 35203548 PMCID: PMC8961790 DOI: 10.3390/biomedicines10020339] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 12/18/2022] Open
Abstract
Autophagy is a robust cellular mechanism for disposing of harmful molecules or recycling them to cells, which also regulates physiopathological processes in cornea. Dysregulated autophagy causes inefficient clearance of unwanted proteins and cellular debris, mitochondrial disorganization, defective inflammation, organ dysfunctions, cell death, and diseases. The cornea accounts for two-thirds of the refraction of light that occurs in the eyes, but is prone to trauma/injury and infection. The extracellular matrix (ECM) is a noncellular dynamic macromolecular network in corneal tissues comprised of collagens, proteoglycans, elastin, fibronectin, laminins, hyaluronan, and glycoproteins. The ECM undergoes remodeling by matrix-degrading enzymes and maintains corneal transparency. Autophagy plays an important role in the ECM and wound healing maintenance. Delayed/dysregulated autophagy impacts the ECM and wound healing, and can lead to corneal dysfunction. Stromal wound healing involves responses from the corneal epithelium, basement membrane, keratocytes, the ECM, and many cytokines and chemokines, including transforming growth factor beta-1 and platelet-derived growth factor. Mild corneal injuries self-repair, but greater injuries lead to corneal haze/scars/fibrosis and vision loss due to disruptions in the ECM, autophagy, and normal wound healing processes. Presently, the precise role of autophagy and ECM remodeling in corneal wound healing is elusive. This review discusses recent trends in autophagy and ECM modulation in the context of corneal wound healing and homeostasis.
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Affiliation(s)
- Duraisamy Kempuraj
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO 65212, USA;
- One-Health Vision Research Program, Departments of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Rajiv R. Mohan
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO 65212, USA;
- One-Health Vision Research Program, Departments of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO 65212, USA
- Mason Eye Institute, School of Medicine, University of Missouri, Columbia, MO 65212, USA
- Correspondence:
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13
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Honig MG, Del Mar NA, Henderson DL, O'Neal D, Doty JB, Cox R, Li C, Perry AM, Moore BM, Reiner A. Raloxifene Modulates Microglia and Rescues Visual Deficits and Pathology After Impact Traumatic Brain Injury. Front Neurosci 2021; 15:701317. [PMID: 34776838 PMCID: PMC8585747 DOI: 10.3389/fnins.2021.701317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022] Open
Abstract
Mild traumatic brain injury (TBI) involves widespread axonal injury and activation of microglia, which initiates secondary processes that worsen the TBI outcome. The upregulation of cannabinoid type-2 receptors (CB2) when microglia become activated allows CB2-binding drugs to selectively target microglia. CB2 inverse agonists modulate activated microglia by shifting them away from the harmful pro-inflammatory M1 state toward the helpful reparative M2 state and thus can stem secondary injury cascades. We previously found that treatment with the CB2 inverse agonist SMM-189 after mild TBI in mice produced by focal cranial blast rescues visual deficits and the optic nerve axon loss that would otherwise result. We have further shown that raloxifene, which is Food and Drug Administration (FDA)-approved as an estrogen receptor modulator to treat osteoporosis, but also possesses CB2 inverse agonism, yields similar benefit in this TBI model through its modulation of microglia. As many different traumatic events produce TBI in humans, it is widely acknowledged that diverse animal models must be used in evaluating possible therapies. Here we examine the consequences of TBI created by blunt impact to the mouse head for visual function and associated pathologies and assess raloxifene benefit. We found that mice subjected to impact TBI exhibited decreases in contrast sensitivity and the B-wave of the electroretinogram, increases in light aversion and resting pupil diameter, and optic nerve axon loss, which were rescued by daily injection of raloxifene at 5 or 10 mg/ml for 2 weeks. Raloxifene treatment was associated with reduced M1 activation and/or enhanced M2 activation in retina, optic nerve, and optic tract after impact TBI. Our results suggest that the higher raloxifene dose, in particular, may be therapeutic for the optic nerve by enhancing the phagocytosis of axonal debris that would otherwise promote inflammation, thereby salvaging less damaged axons. Our current work, together with our prior studies, shows that microglial activation drives secondary injury processes after both impact and cranial blast TBI and raloxifene mitigates microglial activation and visual system injury in both cases. The results thus provide a strong basis for phase 2 human clinical trials evaluating raloxifene as a TBI therapy.
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Affiliation(s)
- Marcia G Honig
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nobel A Del Mar
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Desmond L Henderson
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Dylan O'Neal
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - John B Doty
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Rachel Cox
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Chunyan Li
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Aaron M Perry
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Bob M Moore
- Department of Pharmaceutical Sciences, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Anton Reiner
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States.,Department of Ophthalmology, The University of Tennessee Health Science Center, Memphis, TN, United States
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14
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Dhakal S, He L, Lyuboslavsky P, Sidhu C, Chrenek MA, Sellers JT, Boatright JH, Geisert EE, Setterholm NA, McDonald FE, Iuvone PM. A Tropomycin-Related Kinase B Receptor Activator for the Management of Ocular Blast-Induced Vision Loss. J Neurotrauma 2021; 38:2896-2906. [PMID: 34353120 PMCID: PMC8820286 DOI: 10.1089/neu.2020.7392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pressure waves from explosions or other traumatic events can damage the neurons of the eye and visual centers of the brain, leading to functional loss of vision. There are currently few treatments for such injuries that can be deployed rapidly to mitigate damage. Brain-derived neurotrophic factor (BDNF) and activation of its receptor tropomycin-related kinase B (TrkB) have neuroprotective effects in a number of degeneration models. Small molecule activators of TrkB, such as N-[2-(5-hydroxy-1H-indol-3-yl)ethyl]-2-oxopiperidine-3-carboxamide (HIOC), cross the blood-brain and blood-retina barriers after systemic administration. We characterize the effects of blast-induced ocular trauma on retinal and visual function. We show that systemic administration of HIOC, a potent small molecule activator of the BDNF/TrkB receptor, preserves visual function in mice exposed to ocular blast injury. The HIOC treatment for one week preserves visual function for at least four months. The HIOC treatment effectively protected vision when the initial dose was administered up to 3 h after blast, but not if the initial treatment was delayed for 24 h. We provide evidence that the therapeutic effect of HIOC is mediated by activation of BDNF/TrkB receptors. The results indicate that HIOC may be useful for managing ocular blast injury and other forms of traumatic optic neuropathy.
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Affiliation(s)
- Susov Dhakal
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Li He
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | - Curran Sidhu
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Micah A. Chrenek
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Jana T. Sellers
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | - Eldon E. Geisert
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | | | - P. Michael Iuvone
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
- Department of Pharmacology and Chemical Biology, Emory University, Atlanta, Georgia, USA
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15
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Saliman NH, Belli A, Blanch RJ. Afferent Visual Manifestations of Traumatic Brain Injury. J Neurotrauma 2021; 38:2778-2789. [PMID: 34269619 DOI: 10.1089/neu.2021.0182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Traumatic brain injury (TBI) causes structural and functional damage to the central nervous system including the visual pathway. Defects in the afferent visual pathways affect visual function and in severe cases cause complete visual loss. Visual dysfunction is detectable by structural and functional ophthalmic examinations that are routine in the eye clinic, including examination of the pupillary light reflex and optical coherence tomography (OCT). Assessment of pupillary light reflex is a non-invasive assessment combining afferent and efferent visual function. While a assessment using a flashlight is relatively insensitive, automated pupillometry has 95% specificity and 78.1% sensitivity in detecting TBI-related visual and cerebral dysfunction with an area under the curve of 0.69-0.78. OCT may also serve as a noninvasive biomarker of TBI severity, demonstrating changes in the retinal ganglion cell layer and nerve fiber layer throughout the range of TBI severity even in the absence of visual symptoms. This review discusses the impact of TBI on visual structure and function.
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Affiliation(s)
- Noor Haziq Saliman
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Antonio Belli
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Richard J Blanch
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
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16
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Mostafa J, Porter J, Queener HM, Ostrin LA. Intrinsically photosensitive retinal ganglion cell-driven pupil responses in patients with traumatic brain injury. Vision Res 2021; 188:174-183. [PMID: 34352476 DOI: 10.1016/j.visres.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/25/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Previous findings regarding intrinsically photosensitive retinal ganglion cell (ipRGC) function after traumatic brain injury (TBI) are conflicting. We examined ipRGC-driven pupil responses in civilian TBI and control participants using two pupillography protocols that assessed transient and adaptive properties: (1) a one second (s) long wavelength "red" stimulus (651 nm, 133 cd/m2) and 10 increasing intensities of 1 s short wavelength "blue" stimuli (456 nm, 0.167 to 167 cd/m2) with a 60 s interstimulus interval, and (2) two minutes of 0.1 Hz red stimuli (33 cd/m2), followed by two minutes of 0.1 Hz blue stimuli (16 cd/m2). For Protocol 1, constriction amplitude and the 6 s post illumination pupil response (PIPR) were calculated. For Protocol 2, amplitudes and peak velocities of pupil constriction and redilation were calculated. For Protocol 1, constriction amplitude and the 6 s PIPR were not significantly different between TBI patients and control subjects for red or blue stimuli. For Protocol 2, pupil constriction amplitude attenuated over time for red stimuli and potentiated over time for blue stimuli across all subjects. Constriction and redilation velocities were similar between groups. Pupil constriction amplitude was significantly less in TBI patients compared to control subjects for red and blue stimuli, which can be attributed to age-related differences in baseline pupil size. While TBI, in addition to age, may have contributed to decreased baseline pupil diameter and constriction amplitude, responses to blue stimulation suggest no selective damage to ipRGCs.
