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Seeing is Believing: The Healing Potential of Optometric Vision
Therapy for a TBI Survivor
38th Annual Brain Injury ConferenceMarch 28, 2019
Eileen Lawlor, LICSW, LADC, BCD, SurvivorTheresa J Ruggiero, OD, FCOVDBoard Certified in Optometric Vision Therapy
Theresa J. Ruggiero, OD, FCOVDElizabeth B. Hannigan, OD, FCOVD
Naomi G. Clay, OD
86 Masonic StreetNorthampton, MA 01060
(413) 586-5002northamptonvision.com
“It is a terrible thing to see and yet have no vision”
Helen Keller1880 - 1968
What Does it Mean to See?
What Does it Mean to Have Vision?
Visual Input/Efficiency
• Ocular Motility• Accommodation• Binocularity
Visual Information Processing/Integration
• Group of visual cognitive skills• Selectively extract visual information from
environment• Integrate visual information with other
sensory systems• Assign meaning/understanding
What is it?
Vestibular Ocular Reflex
• VOR• Stabilize gaze• Balance• Spatial awareness• Navigate space safely
Let’s Stand . . .
Eileen Before TBI
Q E 2
Dr. Ruth
Visual Pathways
• Primary– Optic nerve Visual Cortex (occipital lobe)
• Via lateral geniculate nucleus (LGN)
Neural Substrates of Vision
Auxiliary
Common Visual SymptomsPost TBI
• Blur• Photophobia• Dry eyes• Diplopia (double vision)/Eyes out of sync• Loss of place when reading• Headaches
Common Vision Related Consequences of TBI
• Dizziness• Mental Confusion• Fatigue
Common Vision Related Consequences Related to Persistent Symptoms
• Anxiety• Depression• Hyper-vigilance• Sleep Disturbances
If vision is not functioning well , it interferes. If functioning well it enhances and stabilizes!
- Dr. John Streff
Remember Vision-Brain Connection
Pathophysiology of TBI• Closed head injury (vs open): typically causes a more
diffuse or global insultCoup (acceleration) insultContre-coup (deceleration) insultPercussive blast (more with returning veterans)
Results: shearing forces which may lead to:1. Breakage of blood vessels2. Diffuse axonal injury (DAI)
Common Visual Consequences of Acquired Brain Injury
• Blurred Vision• Diplopia• Photophobia• Headache• Visual Field Loss
Ropper & Gorson (2007) NEJM 356: 166-172
•National Hospital Ambulatory Medical Care Survey — United States, 2001–2010 (Emergency Depart Visits)
Neuro-Ophthalmologist: assess visual substrate health
vsNeuro-Optometrist:
restoration of visual function
Role of the Neuro-Optometrist• To diagnose and/or treat vision disturbances to
optimize functional vision for use in a patient’s:- activities of daily living (ADL’s) thereby impacting overall quality of life (QOL) - overall rehabilitation (make your job easier )
Finding a neuro-optometrist:- noravisionrehab.org -covd.org
Visual/Ocular Assessment
• Ocular health• Refractive status
The Neuro-Optometric Evaluation
• Visual Efficiency Assessment• Visual information processing• Visual spatial organization• Visual motor integration• Visual vestibular integration• Posture/gait assessment
Vision Rehabilitation
• Lenses• Prisms• Optometric Vision Therapy• Optometric Phototherapy (Syntonics)• Phototherapy-based Multi-Sensory Training
Lenses
Prisms
Optometric Vision Therapy
Patient Specific Goals
Establish FeedbackMechanisms
Basic – InvolvingVision and Movement
Complex – InvolvingMultiple Systems
Neuroplasticity at Any Age
Virtual Reality
Optometric Phototherapy
Multi-Sensory Training
• Optometric phototherapy• Vestibular• Auditory• Proprioception
Signs and Symptoms of Visual Dysfunction
• Blur• Eyes out of sync/double vision• Headaches• Confusion• Dizziness• Symptoms made worse in busy visual
environment
Brain Injury Vision Symptom Survey
• Overview• Specificity
Professional’s Referral Guide Vision Disturbances and Associated Symptoms Following ABI
Ocular Motility and Vergence Deficits
Limited reading endurance, eye fatigue, HA’s, loss of place, has given up reading
Visual-Vestibular Dysfunction Dizziness, imbalance, motion sensitivity, “shaky” vision, overwhelmed by visually busy environments, “heavy-headedness”
Photophobia Hypersensitive to lights, especially fluorescents; wearing sunglasses indoors
Visual Processing Deficits Concentration difficulties; confusion, unable to multi-task, word retrieval issues
Visual Field Neglect and/or Cut Bumping into doorways, knocking over things; leaning or drifting
Visual-Motor coordination dysfunction
Dropping things, driving difficulties, writing issues
Resources
Neuro-Optometric Rehabilitation Association - noravisionrehab.org
College of Optometrists in Vision Development:- covd.org
Thank You!
Theresa J. Ruggiero, OD, FCOVDElizabeth B. Hannigan, OD, FCOVD
Naomi G. Clay, OD
86 Masonic StreetNorthampton, MA 01060
(413) 586-5002northamptonvision.com