Cost-Benefit Analysis of Comprehensive Military Eye Examination Policies

Vision readiness ensures that service members (SMs) have the visual fitness required to perform their missions successfully, maintain deployability, and serve without duty limitations. However, SMs may become ineligible for deployment due to ocular and visual dysfunctions (OVDs); and even if they are still eligible for deployment, their performance may suffer due to a lack of diagnosis or treatment for these dysfunctions. Moreover, if ocular/vision-related dysfunctions are not diagnosed and managed at an early stage, the cost of health care related to treating these dysfunctions increases. 

While prior research has found that SMs are at high risk for OVDs—and particularly OVDs secondary to traumatic brain injuries (VDTBIs)—current screening processes across all SMs focus on detecting and addressing refractive errors (REs), such as myopia, hyperopia, and astigmatism. As a result, other OVDs that SMs are at risk for may go undiagnosed and untreated. In this study, the authors gather data and develop models to ascertain the costs and benefits of moving from the current visual acuity screening process to comprehensive eye examinations intended to detect a wider range of OVDs earlier, including dry eye, glaucoma, keratoconus, corneal dystrophies, retinal dystrophies, REs, and VDTBIs. They draw on available data on the prevalence and incidence of these dysfunctions for the young adult U.S. population; factor in costs associated with exams, treatment, and discharges within the military context; and consider a range of values for the benefits of detecting otherwise undiagnosed OVDs among SMs.