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Affiliation(s)
- Jakaria Mostafa
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77004, United States
| | - Jason Porter
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77004, United States
| | - Hope M Queener
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77004, United States
| | - Lisa A Ostrin
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77004, United States.
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17
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Hussain SF, Raza Z, Cash ATG, Zampieri T, Mazzoli RA, Kardon RH, Gomes RSM. Traumatic brain injury and sight loss in military and veteran populations- a review. Mil Med Res 2021; 8:42. [PMID: 34315537 PMCID: PMC8317328 DOI: 10.1186/s40779-021-00334-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/23/2021] [Indexed: 01/14/2023] Open
Abstract
War and combat exposure pose great risks to the vision system. More recently, vision related deficiencies and impairments have become common with the increased use of powerful explosive devices and the subsequent rise in incidence of traumatic brain injury (TBI). Studies have looked at the effects of injury severity, aetiology of injury and the stage at which visual problems become apparent. There was little discrepancy found between the frequencies or types of visual dysfunctions across blast and non-blast related groups, however complete sight loss appeared to occur only in those who had a blast-related injury. Generally, the more severe the injury, the greater the likelihood of specific visual disturbances occurring, and a study found total sight loss to only occur in cases with greater severity. Diagnosis of mild TBI (mTBI) is challenging. Being able to identify a potential TBI via visual symptoms may offer a new avenue for diagnosis.
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Affiliation(s)
- Syeda F. Hussain
- Research & Innovation, Blind Veterans UK, 12-14 Harcourt Street, London, W1H 4HD UK
- Bravo Victor, Research, 12-14 Harcourt Street, London, W1H 4HD UK
| | - Zara Raza
- Research & Innovation, Blind Veterans UK, 12-14 Harcourt Street, London, W1H 4HD UK
- Bravo Victor, Research, 12-14 Harcourt Street, London, W1H 4HD UK
| | - Andrew T. G. Cash
- Research & Innovation, Blind Veterans UK, 12-14 Harcourt Street, London, W1H 4HD UK
- Bravo Victor, Research, 12-14 Harcourt Street, London, W1H 4HD UK
| | - Thomas Zampieri
- Blinded Veterans Association, 1101 King Street, Suite 300, Alexandria, Virginia 22314 USA
| | - Robert A. Mazzoli
- Department of Ophthalmology, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, Washington, 98431 USA
| | - Randy H. Kardon
- Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa 52246 USA
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa 52242 USA
| | - Renata S. M. Gomes
- Research & Innovation, Blind Veterans UK, 12-14 Harcourt Street, London, W1H 4HD UK
- Bravo Victor, Research, 12-14 Harcourt Street, London, W1H 4HD UK
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle, NE7 7XA UK
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18
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Bartimote C, Fraser CL, Watson S. Integration of ophthalmology in ocular trauma to improve patient care: A narrative review. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211030793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Ocular trauma can cause significant morbidity and is a leading cause of unilateral blindness. In multi-trauma, life- and sight-threatening injuries can co-occur causing increased complexity in the assessment and management of ocular injuries as the competing priorities in the severely injured must be balanced. We conducted a narrative review to determine how ophthalmology may be further integrated into a trauma service and/or the organisation of an ocular trauma service. Methods The literature was reviewed via EMBASE, MEDLINE, CINAHL and Google Scholar utilising comprehensive search strategies and keyword searches. Our review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results The search yielded 437 articles, 30 studies met selection criteria and were included in the review. The included literature comprised guidelines, observational studies and reviews of registry data from Australia, England, the United States, Singapore, Iran and Israel. Conclusion The Australian Trauma Model has clear guidelines for referral of trauma patients to ensure appropriate care of the severely injured. However, there are no clear guidelines for the integration of ophthalmology into trauma. Therefore, early referral to ophthalmology and streamlining of referral pathways of specialist care would improve the care of patients with ocular trauma.
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Affiliation(s)
- Christopher Bartimote
- Royal North Shore Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia
| | - Clare L Fraser
- Sydney Eye Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia
| | - Stephanie Watson
- Sydney Eye Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia
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19
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Sia RK, Ryan DS, Brooks DI, Kagemann JM, Bower KS, French LM, Justin GA, Colyer MH. The Impact of Combat Ocular Trauma and Traumatic Brain Injury on Vision- and Health-Related Quality of Life Among U.S. Military Casualties. Mil Med 2021; 187:209-215. [PMID: 34117765 DOI: 10.1093/milmed/usab233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to assess visual and health-related quality of life (QOL) among U.S. military service members who sustained combat ocular trauma (COT) with or without associated traumatic brain injury (TBI). METHODS This was a single-center, prospective observational study of U.S. service members (n = 88) with COT who were treated at Walter Reed National Military Medical Center. Participants completed the National Eye Institute Visual Function Questionnaire (VFQ-25) at enrollment and at follow-up (>1 year) and supplemental surveys: Neurobehavioral Symptom Inventory, the Medical Outcomes 36-item Short Form Survey (SF-36), and Mayo-Portland Adaptability Inventory. RESULTS Initial and follow-up VFQ-25 showed a statistically significant increase in median scores for near activities (initial: 75.0, follow-up 83.3; P = .004) and peripheral vision (initial: 50.0, follow-up: 75.0; P = .009) and in composite scores (initial: 79.5, follow-up: 79.8; P = .022). Comparing those who did (n = 78) and did not (n = 8) have a TBI history, there were no significant differences in median change in VFQ-25 composite scores (with TBI: 2.3 vs. no TBI: 10.7; P = .179). Participants with a TBI history had a significantly lower median SF-36 General Health score (with TBI: 67.5 vs. no TBI: 92.5; P = .009). CONCLUSIONS Vision-related QOL of COT patients is generally good in the long term. However, those with both COT and a history of TBI conditions showed significantly worse functioning in several domains than those without TBI. As TBI is a common finding in COT, this association is an important factor impacting this population's overall clinical presentation and daily functions.
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Affiliation(s)
- Rose K Sia
- Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD 20817, USA
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD 20817, USA
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Janice M Kagemann
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD 20817, USA.,Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Kraig S Bower
- The Wilmer Eye Institute, Johns Hopkins University, Lutherville, MD 21093, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Grant A Justin
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.,Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.,Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
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20
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Harper MM, Boehme N, Dutca LM, Anderson MG. The Retinal Ganglion Cell Response to Blast-Mediated Traumatic Brain Injury Is Genetic Background Dependent. Invest Ophthalmol Vis Sci 2021; 62:13. [PMID: 34106210 PMCID: PMC8196410 DOI: 10.1167/iovs.62.7.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to examine the influence of genetic background on the retinal ganglion cell (RGC) response to blast-mediated traumatic brain injury (TBI) in Jackson Diversity Outbred (J:DO), C57BL/6J and BALB/cByJ mice. Methods Mice were subject to one blast injury of 137 kPa. RGC structure was analyzed by optical coherence tomography (OCT), function by the pattern electroretinogram (PERG), and histologically using BRN3A antibody staining. Results Comparison of the change in each group from baseline for OCT and PERG was performed. There was a significant difference in the J:DOΔOCT compared to C57BL/6J mice (P = 0.004), but not compared to BALB/cByJ (P = 0.21). There was a significant difference in the variance of the ΔOCT in J:DO compared to both C57BL/6J and BALB/cByJ mice. The baseline PERG amplitude was 20.33 ± 9.32 µV, which decreased an average of −4.14 ± 12.46 µV following TBI. Baseline RGC complex + RNFL thickness was 70.92 ± 4.52 µm, which decreased an average of −1.43 ± 2.88 µm following blast exposure. There was not a significant difference in the ΔPERG between J:DO and C57BL/6J (P = 0.13), although the variances of the groups were significantly different. Blast exposure in J:DO mice results in a density change of 558.6 ± 440.5 BRN3A-positive RGCs/mm2 (mean ± SD). Conclusions The changes in retinal outcomes had greater variance in outbred mice than what has been reported, and largely replicated herein, for inbred mice. These results demonstrate that the RGC response to blast injury is highly dependent upon genetic background.
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Affiliation(s)
- Matthew M Harper
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States.,Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Department of Veterans Affairs, Iowa City, IA, United States
| | - Nickolas Boehme
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States.,Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Department of Veterans Affairs, Iowa City, IA, United States
| | - Laura M Dutca
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States.,Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Department of Veterans Affairs, Iowa City, IA, United States
| | - Michael G Anderson
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States.,Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Department of Veterans Affairs, Iowa City, IA, United States.,The Department of Molecular Physiology and Biophysics, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States
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21
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Fortenbaugh FC, Gustafson JA, Fonda JR, Fortier CB, Milberg WP, McGlinchey RE. Blast mild traumatic brain injury is associated with increased myopia and chronic convergence insufficiency. Vision Res 2021; 186:1-12. [PMID: 34000559 DOI: 10.1016/j.visres.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/06/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022]
Abstract
While chronic visual symptom complaints are common among Veterans with a history of mild traumatic brain injury (mTBI), research is still ongoing to characterize the pattern of visual deficits that is most strongly associated with mTBI and specifically, the impact of blast-related mTBI on visual functioning. One area that has not been well explored is the potential impact of blast mTBI on refractive error. While myopic shifts have been documented following head injuries in civilian populations, posttraumatic myopic shifts have not been explored in participants with military mTBI. This study investigated the impact of blast mTBIs on a range of visual function measures including distance acuity and refractive error, in a well-characterized cohort of thirty-one Post-9/11 veterans for whom detailed clinical interviews regarding military and TBI history were available. Seventeen participants had a history of blast-related mTBI (blast mTBI + group) while 14 did not (blast mTBI- group). Results show an increased frequency of convergence insufficiency and myopia in the blast mTBI + group relative to the blast mTBI- group. Linear regression analyses further show that deficits in distance acuity and refractive error are associated with the number of blast mTBIs during military service but not the number of non-blast mTBIs or the number of lifetime non-blast TBIs and cannot be accounted for by PTSD. These results are consistent with long-lasting damage following blast mTBI to subcortical visual structures that support both vergence movements and the accommodative functions needed to see clearly objects at varying distances.
