Vision Conservation and Readiness

Military Vision Readiness

Last Updated: April 19, 2019

It has always been recognized that having adequate vision was an essential requirement for service in the military.  Historically, strict physical standards existed which precluded the enlistment or commissioning of candidates with reduced visual acuity and personnel who used prescription eyewear were required to obtain and maintain them at their own expense.  During World War I, about 9 percent of soldiers had a refractive error which required them to wear eyeglasses and the ability to obtain a proper eye examination was a hit-or-miss situation.  There were few ophthalmologists in the military at that time and few optometrists were allowed to provide care.   

The need for proper eyewear in the Army led to the development of a program in 1917 to furnish spectacles to officers and recruits for a price 10 percent over the government's cost for the frame and lenses and resulted in the formation of optical manufacturing units. The following year the Army authorized the free issue of spectacles to enlisted personnel. Officers, nurses, and civilian employees were authorized to purchase eyeglasses through the Post Exchange. The Army purchased frames for 45 cents, cases for 15 cents, and lenses for 95 cents up to four dollars. The program of free issue of spectacles was extended to officers in 1920 and then dropped in 1922.  While Army physicians could prescribe spectacles, the government would not as a rule supply them free of charge. The Medical Department got back in the business, although not for soldiers, in the 1930s when it was tasked with providing medical support to the Civilian Conservation Corps (CCC), one of FDR's New Deal programs.

In 1941, the Army Surgeon General proposed to the War Department to provide spectacles to active duty soldiers.  Claims of broken glasses while performing official duties were not always totally convincing but it was apparent that training ceased once a soldier was unable to see.  When the Surgeon General's staff attempted to determine the estimated requirement, they utilized records from World War I and estimated that 10 percent of military personnel and that half of those soldiers would already having their own glasses.  Based on this data, the Surgeon General's office projected a requirement for 200,000 pairs of spectacles in 1942.  In 1943, the Army Medical Department issued over two million pairs of spectacles.  Unfortunately, they found that 18 to 20 percent, not 10 percent, of the soldiers required corrective eyewear and those who many who entered the service with their own spectacles had glasses that could not withstand the rigors of military life.

For the Navy, the rapid mobilization following the attack on Pearl Harbor necessitated the lowering of visual standards in order to meet the increased manning requirements of the rapidly expanding fleet.  Unable to fabricate eyewear, the Navy entered in to contractual agreements to satisfy the requirement but quickly found that they were unable to meet the demand.  So, the Navy Appropriation Act of 1942 authorized funds for the issuance of prescription eyewear to Navy and Marine Corps personnel serving abroad.  In 1945, this program was expanded to include all Navy personnel.  Also, in 1945, the contract procurement of eyewear was discontinued.

Due to the subsequent demilitarization after the war, fabrication totals reduced to 923,631 pairs of eyewear by 1965.  However, due to Viet Nam buildup, by 1968 a total of 1,596,638 pairs of spectacles and other eyewear, such as gas mask inserts, were made.  It was estimated that one-third of the service members required eyewear and resulted in optometrists being included in the draft since many divisions had a policy that any soldier with an uncorrected acuity greater than 20/200 could not be placed on alert status.  In 1967, optometrists were authorized to be directly placed in the combat divisions and, based upon the demand, the number of optometrists in Viet Nam went from seven to twenty-eight.  In 1969, it was estimated that only about 18 percent of the military reporting to Viet Nam arrived with the required number of spectacles, creating a considerable requirement for optical fabrication within the theater of operations.  In 1969 alone, 270,000 pairs were fabricated in theater.

Operations DESERT SHIELD and DESERT STORM placed large demands on military medical facilities in the United States and Europe. Military optometrists assigned to eye clinics and opticians assigned to optical fabrication laboratories were hard pressed to meet the demand for the more than 112,000 deploying soldiers who did not have the appropriate spectacles or protective mask inserts.  As a result, our program here at APHC embarked on a new course which, in addition to vision conservation, emphasized combat eye safety, military vision readiness, and vision surveillance.

