Department of Defense/Veterans Affairs Vision Center of Excellence, DHA Research and Engineering Directorate, Walter Reed National Military Medical Center, Bethesda, MD 20889-5629, USA.
Department of Mathematics and Statistics, University of Maryland-Baltimore County, Baltimore, MD 21250, USA.
Mil Med. 2024 Aug 19;189(Suppl 3):736-742. doi: 10.1093/milmed/usae251.
Photophobia is a common visual symptom following mild traumatic brain injury (mTBI), which can adversely affect the military readiness and performance of service members (SMs). We employed the Defense and Veterans Eye Injury and Vision Registry (DVEIVR) to identify and describe a cohort of SMs diagnosed with photophobia post-mTBI. The objective of this study was to characterize comorbid conditions and symptoms in an mTBI cohort with photophobia, to assess their co-occurrence, to describe the persistence of photophobia, and to assess the effectiveness of utilization of currently available International Statistical Classification of Diseases and Related Health Problems (ICD) codes in reporting photophobia in this cohort.
The DVEIVR database was searched to identify a cohort of SMs experiencing photophobia after mTBI. Photophobia and other potentially related conditions and symptoms, both coded and descriptive, which were abstracted directly from the medical records of SMs, were found within DVEIVR. The presence of the conditions and symptoms comorbid with photophobia was characterized on both patient and encounter levels. Analysis of co-occurrence of photophobia with these conditions or symptoms was performed on the encounter level using co-occur package in the statistical program R. Persistence of photophobia up to 1 year since the injury was assessed. The utilization of currently available ICD codes for photophobia was analyzed.
A total of 639 SMs exhibiting photophobia after mTBI were identified in DVEIVR. Headaches, including migraines, were the most frequently experienced comorbidity affecting 92% of the SMs in the cohort. The second most frequent complaint was dizziness and/or vertigo (53%) followed by nausea (42%), blurry vision (31%), and irritation and discomfort in the eye (17%). In all, 20% of encounters with photophobia had a complaint of headaches, followed by 8.3% of photophobia encounters co-occurring with dizziness and vertigo, 5.7%-with nausea, 4.5%-with blurred vision, and 2.1%-with subjective sensations in the eye. All comorbidities co-occurred with photophobia at probabilities higher than by chance alone. The percentage of mTBI SMs experiencing photophobia declined to 20% at 30 days after the injury, 17% at 3 months, 12% at 6 months, and 7% at 12 months post-injury, respectively. The use of currently available ICD codes for photophobia was very low-only 27.1% of the cohort had at least 1 ICD code recorded in their medical records.
The results of this study support the idea that there is a strong relationship between photophobia and headache after an mTBI. Additional research is warranted to better understand this relationship and its causes so that clinical management improves. The results of this study show a precipitous decline in the numbers of cases of photophobia after mTBI over the first 30 days and a longer-term persistence up to a year in a minority of cases, which is consistent with other research in this field. Various ICD codes, which are currently used to code for photophobia, along with other vision conditions, were not widely used to document photophobia symptoms. It is important to adopt a dedicated ICD code for photophobia to improve the surveillance, data collection, and analysis of this condition.
畏光症是轻度创伤性脑损伤（mTBI）后常见的视觉症状，可能会对军人的战备状态和表现产生不利影响。我们利用国防和退伍军人眼外伤和视力登记处（DVEIVR）来识别和描述一组 mTBI 后被诊断为畏光症的军人。本研究的目的是描述畏光症 mTBI 队列中的合并症和症状，并评估其同时发生的情况，描述畏光症的持续时间，并评估目前国际疾病分类（ICD）编码在报告该队列中的畏光症的有效性。
在 DVEIVR 数据库中搜索 mTBI 后出现畏光症的军人队列。从军人的医疗记录中直接提取的畏光症和其他潜在相关的疾病和症状（包括编码和描述性的）都在 DVEIVR 中找到。在患者和就诊层面上描述了与畏光症并存的疾病和症状的特征。在统计学程序 R 中的 co-occur 包中，在就诊层面上分析了畏光症与这些疾病或症状同时发生的情况。评估了自损伤后 1 年内畏光症的持续时间。分析了目前用于畏光症的 ICD 编码的使用情况。
在 DVEIVR 中发现 639 名 mTBI 后出现畏光症的军人。头痛，包括偏头痛，是影响该队列中 92%军人的最常见合并症。其次最常见的抱怨是头晕和/或眩晕（53%），其次是恶心（42%）、视力模糊（31%）和眼睛刺激和不适（17%）。在所有畏光症就诊中，有 20%的就诊有头痛，其次是 8.3%的畏光症就诊与头晕和眩晕同时发生，5.7%-恶心，4.5%-视力模糊，2.1%-眼睛有主观感觉。所有的合并症与畏光症同时发生的概率都高于单独发生的概率。mTBI 军人在损伤后 30 天畏光症的发生率下降到 20%，3 个月时下降到 17%，6 个月时下降到 12%，12 个月时下降到 7%。目前用于畏光症的 ICD 编码的使用非常低-只有 27.1%的队列在他们的医疗记录中至少有一个 ICD 编码。
本研究结果支持 mTBI 后存在畏光症和头痛之间存在很强的关系的观点。需要进一步的研究来更好地理解这种关系及其原因，以便改善临床管理。本研究的结果表明，mTBI 后畏光症的病例数在最初 30 天内急剧下降，在少数病例中持续到 1 年，这与该领域的其他研究结果一致。目前用于编码畏光症和其他视力状况的各种 ICD 编码并没有被广泛用于记录畏光症症状。采用专门的 ICD 编码来改善对这种疾病的监测、数据收集和分析是很重要的。
