History

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.

The Vision Center of Excellence, and accompanying Military Eye Injury Registry, were included as provisions in the Military Eye Trauma Treatment Act and included in the fiscal year 2008 National Defense Authorization Act, which passed in late January 2008, but was not funded at that time.

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.

Leadership

Executive Director Colonel Donald A. Gagliano, M.D. is a medical doctor, retinal ophthalmologist, and a Fellow of the American College of Health Care Executives. Dr. Gagliano has most recently served as Director of the Clinical Investigations Regulatory Office in the Army Medical Research and Materiel Command. He has led soldiers at every level of command, including the 30th Medical Brigade in Iraq from February 2003 until February 2004. He simultaneously served as the CJTF-7 Surgeon with responsibility for planning, integrating, and executing coalition combat health support in Iraq during the first year of the war. The 30th Medical Brigade was awarded the Meritorious Unit Citation for exemplary performance during Dr. Gagliano’s command.

Deputy Director Dr. Mary Lawrence, M.D.

Executive Officer MAJ Derek E. Johnson

Department of Defense/Veterans Affairs Responsibilities

The Executive Director of the VCE, a commissioned officer in the U.S. Army, is responsible for day-to-day operations. He is assisted by a Deputy Executive Director and Chief of Staff, both of whom are VA civilian employees, and an Executive Officer, a U.S. Army Major. Additional staff, including a Research Optometrist, Blind Rehabilitation Specialist, Biostatistician, and Administrative Assistant, will be transferred from the VA.

A Memorandum of Understanding has been developed between DoD and the VA to facilitate the integration process for the operational management of the VCE.

An additional level of care will be provided by Visual Impairment Services Teams (VIST). Staffed by local teams of medical professionals in locations across the country, VISTs will ensure that severely disabled visually impaired Veterans are identified, evaluated, and provided services to maximize their adjustment to sight loss. Veterans will receive lifetime case management at a local VA medical center, and VISTs will liaison with DoD Military Treatment Facilities for service members receiving care and treatment.

Defense and Veterans Eye Injury and Vision Registry (DVEIVR)

The Defense and Veterans Eye Injury and Vision Registry (DVEIVR) is the first joint registry shared by the departments of Defense (DoD) and Veterans Affairs (VA). It will track the diagnosis, surgical intervention, operative procedures, related treatments and follow-up of each significant eye injury incurred by members of the Armed Forces while serving on active duty. When fully functional, the DVEIVR will provide the capability for analyzing longitudinal outcomes, assessing intervention strategies, enhancing performance improvement, and developing a common user/provider interface across the DoD and VA to enhance data integrity, improve coding accuracy, and improve work flow processes for vision care. Data from the DoD’s Combat Eye Injury Module, as well as from VA records relating to traumatic brain injury (TBI) will be imported into the DVEIVR.

Successes to Date

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.

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 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.

Looking Ahead

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.
• 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.