a modern approach to comprehensive concussion care: where ...€¦ · a modern approach to...

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