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Deployed ophthalmic workload in support of US and NATO operations in Afghanistan
  1. Richard J Blanch1,2,3,
  2. M T Kerber4 and
  3. W G Gensheimer5
  1. 1 Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
  2. 2 Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
  3. 3 Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  4. 4 United States Air Force Academy, Colorado Springs, Colorado, USA
  5. 5 Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, Maryland, USA
  1. Correspondence to Richard J Blanch, Neurotrauma and Neurodegeneration Section, University of Birmingham, Birmingham B15 2TT, UK; blanchrj{at}


Purpose The extent and types of ophthalmic disease and non-battle injury (DNBI) seen by expeditionary ophthalmologists at deployed military medical treatment facilities have not previously been reported. We aim to characterise the extent and type of ophthalmic pathology including DNBI at a US military medical treatment facility in Afghanistan.

Methods We conducted a retrospective non-interventional cohort study of all patients seen by ophthalmologists at Craig Joint Theater Hospital at Bagram Airfield (BAF), Afghanistan, between 1 October 2018 and 31 August 2019.

Results There were 281 patients seen in 540 separate encounters, of which 146 patients seen were active duty military stationed at BAF with DNBI, of a population at risk of 6000 personnel. Diagnoses managed included open and closed globe injury, bacterial and herpetic keratitis and retinal detachment, with the most common being dry eye, corneal abrasion/foreign body, blepharitis, chalazion and uveitis. Thirteen patients (5%) required aeromedical evacuation out of theatre and 39 patients were aeromedically transferred within theatre for assessment. Expert consensus estimated that 89 patients (36%) would be likely to require aeromedical evacuation out of theatre without ophthalmic input.

Conclusions The rate of ophthalmic DNBI among deployed US, UK and coalition forces at BAF was 2.65% per year, of whom 97% were returned to duty (95% of all patients). We estimate that evacuation and loss to unit would increase from 5% to 36% without an ophthalmologist present. The low number of within-theatre aeromedical transfers suggests that the local presence of an ophthalmologist at a patient’s deployed medical treatment facility affects access to deployed ophthalmic care.

  • ophthalmology
  • epidemiology
  • clinical governance
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  • Contributors All authors collected the data and reviewed and edited the final version of the manuscript. RJB and WGG conceived, obtained approvals and ran the study. RJB wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This project was approved as a performance improvement initiative by the US Central Command (CENTCOM) command surgeon. It was reviewed by the US Army Medical Research and Development Command’s Office of Research Protections, Institutional Review Board Office, and given a Not Research Determination.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The data are clinical data and it would not be appropriate to share it, nor do we have permission to do so.

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