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Affiliation(s)
- Francesca C Fortenbaugh
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA.
| | - Jennifer A Gustafson
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA; Optometry Clinic, VA Boston Healthcare System, USA; New England College of Optometry, USA
| | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA; Department of Psychiatry, Boston University, School of Medicine, USA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA
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22
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Evans LP, Boehme N, Wu S, Burghardt EL, Akurathi A, Todd BP, Newell EA, Ferguson PJ, Mahajan VB, Dutca LM, Harper MM, Bassuk AG. Sex Does Not Influence Visual Outcomes After Blast-Mediated Traumatic Brain Injury but IL-1 Pathway Mutations Confer Partial Rescue. Invest Ophthalmol Vis Sci 2021; 61:7. [PMID: 33030508 PMCID: PMC7582458 DOI: 10.1167/iovs.61.12.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose In a mouse model of blast-mediated traumatic brain injury (bTBI), interleukin-1 (IL-1)-pathway components were tested as potential therapeutic targets for bTBI-mediated retinal ganglion cell (RGC) dysfunction. Sex was also evaluated as a variable for RGC outcomes post-bTBI. Methods Male and female mice with null mutations in genes encoding IL-1α, IL-1β, or IL-1RI were compared to C57BL/6J wild-type (WT) mice after exposure to three 20-psi blast waves given at an interblast interval of 1 hour or to mice receiving sham injury. To determine if genetic blockade of IL-1α, IL-1β, or IL-1RI could prevent damage to RGCs, the function and structure of these cells were evaluated by pattern electroretinogram and optical coherence tomography, respectively, 5 weeks following blast or sham exposure. RGC survival was also quantitatively assessed via immunohistochemical staining of BRN3A at the completion of the study. Results Our results showed that male and female WT mice had a similar response to blast-induced retinal injury. Generally, constitutive deletion of IL-1α, IL-1β, or IL-1RI did not provide full protection from the effects of bTBI on visual outcomes; however, injured WT mice had significantly worse visual outcomes compared to the injured genetic knockout mice. Conclusions Sex does not affect RGC outcomes after bTBI. The genetic studies suggest that deletion of these IL-1 pathway components confers some protection, but global deletion from birth did not result in a complete rescue.
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Affiliation(s)
- Lucy P Evans
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States.,Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, United States
| | - Nickolas Boehme
- Iowa City VA Health Care System Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Shu Wu
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
| | - Elliot L Burghardt
- Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, United States.,Department of Biostatistics, University of Iowa, Iowa City, Iowa, United States
| | - Abhigna Akurathi
- Iowa City VA Health Care System Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Brittany P Todd
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States.,Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, United States
| | - Elizabeth A Newell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
| | - Vinit B Mahajan
- Omics Laboratory, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States
| | - Laura M Dutca
- Iowa City VA Health Care System Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Matthew M Harper
- Iowa City VA Health Care System Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Alexander G Bassuk
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
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23
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Evans LP, Roghair AM, Gilkes NJ, Bassuk AG. Visual Outcomes in Experimental Rodent Models of Blast-Mediated Traumatic Brain Injury. Front Mol Neurosci 2021; 14:659576. [PMID: 33935648 PMCID: PMC8081965 DOI: 10.3389/fnmol.2021.659576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
Blast-mediated traumatic brain injuries (bTBI) cause long-lasting physical, cognitive, and psychological disorders, including persistent visual impairment. No known therapies are currently utilized in humans to lessen the lingering and often serious symptoms. With TBI mortality decreasing due to advancements in medical and protective technologies, there is growing interest in understanding the pathology of visual dysfunction after bTBI. However, this is complicated by numerous variables, e.g., injury location, severity, and head and body shielding. This review summarizes the visual outcomes observed by various, current experimental rodent models of bTBI, and identifies data showing that bTBI activates inflammatory and apoptotic signaling leading to visual dysfunction. Pharmacologic treatments blocking inflammation and cell death pathways reported to alleviate visual deficits in post-bTBI animal models are discussed. Notably, techniques for assessing bTBI outcomes across exposure paradigms differed widely, so we urge future studies to compare multiple models of blast injury, to allow data to be directly compared.
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Affiliation(s)
- Lucy P. Evans
- Department of Pediatrics, University of Iowa, Iowa City, IA, United States
- Medical Scientist Training Program, University of Iowa, Iowa City, IA, United States
| | - Ariel M. Roghair
- Department of Pediatrics, University of Iowa, Iowa City, IA, United States
| | - Noah J. Gilkes
- Department of Pediatrics, University of Iowa, Iowa City, IA, United States
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24
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A Systematic Literature Review on Traumatic Optic Neuropathy. J Ophthalmol 2021; 2021:5553885. [PMID: 33728056 PMCID: PMC7935564 DOI: 10.1155/2021/5553885] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 01/01/2023] Open
Abstract
Traumatic optic neuropathy (TON) is an uncommon vision-threatening disorder that can be caused by ocular or head trauma and is categorized into direct and indirect TON. The overall incidence of TON is 0.7–2.5%, and indirect TON has a higher prevalence than direct TON. Detection of an afferent pupillary defect in the presence of an intact globe in a patient with ocular or head trauma with decreased visual acuity strongly suggests TON. However, afferent pupillary defects may be difficult to detect in patients who have received narcotics that cause pupillary constriction and in those with bilateral TON. Mechanical shearing of the optic nerve axons and contusion necrosis due to immediate ischemia from damage to the optic nerve microcirculation and apoptosis of neurons is a probable mechanism. The proper management of TON is controversial. High-dose corticosteroid therapy and decompression of the optic nerve provide no additional benefit over observation alone. Intravenous erythropoietin may be a safe and efficient treatment for patients with TON.
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25
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Kornguth S, Rylander HG, Smith S, Campbell J, Steffensen S, Arnold D, Athey A, Rutledge JN. Approaches for Monitoring Warfighter Blast-related Exposures in Training to Develop Effective Safety Standards. Mil Med 2021; 186:515-522. [PMID: 33499537 PMCID: PMC7980484 DOI: 10.1093/milmed/usaa426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/04/2020] [Accepted: 11/01/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Traumatic brain injuries are of concern to the sports and military communities because of the age of the participants and costly burden to society. To markedly reduce the impact of traumatic brain injury and its sequela (TBI-S), it is necessary to determine the initial vulnerability of individuals as well as identify new technologies that indicate early signs of TBI-S. MATERIALS AND METHODS Currently, diverse methods have been used by the authors and others in laboratory settings to reveal early signs of persistent TBI-S including simulation modeling of the effect of rapid deceleration on the deviatoric strain (shear force) imposed on specific brain regions, auditory evoked potential (AEP) measurements to determine injury to the auditory cortex optokinetic nystagmus (OKN) measures sensitive to vestibular trauma, and optical coherence tomography (OCT) measures that reveal changes in central visual function obtained noninvasively by examination of the retina. RESULTS Simulation studies provided technical information on maximal deviatoric strain at the base of the sulci and interface of gray and white matter consistent with results from neuropathology and from magnetic resonance imaging. The AEP and OKN reveal measurable injury to similar regions below the Sylvian fissure including auditory cortex and midbrain, and the OCT reveals changes to the retina consistent with forceful deceleration effects. CONCLUSIONS The studies and results are consistent with prior work demonstrating that noninvasive tests may be sensitive to the presence of TBI-S, potentially in the training field as advances in the portability of test instruments are underway. When combined with baseline data gathered from individuals in quantitative form, key variances can emerge. Therefore, it is hypothesized that AEP, OKN, and OCT, taken together, may yield faster objective and quantitative neurophysiological measures serving as a "signature" of neural injury and more indicative of potentially persistent TBI-S-recommending larger scale longitudinal studies.
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Affiliation(s)
- Steven Kornguth
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Henry G Rylander
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Spencer Smith
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Julia Campbell
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Steve Steffensen
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - David Arnold
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Alex Athey
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - J Neal Rutledge
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
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26
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Clinical Practice Guidelines for Occupational Therapists in the Evaluation and Treatment of Oculomotor Impairment Following Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 9:93-99. [PMID: 34094719 PMCID: PMC8171233 DOI: 10.1007/s40141-021-00310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 02/08/2023]
Abstract
Purpose of review Currently, a lack of guidelines exists regarding best practices for occupational therapists (OTs) in the treatment and evaluation of oculomotor dysfunction following traumatic brain injury (TBI). Furthermore, individuals with TBI would benefit significantly from collaboration between OTs and optometrists during inpatient rehab. Recent findings Although few articles examine interdisciplinary models of inpatient rehab care that include optometry, a recent pilot study is explored. Emerging evidence from the field of optometry supports the use of restorative approaches for oculomotor impairment in mild TBI; however, cases with moderate to severe TBI are not addressed. Summary We describe an interdisciplinary approach involving collaboration between optometry and occupational therapy, yielding a comprehensive model to effectively evaluate and treat oculomotor impairments in those with TBI and facilitate improved performance in daily activities. We also provide guidelines useful for OTs working in settings where collaboration with optometry is not feasible.