Department of Defense vision conservation and readiness programs preserve vision and promote techniques, equipment, and education to maximize visual performance and comfort for military and civilian employees.  In the US Army, these efforts ensure soldiers possess mission-essential visual capabilities and optical devices and utilize the best available equipment and processes to protect their eyes from hazards.  The same principles apply to civilian employees, based on occupational demands and hazards.

Historically, DOD vision conservation programs or occupational vision programs focused efforts on industrial operations where civilian employees and their exposure to potential eye hazards while working.  Generally, military personnel were not included in vision safety programs until the late 1980s when efforts shifted towards including operational readiness and compliance.   The military operations in Iraq and Afghanistan led to significant vision conservation and readiness initiatives including the monitoring of eye injuries among active duty personnel.  In 2004, in response to urgent needs statements from deployed and deploying units, the military authorized the use of commercial, off-the-shelf (COTS) protective eyewear that met the minimum military requirements in place of type-classified ballistic eyewear.  In 2006, this practice became the Military Combat Eye Protection (MCEP) Program.   Since all deployed personnel were expected to deploy with an MCEP device, the need for vison and optical readiness requirements significantly changed since 100 percent of those in theater were expected to have protective eyewear in their possession instead of the historical percentage that required prescription eyewear.  This implementation of the use of eye protection in theater resulted in a significant reduction in the number of eye injuries and has continued to prove itself over time.  In addition, all of the Services monitor vision and optical readiness and have medical surveillance programs in place.

On September 11, 2001 the terrorist attacks on the United States brought about the establishment of a multi-national "War on Terrorism" starting with military action against Afghanistan in November that same year.  This mobilization of U.S. forces produced a 226 percent increase in production of gas mask inserts from September to October of that year and a 100 percent increase in total eyewear production for the year after due to deploying personnel not being visually and optically ready.

In 2004, in response to the President's Management Agenda on competitive sourcing, the Naval Audit Service in conjunction with the Army Audit Agency performed a review of the need for optical fabrication in the military and the three Surgeons General stated in a memorandum on the subject that:

"The Department of Defense Optical Fabrication Enterprise (OFE) should be retained in its current configuration under the control of the Military Health System…  The combined $2.3M cost reduction gives the OFE an $8.6M advantage of the private sector."

Readiness Value.  Results of the assessment conducted by the Logistics Management Institute have indicated that the OFE's capability is on par with the best commercial operations with a greater emphasis placed on quality and timely delivery.  The OFE's quality program has maintained a 99.7% compliance rate with labs emphasizing 1-day production turnaround for single vision eyewear.  The OFE is also a force enabler for power projection, maintaining significant laboratory capacity and mobilization capability to support large and rapid deployment surges.  CONUS labs provide a rotation and training base for opticians serving in operational and OCONUS assignments…  Additionally, the OFE is currently positioned to pursue additional support to the war-fighter through prescription solutions that meet new operational eyewear requirements…  Modeling has indicated that several contracting scenarios pose risk to operational support.

Health Care Value.  Vision Readiness is an integral element of Force Health Protection and operational readiness…"

Assessing vision and optical readiness as part of the Periodic Health Assessment ensures that warfighters are ready to deploy in a moment's notice.  A study performed in 2011 demonstrated that about 39 percent of military personnel required prescriptive eyewear for seeing at distance and that percentage is expected to continue to increase over time.  Failure to maintain vision and optical readiness has historically resulted in a surge in demand at eye clinics (for examinations) and optical fabrication labs as military members sought the services and devices required for deployment. Currently, vision readiness has been at around 95 percent active duty personnel recently due to the fact that it is being monitored which assists in stabilizing the workload at clinics, stabilizing their manning requirements.  Also, production has been consistent since the requirements for optical readiness were put in place at about 1.5 million pairs of eyewear fabricated each year.  

Joint Publication 4-02 Joint Health Services External Link  provides military guidance for use by the Armed Forces in preparing and executing their plans and orders and includes Vision Readiness as a Force Health Protection function.  

