Seeing is Believing: The Healing Potentials of Optometric ... conference/AC2019/AC2019...Seeing is...
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Seeing is Believing: The Healing Potential of Optometric Vision Therapy for a TBI Survivor 38 th Annual Brain Injury Conference March 28, 2019 Eileen Lawlor, LICSW, LADC, BCD, Survivor Theresa J Ruggiero, OD, FCOVD Board Certified in Optometric Vision Therapy
Transcript of Seeing is Believing: The Healing Potentials of Optometric ... conference/AC2019/AC2019...Seeing is...
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?
Presenter
Presentation Notes
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
Presenter
Presentation Notes
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
Presenter
Presentation Notes
*What is the fundamental difference between neuro-OMD and neuro-OD? Neuro-OMD role: diagnose dysfunction of the neurologic substrate of vision per Dr. David Hirsh. Over 40 areas of the brain have vision association, top of pg 6 Suter. This is why neuro-optometry needs to be involved in brain injured patients.
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
Presenter
Presentation Notes
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
Presenter
Presentation Notes
Survey is designed by Hannu Laukkanen at Pacific University College of Optometry 96 % specificity . That is, if a patient gets > or equal to 28 on this survey they have a significant visual problem. Can’t say for certain if the problem is caused by the brain injury.
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
Presenter
Presentation Notes
Pocket guide
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