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27
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Arun P, Rossetti F, DeMar JC, Wang Y, Batuure AB, Wilder DM, Gist ID, Morris AJ, Sabbadini RA, Long JB. Antibodies Against Lysophosphatidic Acid Protect Against Blast-Induced Ocular Injuries. Front Neurol 2020; 11:611816. [PMID: 33384658 PMCID: PMC7769950 DOI: 10.3389/fneur.2020.611816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/24/2020] [Indexed: 01/18/2023] Open
Abstract
Exposure to blast overpressure waves is implicated as the major cause of ocular injuries and resultant visual dysfunction in veterans involved in recent combat operations. No effective therapeutic strategies have been developed so far for blast-induced ocular dysfunction. Lysophosphatidic acid (LPA) is a bioactive phospholipid generated by activated platelets, astrocytes, choroidal plexus cells, and microglia and is reported to play major roles in stimulating inflammatory processes. The levels of LPA in the cerebrospinal fluid have been reported to increase acutely in patients with traumatic brain injury (TBI) as well as in a controlled cortical impact (CCI) TBI model in mice. In the present study, we have evaluated the efficacy of a single intravenous administration of a monoclonal LPA antibody (25 mg/kg) given at 1 h post-blast for protection against injuries to the retina and associated ocular dysfunctions. Our results show that a single 19 psi blast exposure significantly increased the levels of several species of LPA in blood plasma at 1 and 4 h post-blast. The anti-LPA antibody treatment significantly decreased glial cell activation and preserved neuronal cell morphology in the retina on day 8 after blast exposure. Optokinetic measurements indicated that anti-LPA antibody treatment significantly improved visual acuity in both eyes on days 2 and 6 post-blast exposure. Anti-LPA antibody treatment significantly increased rod photoreceptor and bipolar neuronal cell signaling in both eyes on day 7 post-blast exposure. These results suggest that blast exposure triggers release of LPAs, which play a major role promoting blast-induced ocular injuries, and that a single early administration of anti-LPA antibodies provides significant protection.
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Affiliation(s)
- Peethambaran Arun
- Blast-Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Franco Rossetti
- Blast-Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - James C DeMar
- Blast-Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Ying Wang
- Blast-Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Andrew B Batuure
- Blast-Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Donna M Wilder
- Blast-Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Irene D Gist
- Blast-Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Andrew J Morris
- Division of Cardiovascular Medicine, Lexington VA Medical Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Roger A Sabbadini
- Department of Biology, San Diego State University, San Diego, CA, United States
| | - Joseph B Long
- Blast-Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
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28
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Harvey MM, Justin GA, Brooks DI, Ryan DS, Weichel ED, Colyer MH. Ocular Trauma in Operation Iraqi Freedom and Operation Enduring Freedom from 2001 to 2011: A Bayesian Network Analysis. Ophthalmic Epidemiol 2020; 28:312-321. [PMID: 32998604 DOI: 10.1080/09286586.2020.1828494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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.
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Affiliation(s)
- Morgan M Harvey
- Department of Flight Medicine, Expeditionary Medical Facility, Camp Lemonnier, Djibouti
| | - Grant A Justin
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA.,Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | - Daniel I Brooks
- Department of Statistics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, VA, USA
| | | | - Marcus H Colyer
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA.,Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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29
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Ambika S, Atiya A, Ravi A, Mani R, Bhattacharya B, Praveen S, Hussaindeen JR. Visual profile of acquired brain injury in Indian cohort: a retrospective study. Brain Inj 2020; 34:1168-1174. [PMID: 32687723 DOI: 10.1080/02699052.2020.1792985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE With the increasing global prevalence of acquired brain injury (ABI), the burden of visual problems as a sequelae to ABI is on the rise. This study reports the visual profile of patients with ABI seen in Neuro-Optometry Clinic (NOC) at a tertiary eye-care center in Southern India. METHODS A retrospective study was carried out between January 2014 and December 2015. Medical records of patients diagnosed with ABI referred by Neuro-Ophthalmologists to the NOC were reviewed. The detailed history, clinical findings of neuro assessment and management details were recorded. RESULTS Of the 241 patients with ABI, 208 had Traumatic Brain Injury (TBI) and 33 had Cerebro-Vascular Accident (CVA). The mean (SD) age of patients with TBI was 35 ± 14 years and CVA was 52 ± 16 years. Binocular diplopia (61%) was seen predominantly in TBI due to vertical deviation (31%). Cranial nerve palsy was most common in TBI (55%) than CVA (36%) and visual field defects were most frequently seen in CVA (27%). CONCLUSION Cranial nerve paresis and restrictive strabismus with diplopia were the most common presentations in TBI and visual field defects in CVA. A neuro-optometric evaluation is recommended to identify visual dysfunctions and provide appropriate management options. ABBREVIATIONS ABI: Acquired Brain Injury; TBI: Traumatic Brain Injury; CVA: Cerebrovascular Accident; NOC: Neuro-Optometry Clinic; NSBVA: Non-Strabismic binocular vision anomalies; OMD: Oculomotor dysfunction; VFD: Visual field defect; GON: Glaucomatous optic neuropathy.
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Affiliation(s)
- S Ambika
- Neuro -Ophthalmology Department, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Ayisha Atiya
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Aishwarya Ravi
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India.,Srimathi Sundari Subramanian Department of Visual Pyschophysics, Unit of Medical Research Foundation , Chennai, India
| | - Revathy Mani
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Bidisha Bhattacharya
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Smita Praveen
- Neuro -Ophthalmology Department, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Jameel Rizwana Hussaindeen
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India.,Srimathi Sundari Subramanian Department of Visual Pyschophysics, Unit of Medical Research Foundation , Chennai, India
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30
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Zhu Y, Howard JT, Edsall PR, Morris RB, Lund BJ, Cleland JM. Blast Exposure Induces Ocular Functional Changes with Increasing Blast Over-pressures in a Rat Model. Curr Eye Res 2020; 44:770-780. [PMID: 30947563 DOI: 10.1080/02713683.2019.1567791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Blast-related brain and ocular injuries can lead to acute and chronic visual dysfunction. The chronic visual consequences of blast exposure and its progression remain unclear. The goal of this study is to analyze ocular functional response to four levels of blast exposure and identify a threshold of blast exposure leading to acute and chronic visual dysfunction. Methods: Anesthetized adult male Long-Evans rats received a single-blast exposure at a peak overpressure of 78, 117, 164 or 213 kPa, delivered by a compressed air-driven shock tube. Clinical eye examination, intraocular pressure (IOP), flash electroretinography (fERG) and spectral-domain optical coherence tomography (SD-OCT) images were assessed prior to, and at multiple time points post exposure. Results: No abnormal fERG were observed for the two lowest-level blast groups (78 kPa or 117 kPa). For the 164 kPa group, the a- and b-wave amplitudes of the fERG were decreased at 3 days postexposure (p = 0.009 for a-wave, p = 0.010 for b-wave), but recovered to baseline levels by 7 days post-exposure. The IOP was unchanged for the 117 kPa and 164 kPa groups. The 78 kPa group demonstrated a small transient increase during week one (p = 0.046). For the highest blast group (213 kPa), the IOP was significantly elevated immediately post-exposure (p = 0.0001), but recovered by 24 hr. A bimodal depression in the fERG a- and b-wave amplitudes was observed for this group: the amplitudes were depressed at day 3 post-exposure (p = 0.007 for a-wave, p = 0.012 for b-wave), and recovered by day 7 post-exposure. However, the fERG amplitudes were once again depressed at week 8 post-exposure, suggesting a chronic retinal dysfunction. All retinae appeared normal in SD-OCT images. Conclusions: Our study demonstrates that a single-blast exposure may result in acute and chronic fERG deficit, and traumatic IOP elevation. Noninvasive functional tests may hold promise for identifying individuals with a risk for developing chronic visual deficits, and indicating a time window for early clinical diagnosis, rehabilitation, and treatment.