8. Vision Readiness 

a. Vision readiness encompasses the Service member having optimal visual clarity to most effectively and efficiently complete their assignments, as well as the optical devices needed for vision correction (if required) and for eye protection of all Service members during hazardous activities, including deployment. Joint Trauma System guidelines for traumatic eye injury should be followed to ensure the appropriate care is rendered in the event of an ocular casualty. 

For additional information, see Assistant Secretary of Defense for Health Affairs Memorandum, Treatment of Traumatic Eye Injuries, dated 7 July, 2014. 

b. Vision services include preventive eye care to reduce or eliminate conditions that may decrease personnel readiness in performing their mission and which could result in members being removed from their duty unit for treatment. Vision services also ensure the Service member has eye protection, decreasing the occurrence of sight-threatening injuries among military personnel. Service members should have all needed devices to protect their eyes to ensure they complete the mission and do not pose a logistical burden to their unit. 

c. The standards for vision readiness are Service-specific. Service-standardized vision classification systems should ensure military personnel meet the preventive eye care requirement and have all required corrective and protective devices.

The Purpose

The purpose is to provide warfighters with the sight to fight - so the purpose of vision readiness assessments is to ensure that we have a visually and optically ready force which:

  • Ensures optimized performance 
  • Assists with the train-as-you-fight ethos
  • Reduces last minute pre-deployment demands for eye examination and optical fabrication services
  • Reduces in-theater demands maintaining mission readiness and                                                                                                                         decreasing travel risks
The Requirement
  • Vision Requirement - Ensure that the Service Member has the minimum visual function to perform the appointed mission in a deployed environment.  It is recommended that you make every effort to optimize the member's vision.
  • Optical Requirement - Service Member has the required optical devices for deployment for the appointed mission.
  • Current data requirement
    • Most recent prescription information
    • Visual acuities
    • Have a mechanism for providing senior leadership with the vision and optical readiness of personnel in their command
  • Vision Screenings
    • Entry into the Armed Forces - mandatory for each Service - Establishes the initial PULHES rating (E is for eyes).
    • Vision screenings after entry into the Armed Forces - Readiness based as part of the PHA 
Policy

DoDD 6200.04 Force Health Protection (FHP) External Link

  • 4.3.1.3. Provide health assessments and wellness interventions to all military personnel that must include at least: a complete health assessment and wellness interventions for new Service members; routine annual health, medical and dental assessments with appropriate wellness interventions; annual assessment of individual medical readiness; pre- and post-deployment health assessments; and, separation medical assessments.
  • 4.3.2.4. Ensure appropriate utilization of effective personal protective equipment and measures to help mitigate specific health and safety hazards.

DoDI 6130.03 Medical Standards for Appointment, Enlistment, or Induction in the Military Services External Link

