History of US Ophthalmology during the Vietnam War

All content on Eyewiki is protected by copyright law and the Terms of Service. This content may not be reproduced, copied, or put into any artificial intelligence program, including large language and generative AI models, without permission from the Academy.

Article initiated by:

Beauregard W Barclay

All contributors:

Hoon Jung, MD, Cat Nguyen Burkat, MD FACS

Assigned editor:

Review:

Assigned status Update Pending

 by Cat Nguyen Burkat, MD FACS on August 28, 2023.

add
Contributing Editors:	add

General Medical Context

Scope of Conflict

The Vietnam War was a drawn-out conflict lasting 20 years from 1955 to 1975. It approximately resulted in the deaths of 2,000,000 civilians, 1,100,000 Northern Vietnam and Viet Cong combatants, and 58,300 US military personnel. American involvement became more pronounced in the years following 1961 in response to Viet Cong guerrilla activities^(p3) and after 1964 in response to the Gulf of Tonkin incident. The war was one of the Indochina wars, which encompassed military actions in Laos and Cambodia dating back to 1946 with French maneuvering in the area.

Medical Organization

Before 1961, no more than 1,000 US troops were stationed at a given time. However, during this year there was an influx of personal, and a 100-bed field hospital, four medical detachments providing specialty care, and one helicopter ambulance detachment were placed in South Vietnam.^(pp3-4) Eventually, about 10 evacuation and field hospitals and another 10 to 15 surgical hospitals were established.

Overall, the standard of eye care was high. For example, there are no documented cases of sympathetic uveitis.^(p14)

Ophthalmology Organization

Surgeon General’s ophthalmology consultant

Consultant in Ophthalmology to the Military Assistance Command Vietnam (MACV) Surgeon at 24^th EV Hospital, Vietnam

Patient Treatment Locations

First Aid

Initial first aid for eye injuries was administered by medical corpsmen. These injuries were often not given appropriate urgency and the initial first aid was less-than-ideal. Treatment mainly consisted of eye dressings, evacuating the patient to a field or evacuation hospital where an ophthalmologist was stationed, and starting intravenous fluids for transport. This was due to corpsmen not possessing training for initial management and detection of ophthalmic injuries. Foreign objects were oftentimes left on or imbedded in the conjunctival forices and eye lid. However, once the patient was boarded for a hospital, the patient’s injury and condition was relayed ahead, which was essential to ophthalmic cases as the injured servicemen could be redirected to a hospital staffed with an ophthalmologist.^(p37) Helicopters were used to transport wounded to the hospital, which proved essential due to the jungle terrain and provided quick evacuation to the operating theater.^(p447)

Air Evacuation

Figure 1. U.S. Air Force C-130 Hercules takes off from Khe Sanh, Vietnam, 1968.

Early in the war (1965-66), ophthalmic cases were normally sent to US Air Force (USAF) Hospital Clark in the Philippines, and air evacuation to the hospital was considered an effective means of treatment. Evacuation took three to four hours on a variety of aircraft, including the C-130 Hercules (fig. 1). On board, wounded were treated by nurses, medical technicians, and sometimes flight surgeons, all of whom had received training at the USAF School of Aerospace Medicine.

However, not all in-flight care was satisfactory. In 1966-69, it was noted that patients sent to Walter Reed sometimes arrived without having their eye patched changed or their eye examined over the course of the flight. This was likely due to concerns by crew that they would cause more damage to the eye together with the demands of more critical patients.^(p42)

Southeast Asia Hospitals

Many injures were treated at the field hospitals in Vietnam as the war progressed, but in some situations the wounded were evacuated out of the county, namely to the Philippines, Japan, or the US.^(p41) For example, USAF Hospital Clark in the Philippines was the only major hospital in Southeast Asia early in the war (1965-66). It treated servicepersons, the diplomatic corps, and some civilians from Vietnam, modern Taiwan, Indonesia, Thailand, and parts of India. Additionally during this early period, Neither the Army nor the Navy had ophthalmologists stationed the region, meaning Hospital Clark treated servicepersons from these branches as well. Despite this, only one military ophthalmologist was stationed at the hospital.