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Affiliation(s)
- Yanli Zhu
- a Ocular Trauma Division , Staff Scientist US Army Institute of Surgical Research, Joint Base San Antonio, USA
| | - Jeffrey T Howard
- a Ocular Trauma Division , Staff Scientist US Army Institute of Surgical Research, Joint Base San Antonio, USA
| | - Peter R Edsall
- b Ocular Trauma Division , Engineer US Army Institute of Surgical Research, Joint Base San Antonio, USA
| | - Ryan B Morris
- c Ocular Trauma Division , Research Technician US Army Institute of Surgical Research, Joint Base San Antonio, USA
| | - Brian J Lund
- a Ocular Trauma Division , Staff Scientist US Army Institute of Surgical Research, Joint Base San Antonio, USA
| | - Jeffery M Cleland
- d Former Director Ocular Trauma Division US Army Institute of Surgical Research, Joint Base San Antonio, USA
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31
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Arun P, Rossetti F, Wilder DM, Sajja S, Van Albert SA, Wang Y, Gist ID, Long JB. Blast Exposure Leads to Accelerated Cellular Senescence in the Rat Brain. Front Neurol 2020; 11:438. [PMID: 32508743 PMCID: PMC7253679 DOI: 10.3389/fneur.2020.00438] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
Blast-induced traumatic brain injury (bTBI) is one of the major causes of persistent disabilities in Service Members, and a history of bTBI has been identified as a primary risk factor for developing age-associated neurodegenerative diseases. Clinical observations of several military blast casualties have revealed a rapid age-related loss of white matter integrity in the brain. In the present study, we have tested the effect of single and tightly coupled repeated blasts on cellular senescence in the rat brain. Isoflurane-anesthetized rats were exposed to either a single or 2 closely coupled blasts in an advanced blast simulator. Rats were euthanized and brains were collected at 24 h, 1 month and 1 year post-blast to determine senescence-associated-β-galactosidase (SA-β-gal) activity in the cells using senescence marker stain. Single and repeated blast exposures resulted in significantly increased senescence marker staining in several neuroanatomical structures, including cortex, auditory cortex, dorsal lateral thalamic nucleus, geniculate nucleus, superior colliculus, ventral thalamic nucleus and hippocampus. In general, the increases in SA-β-gal activity were more pronounced at 1 month than at 24 h or 1 year post-blast and were also greater after repeated than single blast exposures. Real-time quantitative RT-PCR analysis revealed decreased levels of mRNA for senescence marker protein-30 (SMP-30) and increased mRNA levels for p21 (cyclin dependent kinase inhibitor 1A, CDKN1A), two other related protein markers of cellular senescence. The increased senescence observed in some of these affected brain structures may be implicated in several long-term sequelae after exposure to blast, including memory disruptions and impairments in movement, auditory and ocular functions.
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Affiliation(s)
- Peethambaran Arun
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Franco Rossetti
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Donna M Wilder
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Sujith Sajja
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Stephen A Van Albert
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Ying Wang
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Irene D Gist
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Joseph B Long
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
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Evans LP, Woll AW, Wu S, Todd BP, Hehr N, Hedberg-Buenz A, Anderson MG, Newell EA, Ferguson PJ, Mahajan VB, Harper MM, Bassuk AG. Modulation of Post-Traumatic Immune Response Using the IL-1 Receptor Antagonist Anakinra for Improved Visual Outcomes. J Neurotrauma 2020; 37:1463-1480. [PMID: 32056479 PMCID: PMC7249480 DOI: 10.1089/neu.2019.6725] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to characterize acute changes in inflammatory pathways in the mouse eye after blast-mediated traumatic brain injury (bTBI) and to determine whether modulation of these pathways could protect the structure and function of retinal ganglion cells (RGC). The bTBI was induced in C57BL/6J male mice by exposure to three 20 psi blast waves directed toward the head with the body shielded, with an inter-blast interval of one hour. Acute cytokine expression in retinal tissue was measured through reverse transcription-quantitative polymerase chain reaction (RT-qPCR) four hours post-blast. Increased retinal expression of interleukin (lL)-1β, IL-1α, IL-6, and tumor necrosis factor (TNF)α was observed in bTBI mice exposed to blast when compared with shams, which was associated with activation of microglia and macroglia reactivity, assessed via immunohistochemistry with ionized calcium binding adaptor molecule 1 and glial fibrillary acidic protein, respectively, one week post-blast. Blockade of the IL-1 pathway was accomplished using anakinra, an IL-1RI antagonist, administered intra-peritoneally for one week before injury and continuing for three weeks post-injury. Retinal function and RGC layer thickness were evaluated four weeks post-injury using pattern electroretinogram (PERG) and optical coherence tomography (OCT), respectively. After bTBI, anakinra treatment resulted in a preservation of RGC function and RGC structure when compared with saline treated bTBI mice. Optic nerve integrity analysis demonstrated a trend of decreased damage suggesting that IL-1 blockade also prevents axonal damage after blast. Blast exposure results in increased retinal inflammation including upregulation of pro-inflammatory cytokines and activation of resident microglia and macroglia. This may explain partially the RGC loss we observed in this model, as blockade of the acute inflammatory response after injury with the IL-1R1 antagonist anakinra resulted in preservation of RGC function and RGC layer thickness.
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Affiliation(s)
- Lucy P Evans
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.,Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, USA
| | - Addison W Woll
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
| | - Shu Wu
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Brittany P Todd
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Nicole Hehr
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Adam Hedberg-Buenz
- The Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, USA.,Department of Molecular Physiology and Biophysics, and University of Iowa, Iowa City, Iowa, USA
| | - Michael G Anderson
- The Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, USA.,Department of Molecular Physiology and Biophysics, and University of Iowa, Iowa City, Iowa, USA.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | | | - Polly J Ferguson
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Vinit B Mahajan
- Omics Laboratory, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Matthew M Harper
- The Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, USA.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
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Neuro-Ophthalmic Injuries With Systemic Neurologic Injury or Traumatic Brain Injury in Operation Iraqi Freedom and Operation Enduring Freedom. J Neuroophthalmol 2020; 40:322-327. [DOI: 10.1097/wno.0000000000000913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Frick KD, Singman EL. Cost of Military Eye Injury and Vision Impairment Related to Traumatic Brain Injury: 2001-2017. Mil Med 2020; 184:e338-e343. [PMID: 30690455 DOI: 10.1093/milmed/usy420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/30/2018] [Accepted: 12/07/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Annual incidence of eye injury among members of the US armed services is high and can cause vision impairment and blindness. Traumatic brain injury is also associated with visual function. An estimate of the cost of treatment, benefits for those who are disabled, productivity loss for those with reduced vision function, and the cost of replacing and retraining others to take the responsibility of those who are discharged from the military will provide a benchmark to which to compare the cost of new methods to prevent, diagnose, mitigate, treat, and rehabilitate vision loss after injury. MATERIALS AND METHODS The modeling exercise used a combination of data from military websites, results previously published in the literature, and from other government websites. Data were combined to estimate the number of superficial injuries, the number of injuries with a high risk of blindness, the cost of medical care, the cost of disability benefits, and the cost of potential lost productivity. RESULTS Over the time period in question, the average annual incidence of eye injury was 15,681 with 304 hospitalized and 298 at high risk of blindness. There were 4,394 annual TBI cases without injury to the eye but with visual impairment. The total cost of treatment, benefits, and potential lost productivity is $2.4 billion annually; $1.9 billion is associated with TBI. $11.7 million is associated with replacing and retraining members of the military. CONCLUSIONS The cost of eye injury and vision dysfunction in the military is substantial. The cost of potential productivity loss associated with TBI makes up the largest proportion of total costs. Developing new standards to enhance eye safety and limit TBI could be cost-effective. Cost analyses such as this study should prove helpful in determining the economic return on investments to prevent, mitigate, treat, and rehabilitate visual system injury.
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Affiliation(s)
- Kevin D Frick
- Johns Hopkins Carey Business School, 100 International Drive, Baltimore, MD
| | - Eric L Singman
- Wilmer General Eye Services, Johns Hopkins Hospital, Wilmer B-29, 600 N. Wolfe St., Baltimore, MD
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Harper MM, Rudd D, Meyer KJ, Kanthasamy AG, Anantharam V, Pieper AA, Vázquez-Rosa E, Shin MK, Chaubey K, Koh Y, Evans LP, Bassuk AG, Anderson MG, Dutca L, Kudva IT, John M. Identification of chronic brain protein changes and protein targets of serum auto-antibodies after blast-mediated traumatic brain injury. Heliyon 2020; 6:e03374. [PMID: 32099918 PMCID: PMC7029173 DOI: 10.1016/j.heliyon.2020.e03374] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/19/2019] [Accepted: 02/03/2020] [Indexed: 12/13/2022] Open
Abstract
In addition to needing acute emergency management, blast-mediated traumatic brain injury (TBI) is also a chronic disorder with delayed-onset symptoms that manifest and progress over time. While the immediate consequences of acute blast injuries are readily apparent, chronic sequelae are harder to recognize. Indeed, the identification of individuals with mild-TBI or TBI-induced symptoms is greatly impaired in large part due to the lack of objective and robust biomarkers. The purpose of this study was to address these need by identifying candidates for serum-based biomarkers of blast TBI, and also to identify unique or differentially regulated protein expression in the thalamus in C57BL/6J mice exposed to blast using high throughput qualitative screens of protein expression. To identify thalamic proteins differentially or uniquely associated with blast exposure, we utilized an antibody-based affinity-capture strategy (referred to as "proteomics-based analysis of depletomes"; PAD) to deplete thalamic lysates from blast-treated mice of endogenous thalamic proteins also found in control mice. Analysis of this "depletome" detected 75 unique proteins, many with associations to the myelin sheath. To identify blast-associated proteins eliciting production of circulating autoantibodies, serum antibodies of blast-treated mice were immobilized, and their immunogens subsequently identified by proteomic analysis of proteins specifically captured following incubation with thalamic lysates (a variant of a strategy referred to as "proteomics-based expression library screening"; PELS). This analysis identified 46 blast-associated immunogenic proteins, including 6 shared in common with the PAD analysis (ALDOA, PHKB, HBA-A1, DPYSL2, SYN1, and CKB). These proteins and their autoantibodies are appropriate for further consideration as biomarkers of blast-mediated TBI.
