TBI and Hidden Vision Problems

Full Article at: Some Veterans Return With 'Hidden' Vision Problems

by Amy Standen, National Public Radio
November 11, 2010

Staff Sgt. Jay Wilkerson says, looking back, he thinks he knows what mistake his convoy of Humvees made more than four years ago: They were heading from Habbaniyah, Iraq, back to Baghdad -- but they were moving along the same route they'd come in on. Insurgents knew exactly where to plant a powerful roadside bomb. Wilkerson's Humvee took the hit.

"I remember everything just went black," he says. "I was talking, and then all of a sudden, I heard the vehicle exploding. And I heard the people in the truck screaming at the same time."

Wilkerson was in a coma for 12 days. He had severed two fingers, and the left side of his face was blown open. He couldn't walk for months. Given the extent of his injuries, it's easy to see why doctors -- and even Wilkerson himself -- failed to realize that something else was wrong. It had to do with the way Jay Wilkerson sees.

To demonstrate, Wilkerson holds up his left hand, as if he were taking an oath in a courtroom. "If it's right here, I couldn't see it," he says. "And that's true today. If it's right here, I can't see it."

He has a hemianopsia. It's a problem not of the eyes, but of the brain. In Jay's case, his brain doesn't recognize signals from either of his eyes' left visual fields.

Undetected By Routine Tests

"Often people don't realize they have the problem," says Greg Goodrich, a vision researcher at the VA Medical Center in Palo Alto.

In 2003, Goodrich and another doctor started noticing something surprising in the young vets they were treating. According to their charts, these men and women could see just fine. Goodrich says many of them had full 20/20 vision. And yet, he says, "they had this huge hemianopsia. Half their visual world was gone. And the most common visual tests used didn't catch it."

Glenn Cockerham, chief of ophthalmology at the VA Palo Alto, says he and others took to calling these "occult" injuries, because of the way they seemed to escape detection."