the absence of ocular trauma are still recommended to obtain examination by an optometrist. outside of the treatment facility, these patients must monitor any signs of late-onset ocular pathologies secondary to the btbi, including decreased visual/reading ability and speed, photophobia, blurred vision, reduced accommodation abilities, and headaches. visual outcomes visual outcomes for patients with ocular trauma due to blast injuries vary, and prognoses depend upon the type of injury sustained. the majority of poor visual outcomes arise from perforating injuries: only 21% of patients with perforating injuries with pre-operative light perception had a final best-corrected visual acuity (bcva) better than 20/200. collectively, patients who experienced choroidal hemorrhage, perforated or penetrated globes, retinal detachment, traumatic optic neuropathy, and subretinal macular hemorrhage carried the highest incidence rates of bcvas worse than 20/200. reports from operation iraqi freedom (oif) indicate that 42% of soldiers with globe injuries of any kind had a bcva greater than or equal to 20/40 six months after injury, and soldiers with intraocular foreign bodies (iofbs) retained 20/40 or better vision in 52% of studied cases. globe perforation, oculoplastic intervention, and neuro-ophthalmic injuries contribute significantly to reported poor visual outcomes. 21% of tertiary centers treating patients exposed to blast trauma reported traumatic optic neuropathy (ton) in their patients, although avulsion of the optic nerve and ton were reported in only 3% of combat injuries. in the event that a victim of globe penetrating trauma cannot perceive any light within two weeks of surgical intervention, the ophthalmologist may choose to enucleate as a preventative measure against sympathetic ophthalmia. however, this procedure is extremely rare, and current reports indicate that only one soldier in oif has undergone enucleation in a tertiary care facility to prevent sympathetic ophthalmia. prevention eye armor prevention of ocular trauma is most effective when soldiers wear polycarbonate eye armor correctly in the battlefield. for operation iraqi freedom and operation enduring freedom, the united states military have made ballistic laser protective spectacles (blps), special protective eyewear cylindrical system (specs), and sun/wind/dust goggles (swdg) available to combatants and associated personnel. these forms of eye protection are available in non-prescription and prescription lenses, and their use has been made mandatory at all times when soldiers are in areas of potential conflict. despite their proven record of protection against secondary blast trauma, soldier compliance remains low: 85% of soldiers afflicted ocular trauma in the first year of oef were not wearing their protective lenses at the time of detonation. while 41% of soldiers could not recall whether or not they were wearing eye protection at the time of detonation, 17% of casualties were wearing eye protection while 26% of casualties were not. among this group, the poorest visual prognoses were documented in individuals who did not wear eye protection. the lack of compliance has been attributed to complaints about comfort, stylishness, and “misting” of the lenses when in the field. blps and specs offer the same line of protection against secondary trauma as the swd goggles, and these lenses may overcome the complaints many soldiers have with their military-issue goggles. eye armor and the primary blast wave trauma despite the success of goggles and lenses against ballistic and secondary trauma, blps, specs, and swdg forms of eye armor do not protect against primary-blast injuries. the space between the lenses and the eyes promotes sonic wave diffraction, and current efforts to eradicate ocular trauma due to the primary blast wave have been unsuccessful due to this lens-eye air interface. helmet design and blast-related traumatic brain injury additionally, current researchers have correlated helmet design to an amplification of waves that may cause btbi. moss et al. (2009) used model human heads outfitted with helmets approved for use in oef and oif and subjected them to blast waves at 194g for 2.1 milliseconds. these helmets, the modular integrated communications helmet (mich) feature a mesh netting that offers comfort between the wearer's head and the helmet's kevlar shell. while effective against ballistic trauma, moss's group reported that skull flexure is amplified by the air interface between the helmet and the skull. this space may amplify the effects of btbi, and the group suggested that a foam connection between the helmet and the wearer's head may diminish the effects of the peak pressure wave during an explosion. brainport vision device a tremendous amount of the research surrounding war-related ocular trauma has come from the academic department of military surgery and trauma (admst) in conjunction with wicab industries, the admst has developed the brainport vision device, a sensory substitute for soldiers blinded in service. the device uses the tongue, coupled with a camera mounted on a pair of sunglasses, to provide the user with an electrotactile depiction of the environment. after calibration and practice, the user may interpret objects, shapes, and patterns in their immediate surroundings.