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Affiliation(s)
- Matthew M. Harper
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
- The University of Iowa Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Danielle Rudd
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
| | - Kacie J. Meyer
- The University of Iowa Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA
| | | | | | - Andrew A. Pieper
- Harrington Discovery Institute, University Hospitals of Cleveland, Department of Psychiatry Case Western Reserve University, Geriatric Research Education and Clinical Centers, Louis Stokes VA Medical Center, Cleveland, OH 44106, USA
| | - Edwin Vázquez-Rosa
- Harrington Discovery Institute, University Hospitals of Cleveland, Department of Psychiatry Case Western Reserve University, Geriatric Research Education and Clinical Centers, Louis Stokes VA Medical Center, Cleveland, OH 44106, USA
| | - Min-Kyoo Shin
- Harrington Discovery Institute, University Hospitals of Cleveland, Department of Psychiatry Case Western Reserve University, Geriatric Research Education and Clinical Centers, Louis Stokes VA Medical Center, Cleveland, OH 44106, USA
| | - Kalyani Chaubey
- Harrington Discovery Institute, University Hospitals of Cleveland, Department of Psychiatry Case Western Reserve University, Geriatric Research Education and Clinical Centers, Louis Stokes VA Medical Center, Cleveland, OH 44106, USA
| | - Yeojung Koh
- Harrington Discovery Institute, University Hospitals of Cleveland, Department of Psychiatry Case Western Reserve University, Geriatric Research Education and Clinical Centers, Louis Stokes VA Medical Center, Cleveland, OH 44106, USA
| | - Lucy P. Evans
- The University of Iowa Department of Pediatrics, University of Iowa, Iowa City, IA, USA
- The University of Iowa Department of Neurology, University of Iowa, Iowa City, IA, USA
- The University of Iowa Department of Medical Scientist Training Program, University of Iowa, Iowa City, IA, USA
| | - Alexander G. Bassuk
- The University of Iowa Department of Pediatrics, University of Iowa, Iowa City, IA, USA
- The University of Iowa Department of Neurology, University of Iowa, Iowa City, IA, USA
| | - Michael G. Anderson
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
- The University of Iowa Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- The University of Iowa Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA
| | - Laura Dutca
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
| | - Indira T. Kudva
- Food Safety and Enteric Pathogens Research Unit, National Animal Disease Center, Agricultural Research Service, U.S. Department of Agriculture, Ames, IA, USA
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Stuart S, Parrington L, Martini D, Peterka R, Chesnutt J, King L. The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area. Front Sports Act Living 2020; 2:5. [PMID: 33345000 PMCID: PMC7739790 DOI: 10.3389/fspor.2020.00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/08/2020] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI), or concussion, occurs following a direct or indirect force to the head that causes a change in brain function. Many neurological signs and symptoms of mTBI can be subtle and transient, and some can persist beyond the usual recovery timeframe, such as balance, cognitive or sensory disturbance that may pre-dispose to further injury in the future. There is currently no accepted definition or diagnostic criteria for mTBI and therefore no single assessment has been developed or accepted as being able to identify those with an mTBI. Eye-movement assessment may be useful, as specific eye-movements and their metrics can be attributed to specific brain regions or functions, and eye-movement involves a multitude of brain regions. Recently, research has focused on quantitative eye-movement assessments using eye-tracking technology for diagnosis and monitoring symptoms of an mTBI. However, the approaches taken to objectively measure eye-movements varies with respect to instrumentation, protocols and recognition of factors that may influence results, such as cognitive function or basic visual function. This review aimed to examine previous work that has measured eye-movements within those with mTBI to inform the development of robust or standardized testing protocols. Medline/PubMed, CINAHL, PsychInfo and Scopus databases were searched. Twenty-two articles met inclusion/exclusion criteria and were reviewed, which examined saccades, smooth pursuits, fixations and nystagmus in mTBI compared to controls. Current methodologies for data collection, analysis and interpretation from eye-tracking technology in individuals following an mTBI are discussed. In brief, a wide range of eye-movement instruments and outcome measures were reported, but validity and reliability of devices and metrics were insufficiently reported across studies. Interpretation of outcomes was complicated by poor study reporting of demographics, mTBI-related features (e.g., time since injury), and few studies considered the influence that cognitive or visual functions may have on eye-movements. The reviewed evidence suggests that eye-movements are impaired in mTBI, but future research is required to accurately and robustly establish findings. Standardization and reporting of eye-movement instruments, data collection procedures, processing algorithms and analysis methods are required. Recommendations also include comprehensive reporting of demographics, mTBI-related features, and confounding variables.
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Affiliation(s)
- Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Douglas Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Robert Peterka
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - James Chesnutt
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
- Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, United States
| | - Laurie King
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
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Yoo PY, Scott K, Myszak F, Mamann S, Labelle A, Holmes M, Guindon A, Bussieres AE. Interventions Addressing Vision, Visual-perceptual Impairments Following Acquired Brain Injury: A Cross-sectional Survey. The Canadian Journal of Occupational Therapy 2020; 87:117-126. [PMID: 31896281 DOI: 10.1177/0008417419892393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. The existing literature on the effectiveness of interventions targeting vision, visual-perceptual impairments following acquired brain injury (ABI) is scarce and unlinked to occupational performance. PURPOSE. To explore current occupational therapy practice in vision-rehabilitation among adults with ABI in Canada, and to determine the evidence-practice gaps. METHODS. An online survey was made available through the Canadian Association of Occupational Therapists (CAOT) website, and disseminated to seven public healthcare institutions in Quebec. The survey collected respondent demographic information, and the types and frequency of treatments delivered. Descriptive statistics were conducted to determine interventions' frequency. Participant comments were collected and grouped into recurring themes. FINDINGS. Over half (55%) of respondents regularly use evidence-based interventions when addressing visual acuity (VA) and visual field (VF) deficits, but only very few (3%) use it when dealing with oculomotor function and visual stress impairments. IMPLICATIONS. Results gave a glimpse of interventions used and suggested the need for further research in vision rehabilitation.
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Harper MM, Hedberg-Buenz A, Herlein J, Abrahamson EE, Anderson MG, Kuehn MH, Kardon RH, Poolman P, Ikonomovic MD. Blast-Mediated Traumatic Brain Injury Exacerbates Retinal Damage and Amyloidosis in the APPswePSENd19e Mouse Model of Alzheimer's Disease. Invest Ophthalmol Vis Sci 2019; 60:2716-2725. [PMID: 31247112 PMCID: PMC6735799 DOI: 10.1167/iovs.18-26353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Traumatic brain injury (TBI) is a risk factor for developing chronic neurodegenerative conditions including Alzheimer's disease (AD). The purpose of this study was to examine chronic effects of blast TBI on retinal ganglion cells (RGC), optic nerve, and brain amyloid load in a mouse model of AD amyloidosis. Methods Transgenic (TG) double-mutant APPswePSENd19e (APP/PS1) mice and nontransgenic (Non-TG) littermates were exposed to a single blast TBI (20 psi) at age 2 to 3 months. RGC cell structure and function was evaluated 2 months later (average age at endpoint = 4.5 months) using pattern electroretinogram (PERG), optical coherence tomography (OCT), and the chromatic pupil light reflex (cPLR), followed by histologic analysis of retina, optic nerve, and brain amyloid pathology. Results APP/PS1 mice exposed to blast TBI (TG-Blast) had significantly lower PERG and cPLR responses 2 months after injury compared to preblast values and compared to sham groups of APP/PS1 (TG-Sham) and nontransgenic (Non-TG-Sham) mice as well as nontransgenic blast-exposed mice (Non-TG-Blast). The TG-Blast group also had significantly thinner RGC complex and more optic nerve damage compared to all groups. No amyloid-β (Aβ) deposits were detected in retinas of APP/PS1 mice; however, increased amyloid precursor protein (APP)/Aβ-immunoreactivity was seen in TG-Blast compared to TG-Sham mice, particularly near blood vessels. TG-Blast and TG-Sham groups exhibited high variability in pathology severity, with a strong, but not statistically significant, trend for greater cerebral cortical Aβ plaque load in the TG-Blast compared to TG-Sham group. Conclusions When combined with a genetic susceptibility for developing amyloidosis of AD, blast TBI exposure leads to earlier RGC and optic nerve damage associated with modest but detectable increase in cerebral cortical Aβ pathology. These findings suggest that genetic risk factors for AD may increase the sensitivity of the retina to blast-mediated damage.
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Affiliation(s)
- Matthew M Harper
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Adam Hedberg-Buenz
- The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Molecular Physiology and Biophysics, The University of Iowa, Iowa City, Iowa, United States
| | - Judith Herlein
- The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Eric E Abrahamson
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.,Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, Pennsylvania, United States
| | - Michael G Anderson
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Molecular Physiology and Biophysics, The University of Iowa, Iowa City, Iowa, United States
| | - Markus H Kuehn
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Randy H Kardon
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Pieter Poolman
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Milos D Ikonomovic
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.,Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, Pennsylvania, United States.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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Miller NR, Justin GA, Kim WI, Brooks DI, Ryan DS, Weichel ED, Colyer MH. Hyphema in Open-Globe Versus Closed-Globe Injuries in Operation Iraqi Freedom and Enduring Freedom: 2001–2011. Mil Med 2019; 185:e768-e773. [DOI: 10.1093/milmed/usz405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/24/2019] [Accepted: 08/03/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The goal of this study is to update the incidence of hyphema in Operation Iraqi (OIF) and Enduring Freedom (OEF). We wanted to assess associated ocular injuries and final visual acuity (VA) in open-globe versus closed-globe injuries with a hyphema.
