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