a modern approach to comprehensive concussion care: where ...€¦ · a modern approach to...
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A Modern Approach to Comprehensive
Concussion Care:
Where is Vision?
Tanya Polec OD, FCOVD
Personal Story
My History/ My Vision Story
Private Clinic: VQ learning, sport, rehab
● 85% Concussed, 15% Stroke and Learning Related Difficulties.
● U of A Concussed Athletes, Special Forces for Air Force,
Tucson Roadrunner Hockey Team
Vision Consultant: SPARCC
(Sports Medicine, Rehabilitation and Concussion Center)
Board of Directors for NORA
(Neuro-Optometric Rehabilitation Association )
(NeuroOptometric Rehabilitation Association) 2
Outline
● Background and Current Literature
● Concussion and Visual Dysfunction
● Vision Screening
● Management / Accommodations
Lovell etal. 2004
Vision symptoms
● Common in concussion and PCS
● 50-90% after concussion
● Can be subtle and missed on exam
● Vision testing improves recognition
● Visual dysfunction and management options
Lovell, Ciuffreda, Kontos, Mucha etal
CISS from 32 to 9 and NPC from 13.7cm to 4.5cm in VT group (P<0.001)
Mucha etal. UPMC
Vision Problems Following Brain Injury (BI)
● https://noravisionrehab.org/patients-caregivers/about-brain-injuries-
vision/common-vision-problems-symptoms-following-a-brain-injury
● Eye Focusing (Accommodation) - Blurred vision or ability to shift focus
between objects (near and far.
● Eye teaming ( Binocularity)- Your eyes may not work together at a team.
● Eye movements (Pursuit/ Saccades)- Your may experience difficulty with
reading.
● Motion sensitivity- Integration between vision and the balance system.
Secondary symptoms
Mucha etal. UPMC
Mobility Observations
○ Difficulty with stairs when walking downward
○ “Searching” for the floor with the foot when walking
○ Bumping into objects or not understanding the spatial
relationship between objects
○ Insufficient weight shift/centering, usually over the more
affected side
Manifestations-Visual ABN
Mucha etal. UPMC
Visual Treatment –Lens Options
● Near-sighted / Far-sighted
Balance eyes (possible less “clear”)- reduce visual input
● Vision/ Body Matching
Prism to balance visual and body input
● Near Point Clear (i.e. computer and reading)
Accommodation (focus) – magnify the font
Binocularity (eye teaming) – prisms to align eyes
● Tint
Communication between the central/peripheral vision
(blue or blue/green)
● Binasals
Decrease peripheral stimuli helps with binocularity and anxiety
25
Accommodations- school / work
● Take Breaks with Visual Tasks –20/20/20 Rule
● Reduce Glare – use natural light, avoid fluorescent tubes, neutral
non-glare filter, tinted lenses (indoors and out), special colors of tint
● Think Big- increase font size
● Keep your eyes moist- blink rate slows down
● Reduce Visual Overload- clear clutter
Accommodations – school / work
● Reduce Peripheral Vision –
Cap, sunglasses with large temples
● Reduce Accommodative Demand –
Print hand-outs - light/pastel paper (blue, green and tan)
Re-test every 3 weeks to see if color has changed
… much more than
20/20 eyesight
Affects
• Balance
• Anxiety
• Academics