Materials and Methods
We performed a retrospective review of the Walter Reed Ocular Trauma Database (WRTOD) to identify U.S. Service members and DoD civilians with hyphema who were evacuated to Walter Reed Army Medical Center between 2001 and 2011. Primary outcome measures were the final VA and differences in concomitant ocular injuries in open-globe hyphema and closed-globe hyphema.
Results
168 of 890 eyes (18.9%) in the WROTD had a hyphema. Closed-globe injuries were noted in 64 (38.1%) eyes and open-globe injuries in 104 (61.9%) eyes. A final VA of less than 20/200 was noted in 88 eyes (51.8%). Eyes with hyphema were more likely to have traumatic cataract formation (odds ratio (OR) 6.2, 95% confidence interval (CI) 4.2–9.2, P < 0.001), retinal detachment (OR 4.2, CI 2.8–6.4, P < 0.001), angle recession (OR 8.1, CI 2.9–24.3, P < 0.001), and final VA of less than 20/200 (OR 3.7, CI 2.6–5.4, P < 0.001). Traumatic cataract formation (OR 7.4, CI 2.9–18.7, P < 0.001), retinal detachment (OR 6.1, CI 2.1–17.5, P < 0.001), and a final VA less than 20/200 (OR 6.1, CI 2.4–15.4 P < 0.001) were statistically more likely to occur with an open-globe hyphema than with a closed-globe hyphema.
Conclusions
Close follow-up in patients with hyphema is important due to the associated development of traumatic cataract and retinal detachment and poor final visual outcome.
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Affiliation(s)
- Natalie R Miller
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431
| | - Grant A Justin
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
- Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, 4301 Jones Bridge Rd, Bethesda, MD 20814
| | - Won I Kim
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Wisconsin Ave, Bethesda, MD 20814
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, Virginia, 9300 DeWitt Loop, Fort Belvoir, VA 22060
| | - Eric D Weichel
- Retina Group of Washington D.C., Greenbelt, 7501 Greenway Center Dr #300, Greenbelt, MD 20770
| | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, 4301 Jones Bridge Rd, Bethesda, MD 20814
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Wisconsin Ave, Bethesda, MD 20814
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Das M, Tang X, Mohapatra SS, Mohapatra S. Vision impairment after traumatic brain injury: present knowledge and future directions. Rev Neurosci 2019; 30:305-315. [PMID: 30226209 DOI: 10.1515/revneuro-2018-0015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/15/2018] [Indexed: 01/23/2023]
Abstract
Traumatic brain injury (TBI) is a major cause of mortality and morbidity in the USA as well as in the world. As a result of TBI, the visual system is also affected often causing complete or partial visual loss, which in turn affects the quality of life. It may also lead to ocular motor dysfunction, defective accommodation, and impaired visual perception. As a part of the therapeutic strategy, early rehabilitative optometric intervention is important. Orthoptic therapy, medication, stem cell therapy, motor and attention trainings are the available treatment options. Gene therapy is one of the most promising emerging strategies. Use of state-of-the-art nanomedicine approaches to deliver drug(s) and/or gene(s) might enhance the therapeutic efficacy of the present and future modalities. More research is needed in these fields to improve the outcome of this debilitating condition. This review focuses on different visual pathologies caused by TBI, advances in pre-clinical and clinical research, and available treatment options.
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Affiliation(s)
- Mahasweta Das
- James A. Haley Veterans Administration Hospital, Tampa, FL 33612, USA.,Department of Molecular Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Xiaolan Tang
- James A. Haley Veterans Administration Hospital, Tampa, FL 33612, USA.,Department of Molecular Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Shyam S Mohapatra
- James A. Haley Veterans Administration Hospital, Tampa, FL 33612, USA.,Department of Internal Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Subhra Mohapatra
- James A. Haley Veterans Administration Hospital, Tampa, FL 33612, USA.,Department of Molecular Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
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41
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Olczak M, Poniatowski ŁA, Niderla-Bielińska J, Kwiatkowska M, Chutorański D, Tarka S, Wierzba-Bobrowicz T. Concentration of microtubule associated protein tau (MAPT) in urine and saliva as a potential biomarker of traumatic brain injury in relationship with blood–brain barrier disruption in postmortem examination. Forensic Sci Int 2019; 301:28-36. [DOI: 10.1016/j.forsciint.2019.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/23/2019] [Accepted: 05/03/2019] [Indexed: 02/06/2023]
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Rucker JC, Buettner-Ennever JA, Straumann D, Cohen B. Case Studies in Neuroscience: Instability of the visual near triad in traumatic brain injury-evidence for a putative convergence integrator. J Neurophysiol 2019; 122:1254-1263. [PMID: 31339793 DOI: 10.1152/jn.00861.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Deficits of convergence and accommodation are common following traumatic brain injury, including mild traumatic brain injury, although the mechanism and localization of these deficits have been unclear and supranuclear control of the near-vision response has been incompletely understood. We describe a patient who developed profound instability of the near-vision response with inability to maintain convergence and accommodation following mild traumatic brain injury, who was identified to have a structural lesion on brain MRI in the pulvinar of the caudal thalamus, the pretectum, and the rostral superior colliculus. We discuss the potential relationship between posttraumatic clinical near-vision response deficits and the MRI lesion in this patient. We further propose that the MRI lesion location, specifically the rostral superior colliculus, participates in neural integration for convergence holding, given its proven anatomic connections with the central mesencephalic reticular formation and C-group medial rectus motoneurons in the oculomotor nucleus, which project to extraocular muscle nontwitch fibers specialized for fatigue-resistant, slow, tonic activity such as vergence holding.NEW & NOTEWORTHY Supranuclear control of the near-vision response has been incompletely understood to date. We propose, based on clinical and anatomic evidence, functional pathways for vergence that participate in the generation of the near triad, "slow vergence," and vergence holding.
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Affiliation(s)
- Janet C Rucker
- Departments of Neurology and Ophthalmology, New York University School of Medicine, New York, New York
| | | | - Dominik Straumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Swiss Concussion Center, Zurich, Switzerland
| | - Bernard Cohen
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
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43
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Chan JW, Hills NK, Bakall B, Fernandez B. Indirect Traumatic Optic Neuropathy in Mild Chronic Traumatic Brain Injury. ACTA ACUST UNITED AC 2019; 60:2005-2011. [DOI: 10.1167/iovs.18-26094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jane W. Chan
- Department of Ophthalmology, University of Arizona College of Medicine, Phoenix, Arizona, United States
- Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, United States
| | - Nancy K. Hills
- Department of Neurology, University of California, San Francisco, School of Medicine, San Francisco, California, United States
| | - Benjamin Bakall
- Department of Ophthalmology, University of Arizona College of Medicine, Phoenix, Arizona, United States
- Associated Retinal Consultants, Phoenix, Arizona, United States
| | - Brian Fernandez
- Heidelberg Engineering, Inc., Franklin, Massachusetts, United States
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44
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Gupta R, Saha P, Sen T, Sen N. An augmentation in histone dimethylation at lysine nine residues elicits vision impairment following traumatic brain injury. Free Radic Biol Med 2019; 134:630-643. [PMID: 30790655 PMCID: PMC6588499 DOI: 10.1016/j.freeradbiomed.2019.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/16/2019] [Accepted: 02/13/2019] [Indexed: 12/26/2022]
Abstract
Traumatic Brain Injury (TBI) affects more than 1.7 million Americans each year and about 30% of TBI-patients having visual impairments. The loss of retinal ganglion cells (RGC) in the retina and axonal degeneration in the optic nerve have been attributed to vision impairment following TBI; however, the molecular mechanism has not been elucidated. Here we have shown that an increase in histone di-methylation at lysine 9 residue (H3K9Me2), synthesized by the catalytic activity of a histone methyltransferase, G9a is responsible for RGC loss and axonal degeneration in the optic nerve following TBI. To elucidate the molecular mechanism, we found that an increase in H3K9Me2 results in the induction of oxidative stress both in the RGC and optic nerve by decreasing the mRNA level of antioxidants such as Superoxide dismutase (sod) and catalase through impairing the transcriptional activity of Nuclear factor E2-related factor 2 (Nrf2) via direct interaction. The induction of oxidative stress is associated with death in RGC and oligodendrocyte precursor cells (OPCs). The death in OPCs is correlated with a reduction in myelination, and the expression of myelin binding protein (MBP) in association with degeneration of neurofilaments in the optic nerve. This event allied to an impairment of the retrograde transport of axons and loss of nerve fiber layer in the optic nerve following TBI. An administration of G9a inhibitor, UNC0638 attenuates the induction of H3K9Me2 both in RGC and optic nerve and subsequently activates Nrf2 to reduce oxidative stress. This event was concomitant with the rescue in the loss of retinal thickness, attenuation in optic nerve degeneration and improvement in the retrograde transport of axons following TBI.
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Affiliation(s)
- Rajaneesh Gupta
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Scaife Hall, Pittsburgh, 15213, USA
| | - Pampa Saha
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Scaife Hall, Pittsburgh, 15213, USA
| | - Tanusree Sen
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Scaife Hall, Pittsburgh, 15213, USA
| | - Nilkantha Sen
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Scaife Hall, Pittsburgh, 15213, USA.