Vietnam Hospitals

Asides from the several notable limitations described below, the eye clinic of a military hospital in-country was serviceable. The ophthalmologist consultant in Vietnam described his eye clinic at the 24th EV Hospital as "small but adequate." Two ophthalmologists were stationed there since the hospital was considered a head and neck trauma center, and the clinic was divided between ophthalmology and optometry. After triage, if a patient with eye injury was ambulatory, he was sent an eye clinic for examination. However, most patients had sustained several other injuries making this impossible. The triage examination and radiographic studies served as the basis for surgery decisions.^(pp33-35) Some patients were eventually evacuated to hospitals in the US and other American military hospitals. This was done when the patient's injures were thought to likely end his active duty or if operating in the US was believed to have a better outcome. Some conditions that qualified for evacuation to the US included keratoplasty, glaucoma surgery, and repair of retinal detachments.^(pp40-41)

Simultaneous Operations

Limitations

Hospitals equipment put many restraints on ophthalmologist. Operating was sometimes difficult, as a foot of water sometimes covered the operating room and lights at times had to be dimmed. The diagnosis and management of injuries was impleaded by the absence of operating microscopes, cryotherapy units, gonioprisms, and metal locators. At their disposable were obsolete slit lamps, indirect ophthalmoscopes, and few microsurgical instruments. Providers found it difficult to obtain fine ophthalmic sutures with cutting needles and standard medications. The lack of proper interments was so dire that treatment of chorioretinal injuries was preformed outside Vietnam due to the absence of cryotherapy units. Despite these limitations, some remarkable military ophthalmologist sought to personally remedy the situation. For example, one ophthalmologist contacted persons in the United States when leaving for Vietnam, and revived supplies such as fine forceps, received scissors, and needle holders. He left the remainder of his supplies with several military and civilian outfits before returning to the US.^(pp33-35)

Providers

Ophthalmologists

The first US military ophthalmologist arrived 1965 with the 85th Evacuation Hospital in Qui Nhon.^(p33)

The availability of properly trained providers of ophthalmic care in-country was less than ideal. Many ophthalmologists had not completed or only recently completed residency, had not yet been board certified,^(p35) and by some accounts had not begun residency. For example, Major William Dale Anderson, MD was stationed as an ophthalmologist at the 24th Evacuation Hospital and was assigned Consultant to the Surgeon for the entirety of the US force in Vietnam. However, he described himself as being “barely Board Certified” and knew of only of three to four others residency trained ophthalmologist. He described the lack of senior ophthalmologists in-county when Regular Army surgeons were stationed elsewhere as “indeed a poorly conceived system.”

Non-Ophthalmologist

Nursing Support

Medical Corps

First Aid Providers

Evac Personal

Casualty Statistics

Unlike the American Civil War and the World Wars, no official exhaustive medical history was compiled for the Vietnam War. However, data from various studies and first hand reports can be considered to provide a picture of Vietnam Ocular injuries.

LaPana's statistics:

The conflict exhibited the highest ocular injury rate of any other US conflict and is estimated to account for 1,849 injuries at a rate of 9%. The largest category of injury is disruption necessitating enucleation, accounting for 50% of injures. Scleral and corneal laceration follow at 19%, then intraocular foreign bodes at 15%, laceration of the ocular adnexa at 11%, and foreign bodies in cornea accounting for 1.6%. All other injures account for less than 1% of injures. One study stated that munitions such as rockets, bombs, and lang mines accounted for most of nonfatal injuries, with fragments accounting for 68%, followed by bullets at 30%, and all others at 2%.

USAF Hospital Clark statistics:

Research During Conflict

Anderson

La Piana

Penner and Passmore

Cowden and Runyan