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Posted on 03-17-2015
Here is another story for Brain Injury Awareness Month. This time it’s Bill. I’ve known Bill for many years, unlike most of my brain injured patients. We successfully eliminated Bill’s seasickness in 1999 with just a few months of VT, as recently posted on this blog. Then in April 2010 Bill was involved in a car accident, resulting in an undiagnosed brain injury. Vision therapy and proper lenses are usually very potent in treating visual symptoms resulting from concussions and other brain injuries. Vision therapy should be considered for anyone who has suffered a concussion/brain injury. It can be critical for improving quality of life after suffering a traumatic brain injury.
Bill, a 67 year-old long-time patient was involved in a car accident eighteen months prior to his latest visual evaluation. He reported that immediately upon exiting his vehicle he noticed that things far in the distance were double; this problem persisted, but only when looking at something further than a quarter of a mile away from him. Bill also reported that any sudden eye movement resulted in intense pain around his right eye. His exact words were, “like my eye was trying to unscrew itself from my head.” These episodes caused Bill to wince in pain and stop whatever he was doing until the acute pain subsided back into the constant dull ache present since the accident. These episodes also caused Bill to lose his balance and feel like he was “not in his body.” He said it felt like he was next to where he knew himself to be. Bill’s wife had to be taken from the scene by helicopter. He was diagnosed with whiplash, but was never properly diagnosed with a head injury. I have no doubt that closed head trauma and a mild traumatic brain injury did occur.
Initially, Bill’s lawyer insisted he see an ophthalmologist. The complaints of diplopia were brushed off as inaccurate for a year and a half. Bill’s eyeglass prescription had remained unchanged for 16 years prior to the accident. It was drastically changed by the ophthalmologist, who also added prism once he finally admitted apologetically that Bill actually did have intermittent double vision during the third visit. The treatment had no effect whatsoever. When the prism failed to provide any relief, the amount was simply increased - still to no avail.
One of the unusual aspects with Bill was that I had seen him several times over the years before his accident. Usually, when we see patients with acquired brain injuries, we have no knowledge of their visual status prior to the injury. Bill was not the most consistent patient as far as coming in for evaluations; I first saw him in 1994, then again in 1999 and 2005. He was however very consistent as far as his visual profile over the years. His prescription - as mentioned earlier - was completely unchanged. His other findings remained virtually the same throughout this time.
The main differences in findings after Bill’s head injury were: decreased distance acuity, reduced stereo acuity (a measurement of depth perception) at near, the presence of poor vertical alignment of the eyes at near, increased outward turning of the eyes at near and of course seeing double at great distances. My primary concern centered on Bill’s complaints of losing balance and feeling like his eye was trying to unscrew itself from his head. This sounded quite unpleasant to me. I tend to consider using binasal occlusion when confronted with less common complaints and Bill’s description of his experiences since the accident certainly qualified. I applied narrow binasal occlusion to Bill’s current glasses. He immediately made the kind of rapid eye movements that had been causing his acute symptoms. Nothing happened – no severe head pain and no sensation of dizziness. He stood up and tried again. No loss of balance and no sensation of being outside his body. Bill reported that it was almost one hundred percent better, immediately. We decided to pursue a vision therapy program to maximize Bill’s ability to handle his daily visual demands with less discomfort. We were both extremely happy with the improvement that narrow binasal occlusion and vision therapy achieved.
Go to OEPF to find a behavioral optometrist near you.
Vision therapy is very important for visual processing. If Dr. Gollap does it personally,really will be great for all.