Vision and brain injury

Column by Chris DeWald
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A person who has suffered a traumatic brain injury (TBI) or cerebral vascular accident (CVA) may often experience difficulties with balance, spatial orientation, coordination, cognitive function, and speech. In most cases, a referral for visual consultation only occurs if there’s an injury to an eye or if ocular pathology is suspected. Persons with a TBI or CVA frequently will experience symptoms of double vision, movement of print or stationary objects such as walls and floor, eye strain, visual fatigue, headaches and problems with balance, to name several. Frequently, people will report problems with their vision to rehabilitation professionals and be referred for eye examination. Unfortunately, many will be told that there is nothing wrong with their eye and that it is the effects of their TBI or CVA. Others will be told that their symptoms are not related to their vision.

In my case, I had lost my depth perception and also my outside world bounced from side to side. Now, here was the weird thing, I could watch black-and-white television without these symptoms. I re-existed on old Westerns courtesy of the Western Channel. Gene Autry is great once again, the Durango Kid, “Oh Sisco, Oh Pancho” was heard once more. Gary Cooper, the man from Orange, Va., again graced the television screen.

I would guess that the fact that a television is not three-dimensional has a lot to do with this. I had no idea that the eye had a system of muscles. Found that out quick.

Visual problems are among the most common sequella following a TBI or CVA, but frequently not dealt with in a rehabilitation model. In order to address visual problems, the Neuro-Optometric Rehabilitation Association is a multi disciplinary institution that provides literature and educational programs for its members. It also serves as a referral source for doctors and rehabilitation professionals who have specific understanding of visual difficulties that arise following a neurological event. A definition of neuro-optometric rehabilitation is: an individualized treatment regimen for patients with visual deficits as a direct result to physical disabilities, traumatic brain injuries, and other neurological insults. Neuro-optometric therapy is a process of rehabilitation to visual/perceptual/motor disorders. It includes, but is not limited to, acquired strabismus, diplopia, binocular dysfunction, convergence and /or accommodation paresis/paralysis, oculomotor dysfunction, visual-spatial dysfunction, visual-perceptual and cognitive deficits, and traumatic, visual acuity loss.

For me, I was referred to a “Neuro-Optician” who specializes in injuries from brain injuries. The rehab unit recognized I had issues with my eyes and sent me to a specialist in Charlottesville. It was at this office that I had to retrain my muscles around my eye. I have talked to some that had total recovery and some that had not. I was one of the not fully recovered with the vision. I did regain all I could and was prescribed what are called prism glasses.

Prism eyeglasses are not normal glasses. They are not designed to improve the vision of one or both eyes, and they do not help a person see better at a distance or close up. They are used when an individual is having trouble keeping his eyes working together. In other words, the eyes are looking at two different points instead of the same point.

The prism in eyeglasses bends light. It is placed in the glasses so that as the eyes look through them, the objects are pulled into focus. It is similar to a triangle or cone. The focus occurs because the bottom of the prism is on the outside of the glasses. It pulls the object in and narrows its focus as it makes its way up the prism. The object visualized is pulled together in both lenses to a closer point, creating a clearer picture. This makes the vision clear, without forcing the eyes to work as one.

Following a TBI, CVA or other neurological event frequently individuals lose this ambient visual process and instead are left with a focal processing system that breaks up the visual world into isolated parts. This causes individuals extreme difficulty, not only with balance and movement, but also affects the person in other ways such as in the person’s tendency to compress and limit their spatial world. This creates experiences such as an inability to find an object on a shelf in a store. The compression of space causes a focalization process to function both centrally as well as peripherally. This has greater meaning when one thinks of what the experience must be like when all the bottles, cans, and boxes on the shelf is suddenly experienced as massive amounts of detail causing the person to be unable to isolate one detail from another.

This explains why many of us have horrible incidents inside stores as WalMart. Mine happened to be the paper isle. It is basically all white and it unnerved me. Unnerved is a soft way to say it scared me and you assume this is you for the rest of your life.

Movement in a crowded environment also becomes quite disturbing because the ambient visual process is supposed to assist in stabilizing the image of the peripheral retina. Without this system the person internalizes the movement that he or she is experiencing in the peripheral vision. This become extremely disturbing and causes vertigo, and severe dysfunction. The authors have found that a combination of low amount of base-in prisms and binasal occlusion have been extremely effective in almost immediately offering increased stability to the ambient visual process, thereby reducing the symptoms and enabling the person to re-establish levels of independence that were otherwise not achieved.

Seem familiar to some of you out there? If this seems like it may pertain to you, ask your therapist, general practitioner or neurologist if seeing a neuro-optician might be to your advantage. It was a vital and needed referral to me. You see, I am typing these article from having the benefit of “prism” glasses and having therapy for my eyes. This has not totally cured my anxiety inside large stores with crowds. I avoid them when I can. But it has had tremendous advantages for me. I don’t walk into walls, I can see the world without two of them. I can see the birds in their splendor and not bouncing side to side.

Life and the world can be beautiful. Ask your physician. Be part of your recovery. Take control of your life.

Here are some sites to visit:

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