Jack W. Smith, M.D., M.M.M.

Mr. Chairman, Members of the Committee, thank you for the opportunity to discuss with you the Department of Defense (DoD) and Department of Veterans Affairs (VA) Vision Center of Excellence (VCE) current initiatives and way forward. Vision complications, such as loss of vision and blindness, are the "silent epidemic" of Operation Iraq Freedom and Operation Enduring Freedom, but there are also typical eye injuries and diseases affecting our soldiers and Veterans that must be addressed.

DoD’s primary focus is to provide expert services to our Service members, our Veterans and their families in all areas of vision care (prevention, diagnosis, mitigation, treatment, rehabilitation and research).  Developing and implementing innovative ways of managing eye injuries is crucial.  The Department is committed to improving the quality of care for our wounded warriors, who deserve the very best for the sacrifices they have made for our Nation.  We are pleased to be here to talk about this significant initiative.

Establish a Vision Center of Excellence

Due to the increase in vision injuries and diseases sustained by the men and women of our Armed Services, Congress directed that the Department establish a Vision Center of Excellence to ensure the full spectrum of care is fully supported.  It is our duty to protect our Service members and assist them with all their medical needs, including vision.

There is much to accomplish, establish, implement, and set in motion in order to achieve the goals and objectives of the VCE. I want to share with you some of the VCE accomplishments to date.

The Department envisions that the VCE’s permanent headquarters will be integrated with the vision capabilities in the National Capital Region.  The current goal is to secure long- term space in the same area as the Eye Clinic (Ophthalmology and Optometry) in the new Walter Reed National Military Medical Center.  This will allow for synergies between vision care providers and patients in the National Capital Area, and will benefit from proximity to the new National Intrepid Center of Excellence building and to the National Eye Institute.

VA and DoD have developed a process for collaboration at Walter Reed Army Medical Center (WRAMC) for blind rehabilitation care while Service members are still receiving DoD care.  This effort will enhance the continuum of care and better integrate a continuum of care across the DoD and VA for vision rehabilitation. The next steps are:

• Finalize a Memorandum of Understanding (MOU) for collaboration at WRAMC for blind rehabilitation care while Service members are still receiving DoD care; and
• Establish approval for privileging rehabilitation care providers in DoD facilities.

To enhance continuity of care between DoD and VA vision centers, we have worked together to define common vision care data exchange protocols for the DoD Bilateral Health Information Exchange developers.  We also plan to develop a training program for the use of the DoD/VA Bilateral Health Information Exchange to continue the collaboration effort to support optimal DoD/VA transitional vision care.  We will continue to do this since health information exchange is key to successful collaboration.

We have established priorities for vision research based on identified requirements by working with the Congressional Special Interest Vision Research Administrators and the Congressionally-Directed Medical Research Program (CDMRP).  We plan to host a meeting with vision research entities to establish priorities for vision research through the Congressional Special Interest Vision Research Administrators and CDMRP.

The VCE involves the coordinated effort of the DoD, VA, institutions of higher education and various commercial, academic and non-profit entities.  The VCE will have the opportunity to transform the way we provide vision care through these collaboration efforts. We plan to:

• Promote affiliation with research institutes, including the National Eye Institute, FDA, and other academic institutions; and
• Develop an eye trauma training center affiliated with an academic institution with a high volume of trauma patients to enhance the readiness of the vision care teams.

Implement the Defense and Veterans Eye Injury Registry

Currently, we do not have an optimal mechanism to capture long-term data for eye injuries and diseases that are affecting our Service members returning from theater and our Veterans undergoing long-term care.  This registry will support care coordination for Service members and Veterans with significant eye injuries, provide data necessary to measure longitudinal outcomes, and provide statistical and accurate data requested by Congress and Veterans Service Organizations. 

VA and DoD developed a Defense and Veterans Eye Injury Registry Concept of Operations (CONOPS).  Included in this CONOPS is the development of an eye trauma module that will be incorporated into the Joint Trauma Tracking Registry (JTTR).  The next step is to begin populating the Defense and Veterans Eye Injury Registry by late 2009.

The Defense and Veterans Eye Injury Registry will drive innovation forward.  It will provide those with eye injuries, diseases and those with visual loss associated with Traumatic Brain Injury (TBI) many opportunities as it will allow for sharing studies outcomes, establishing best practices and clinical guidelines.

Conclusion

The VCE is designed to improve the care of American military personnel and Veterans affected by combat eye trauma, to bring back those suffering from vision loss, injuries and vision anomalies to a fully functional capability, and to create a Joint Defense and Veterans Eye Injury Registry that will drive research and innovation in vision care.  We are working diligently to ensure the VCE becomes the leader in vision care as we understand how important this mission is for our Service members and Veterans.

We are grateful to the members of the House Veterans’ Affairs Committee for your efforts to assist our soldiers. We have come a long way, but now our work intensifies.

Thank you for your time and the opportunity to update you on the VCE.  We look forward to answering your questions.