• Hong Gao, Jay E Clasing, Robert N Kang, and Micah J Kinney.
• Tri-Service Vision Conservation & Readiness Program, U.S. Army Public Health Center (APHC), Aberdeen, MD 21010-5403, USA.
• Mil Med. 2021 Nov 2; 186 (11-12): e1215-e1220.

IntroductionThe standard issue clear or sun Military Combat Eye Protection (MCEP) is often inadequate in visually challenging training or combat environment. Intermediate-tinted lenses may offer a viable option for warfighters operating in dynamic visual conditions such as moving rapidly from bright sunny areas to darker building interiors in combat. Because the use of intermediate-tinted lenses has been delayed as a result of a potential negative impact on vision performance such as color perception, this investigation evaluated several commercially available intermediate-tinted lenses for operation performance during a U.S. military field training. Test lenses complied with all the requirements of the current MCEP except for the visible light transmittance (VLT) values that ranged between 32 and 62%.Materials And MethodsStudy subjects consisted of 22 service members who attended a military Close Combat and Marksmanship training course in May 2019. Visual and pistol marksmanship performance of three intermediate-tinted lenses (Eye Safety Systems [ESS] Copper [32% VLT], Oakley Prizm TR45 [44% VLT], and ESS Bronze [62% VLT]) was compared to that of a standard issue MCEP, ESS Clear (90% VLT). Quick contrast sensitivity function test was used to assess quality vision (AULCSF, area under a log contrast sensitivity function) and visual acuity (CSF Acuity). Color vision was assessed by Cone Contrast Test. Pistol marksmanship (Bill Drill) was used for performance testing. A pre-survey inquired about MCEP use, and a MCEP survey during the pistol marksmanship testing inquired about lens performance and ranking.ResultsAULCSF and CSF Acuity were significantly affected by the lenses (general linear model, repeated measures, P < .05). Bonferroni post hoc test showed a significant reduction of binocular AULCSF from ESS Clear to Oakley Prizm TR45 (P = .003) and ESS Copper (P < .001) and a significant reduction in binocular CSF Acuity from ESS Clear to ESS Copper (P = .001). Color vision and pistol marksmanship performance were not significantly affected by wearing different lenses (P > .05). Subjectively, there were no statistically significant differences among study lenses in perceived "clarity of vision," "ability to clearly identify the target," or "overall performance" (Friedman test and Wilcoxon signed-rank post hoc test with Bonferroni adjustment, P > .017). Participants ranked Prizm TR45 (44% VLT) and ESS Bronze (62% VLT) lenses significantly more favorably than EES Clear (P = .001 and P = .009).ConclusionsQuality of vision and visual acuity decreased with darker lenses; however, the study lenses had insignificant impacts on pistol marksmanship and subjective acceptance. Our surveys indicated that Intermediate-tinted lenses were operationally acceptable and preferred over a standard issue MCEP. While more evaluations for color vision deficient subjects are needed, overall results suggest that commercially available intermediate-tinted lenses may be a viable option to enhance protection and performance in a visually dynamic combat environment.© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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