The visual process involves so much of the brain that almost any head trauma whether it is due to traumatic brain injury for example in a whiplash accident or blow to the head. Or from vascular disease such as a stroke, vision and visual perception is going to be affected. We have also seen a number of patients who have been left with difficulties due to infection and demyelinating conditions. For example, we have several cases where the patient has been able to recommence driving after our intervention. We support patients following traumatic and acquired brain injury to improve vision, gross and fine motor movement, concentration and vestibular problems.
Sometimes the trauma is not obviously to the head such as whiplash which we often think of as a neck problem. However the brain is a delicate jelly encased in a hard and incredibly rough bone box and the rapid forward and backward movement causes tearing of some of the delicate blood vessels. The subsequent damage is often too minor to show up on a CT scan but will manifest itself functionally.
These effects can be variable ranging from some mild temporary visual confusion or uncertainty right through to an inability to walk straight, constant double vision and even blindness.
Medical attention is focused on the source of the hurt, repair of obvious damage, regulation of blood pressure and possibly some physiotherapy if movement is affected, but little attention if any is given to the visual system, the usual treatment being “wait six months and see how it is then”.
New approaches by Neuro-Developmental Optometrists in America have the Optometrist in at the first admission to Hospital, assessing the patient for visual problems.
Examples of patients we have recently worked with include one woman who could only walk and see with her head on one side and a man who had double vision for the previous two years.
There has been significant work undertaken in America on the effects of Traumatic Brian Injury (TBI) on vision particularly relating to the problems soldiers returning with the effects from Improvised Explosive Devices (IEDs) and other blasts returning from Afghanistan and Iraq are suffering. These involve blurred vision or double vision, headaches, photophobia, difficulties with balance or a number of other visually initiated symptoms. I t is clear that these people can be helped with the prescription of lenses, tints, prisms and other spectacle devices in order to relieve symptoms. Photophobia is one of the most frequent complaint amongst soldiers who are returning as the victim of bomb blasts and the prescription of a particularly prescribed lens can make all the difference along with the problems of diploplia (double vision) either intermittent or permanent which can be relieved by prisms and reading difficulties which can be helped with conventional reading lenses. Few of these people get to see a Neuro-Developmental Optometrist but are referred directly to the Ophthalmologist, whose main interest is in treating disease or repairing physical trauma but not restoring meaningful function.
Our approach is to detail the difficulties experienced and then by a careful examination of the vision system look for loss or diminution of ability which might be a cause. Then we provide a compensatory lens or a course of vision therapy, which can be likened to physiotherapy for the eyes to restore the situation