  • Current distant visual acuity of any degree that does not correct with spectacle lenses to at least 20/40 in each eye.
  • For entrance into Service academies and officer programs, the individual DoD Components may set additional requirements. The DoD Components will determine special administrative criteria for assignment to certain specialties.
  • Current near visual acuity of any degree that does not correct to 20/40 in the better eye.
  • Current refractive error (hyperopia, myopia, astigmatism) in excess of -8.00 or +8.00 diopters spherical equivalent or astigmatism in excess of 3.00 diopters.
  • Any condition that specifically requires contact lenses for adequate correction of vision, such as corneal scars and opacities and irregular astigmatism.
  • Color vision requirements will be set by the individual DoD Components.
  • 6 elements are required including "Individual Medical Equipment.
    • Medical equipment will be monitored as appropriate for personnel subject to deployment. The core requirement is one pair of gas mask inserts (GMI) for all deployable assets needing visual correction (Pass).  Fail is no GMI.  Service-specific policies may identify additional items of medical equipment such as two pair of prescription spectacles, hearing aid batteries, etc., but they are not part of the DoD core-reporting element. 
      • Not having GMI would make the member "Partially Medically Ready" are considered to be part of the Total Force Medically Ready metric.
      • Inability to determine current health status "Medical Readiness Indeterminate."                                 
  • (2) Vision Loss. Best corrected visual acuity must meet job requirements to perform duties safely.
Defense Health Agency Procedural Instruction DHA-PI 6200.06 Periodic Health Assessment (PHA) Program  External Link  Note:  The link takes you to the DHA Publications Digital Library page.  You will need to scroll down to the actual document to open it.
  • The purpose is to monitor health of the force, identify duty limiting and deployment limiting conditions to provide preventive health screening and education, and determine if further screening or evaluation is indicated.  Requires that Deployment-Related Health Assessments must be identified if the Service Member is within the time frame for completion.
  • The Annual PHA will consist of:
    • Self assessment by the Service Member
    • Medical record review by a health care provider
    • Must complete form DD FORM 3024 Annual Periodic Health Assessment External Link
      • Asks if member's military specialty requires and operational duty physical exam
      • Asks if member is currentlly enrolled in a medical surveillance/occupational healt program
      • Asks if member has had a change in vision that impacts their duty performance (Asked twice)
      • Asks if member has had a change in their vision that resulted in them being on any profile or limited duty
      • Asks if the member wears corrective lenses, how many pairs of glasses they have and whether or not they have gas mask inserts
      • During the Record Reviews, asks if the Service Member is current with Service-specifc requirements for glasses and gas mask inserts.
  • 15.E.1. PERMITTED EQUIPMENT. PERSONNEL WHO REQUIRE MEDICAL EQUIPMENT (E.G., CORRECTIVE EYEWEAR, HEARING AIDS) MUST DEPLOY WITH ALL REQUIRED ITEMS IN THEIR POSSESSION TO INCLUDE TWO PAIRS OF EYEGLASSES, PROTECTIVE MASK EYEGLASS INSERTS, BALLISTIC EYEWEAR INSERTS, AND HEARING AID BATTERIES. SEE REF C. 
  • 15.E.3. CONTACT LENSES. 15.E.3.A. ARMY, NAVY AND MARINE PERSONNEL WILL NOT DEPLOY WITH CONTACT LENSES EXCEPT IAW SERVICE POLICY. 15.E.3.B. AIR FORCE PERSONNEL (NON-AIRCREW) WILL NOT DEPLOY WITH CONTACT LENSES UNLESS WRITTEN AUTHORIZATION IS PROVIDED BY THE DEPLOYED UNIT COMMANDER. CONTACT LENSES ARE LIFE SUPPORT EQUIPMENT FOR USAF AIRCREWS AND THEREFORE ARE EXEMPT IAW SERVICE GUIDELINES. AIR FORCE PERSONNEL DEPLOYING WITH CONTACT LENSES MUST RECEIVE PRE-DEPLOYMENT EDUCATION IN THE SAFE WEAR AND MAINTENANCE OF CONTACT LENSES IN THE DEPLOYED ENVIRONMENT. THEY MUST ALSO DEPLOY WITH TWO PAIRS OF EYEGLASSES AND A SUPPLY OF CONTACT LENS MAINTENANCE ITEMS (E.G., CLEANSING SOLUTION) ADEQUATE FOR THE DURATION OF THE DEPLOYMENT.

So what should you do?  Whether it is a requirement or not, checking vision and discussing whether or not they have more than one pair of glasses and the proper inserts takes only a couple of seconds and should be considered whenever a health assessment is performed. The difference becomes that, if it is not a requirement, you can recommend an eye examination if they do not correct to 20/20 in each eye but cannot require them to do so.  The choice, of course, is yours to make but can fall into the category of doing what you feel is best for the person.   

Also ask if a person may deploy soon.  If so, recognize that it may take a long time to obtain replacement eyewear while deployed so members should consider obtaining spare eyewear, especially UPLCs just in case.

Personnel here at the Tri-Service Vision Conservation and Readiness Program (TSVCRP) continue to support the Warfighter through analysis, experience and collaboration across the Services, the Departments and industry and will continue to do so.  The success of the TSVCRP and vision readiness efforts across the enterprise demonstrates the need for continued efforts in ensuring that the Warfighter is ready when needed.

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