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45
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Guley NM, Del Mar NA, Ragsdale T, Li C, Perry AM, Moore BM, Honig MG, Reiner A. Amelioration of visual deficits and visual system pathology after mild TBI with the cannabinoid type-2 receptor inverse agonist SMM-189. Exp Eye Res 2019; 182:109-124. [PMID: 30922891 DOI: 10.1016/j.exer.2019.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 12/20/2022]
Abstract
Mild TBI is often accompanied by visual system dysfunction and injury, which is at least partly caused by microglial neuroinflammatory processes initiated by the injury. Using our focal cranial blast mouse model of closed-skull mild TBI, we evaluated the ability of the cannabinoid type-2 (CB2) receptor inverse agonist SMM-189, which biases microglia from the harmful M1 state to the beneficial M2 state, to mitigate visual system dysfunction and injury after TBI. Male C57BL/6 or Thy1-EYFP reporter mice received a closed-head blast of either 0-psi (sham) or 50-psi to the left side of the cranium. Blast mice received vehicle or 6 mg/kg SMM-189 daily beginning 2 h after blast. Sham mice received vehicle. In some mice, retina and optic nerve/tract were assessed morphologically at 3-7 days after blast, while other mice were assessed functionally by Optomotry 30 days after blast and morphologically at ≥30 days after blast. Mice sacrificed at 3-7 days were treated daily until sacrificed, while those assessed ≥30 days after blast were treated daily for 2 weeks post blast. Axon damage was evident in the left optic nerve and its continuation as the right optic tract at 3 days post blast in vehicle-treated blast mice in the form of swollen axon bulbs, and was accompanied by a significant increase in the abundance of microglia. Testing at 30 days post blast revealed that the contrast sensitivity function was significantly reduced in both eyes in vehicle-treated blast mice compared to vehicle-treated sham blast mice, and axon counts at ≥30 days after blast revealed a ∼10% loss in left optic nerve in vehicle-treated blast mice. Left optic nerve axon loss was highly correlated with the left eye deficit in contrast sensitivity. Immunolabeling at 30 days post blast showed a significant increase in the abundance of microglia in the retinas of both eyes and in GFAP + Müller cell processes traversing the inner plexiform layer in the left eye of vehicle-treated blast mice. SMM-189 treatment reduced axon injury and microglial abundance at 3 days, and mitigated axon loss, contrast sensitivity deficits, microglial abundance, and Müller cell GFAP upregulation at ≥30 days after blast injury. Analysis of right optic tract microglia at 3 days post blast for M1 versus M2 markers revealed that SMM-189 biased microglia toward the M2 state, with this action of SMM-189 being linked to reduced axonal injury. Taken together, our results show that focal left side cranial blast resulted in impaired contrast sensitivity and retinal pathology bilaterally and optic nerve loss ipsilaterally. The novel cannabinoid drug SMM-189 significantly mitigated the functional deficit and the associated pathologies. Our findings suggest the value of combatting visual system injury after TBI by using CB2 inverse agonists such as SMM-189, which appear to target microglia and bias them away from the pro-inflammatory M1 state, toward the protective M2 state.
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Affiliation(s)
- Natalie M Guley
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Nobel A Del Mar
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Tyler Ragsdale
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Chunyan Li
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Aaron M Perry
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Bob M Moore
- Dept. of Pharmaceutical Sciences, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Marcia G Honig
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Anton Reiner
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN 38163, United States; Department of Ophthalmology, The University of Tennessee Health Science Center, Memphis, TN 38163, United States.
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46
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Vest V, Bernardo-Colón A, Watkins D, Kim B, Rex TS. Rapid Repeat Exposure to Subthreshold Trauma Causes Synergistic Axonal Damage and Functional Deficits in the Visual Pathway in a Mouse Model. J Neurotrauma 2019; 36:1646-1654. [PMID: 30451083 DOI: 10.1089/neu.2018.6046] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We examined the effect of repeat exposure to a non-damaging insult on central nervous system axons using the optic projection as a model. The optic projection is attractive because its axons are spatially separated from the cell bodies, it is easily accessible, it is composed of long axons, and its function can be measured. We performed closed-system ocular neurotrauma in C57Bl/6 mice using bursts of 15 or 26-psi (pounds per square inch) overpressure air that caused no gross damage. We quantified the visual evoked potential (VEP) and total and degenerative axons in the optic nerve. Repeat exposure to a 15-psi air blast caused more axon damage and vision loss than a single exposure to a 26-psi air blast. However, an increased VEP latency was detected in both groups. Exposure to three 15-psi air blasts separated by 0.5 sec caused 15% axon degeneration at 2 weeks. In contrast, no axon degeneration above sham levels was detected when the interinjury interval was increased to 10 min. Exposure to 15-psi air blasts once a day for 6 consecutive days caused 3% axon degeneration. Therefore, repeat mild trauma within an interinjury interval of 1 min or less causes synergistic axon damage, whereas mild trauma repeated at a longer interinjury interval causes additive, cumulative damage. The synergistic damage may underlie the high incidence of traumatic brain injury and traumatic optic neuropathy in blast-injured service members given that explosive blasts are multiple injury events that occur in a very short time span. This study also supports the use of the VEP as a biomarker for traumatic optic neuropathy.
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Affiliation(s)
- Victoria Vest
- 1 Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Dexter Watkins
- 3 Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Bohan Kim
- 2 Department of Ophthalmology & Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Tonia S Rex
- 1 Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee.,2 Department of Ophthalmology & Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
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47
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Iskow C. From War Injured to the Elderly, Brain Injuries Are on the Rise for Vision Rehabilitation Practitioners. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x1010401005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Cyndy Iskow
- Polytrauma BROS, Office 1B-141A, Richmond VA Medical Center, 1201 Broad Rock Boulevard, Stop 171, Richmond, VA 23249
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48
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Abstract
The wars in Afghanistan and Iraq have been notable for the high rates of traumatic brain injury (TBI) that have been incurred by the troops. Visual impairments often occur following TBI and present new challenges for rehabilitation. We describe a neurological vision rehabilitation therapy that addresses the unique needs of patients with vision loss that is due to TBI.
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49
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Wang S, Hu L, Cao J, Huang W, Sun C, Zheng D, Wang Z, Gan S, Niu X, Gu C, Bai G, Ye L, Zhang D, Zhang N, Yin B, Zhang M, Bai L. Sex Differences in Abnormal Intrinsic Functional Connectivity After Acute Mild Traumatic Brain Injury. Front Neural Circuits 2018; 12:107. [PMID: 30555304 PMCID: PMC6282647 DOI: 10.3389/fncir.2018.00107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/13/2018] [Indexed: 01/12/2023] Open
Abstract
Mild traumatic brain injury (TBI) is considered to induce abnormal intrinsic functional connectivity within resting-state networks (RSNs). The objective of this study was to estimate the role of sex in intrinsic functional connectivity after acute mild TBI. We recruited a cohort of 54 patients (27 males and 27 females with mild TBI within 7 days post-injury) from the emergency department (ED) and 34 age-, education-matched healthy controls (HCs; 17 males and 17 females). On the clinical scales, there were no statistically significant differences between males and females in either control group or mild TBI group. To detect whether there was abnormal sex difference on functional connectivity in RSNs, we performed independent component analysis (ICA) and a dual regression approach to investigate the between-subject voxel-wise comparisons of functional connectivity within seven selected RSNs. Compared to female patients, male patients showed increased intrinsic functional connectivity in motor network, ventral stream network, executive function network, cerebellum network and decreased connectivity in visual network. Further analysis demonstrated a positive correlation between the functional connectivity in executive function network and insomnia severity index (ISI) scores in male patients (r = 0.515, P = 0.006). The abnormality of the functional connectivity of RSNs in acute mild TBI showed the possibility of brain recombination after trauma, mainly concerning male-specific.
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Affiliation(s)
- Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Liuxun Hu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jieli Cao
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Wenmin Huang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Chuanzhu Sun
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Dongdong Zheng
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhuonan Wang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuoqiu Gan
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.,Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuan Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chenghui Gu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Limei Ye
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Danbin Zhang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nu Zhang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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50
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Bhatnagar S, Anderson M, Chu M, Kuo D, Azuh O. Rehabilitation Assessment and Management of Neurosensory Deficits After Traumatic Brain Injury in the Polytrauma Veteran. Phys Med Rehabil Clin N Am 2018; 30:155-170. [PMID: 30470419 DOI: 10.1016/j.pmr.2018.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Neurosensory deficits after traumatic brain injury can frequently lead to disability; therefore, diagnosis and treatment are important. Posttraumatic headaches typically resemble migraines and are managed similarly, but adjuvant physical therapy may be beneficial. Sleep-related issues are treated pharmacologically based on the specific sleep-related complaint. Fatigue is difficult to treat; cognitive behavioral therapy and aquatic therapy can be beneficial. Additionally, methylphenidate and modafinil have been used. Peripheral and central vestibular dysfunction causes dizziness and balance dysfunction, and the mainstay of treatment is vestibular physical therapy. Visual dysfunction incorporates numerous different diagnoses, which are frequently treated with specific rehabilitation programs.
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Affiliation(s)
- Saurabha Bhatnagar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA 02025, USA.
| | - Meredith Anderson
- Department of Physical Medicine and Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Michael Chu
- Department of Physical Medicine and Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Daniel Kuo
- Department of Physical Medicine and Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Ogo Azuh
- Department of Physical Medicine and Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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