Susan Jong, OD, FCOVD Advanced Eye Center Baton Rouge, LA 70809 How “Eye” See It Now Susan Jong, OD, FCOVD Advanced Eye Center Baton Rouge, LA 70809

Presentation Goals Create awareness of what to look for in patients with a TBI (Traumatic Brain Injury) or stroke Current optometric diagnostic and therapeutic strategies available Neuro-vision rehabilitation and importance of having an evaluation

Incidence of TBI According to the Center for Disease Control: 1.7 million cases of TBI reported per year The actual estimation is 3.5 million since many aren’t diagnosed or don’t seek treatment 75% of TBIs are considered to be concussions or other “mild TBI” 90% of TBI patients suffer from visual dysfunction* *AOA Journal 2007; 78(4); 155-161

Common Symptoms with Acquired Brain Injury Many patients with head injuries have characteristic visual sequelae These include problems with: Binocular vision Spatial localization Concentration Visual motor tasks Treating vision must be as much a priority as PT, OT and SLP to make a good recovery

Causes of Visual Dysfunction As many as 50% of those with a neurological injury suffer from visual changes Disruption in neuro pathways Damage to structures Brain stem Cortex Cerebellum

Visual System-General Overview 70% of all sensory processing in the entire body is directly affected by information coming from the two eyes Optic Nerve- 1,000,000 nerve fibers per eye Several important pathways where visual information travels 8 of 12 cranial nerves relate to the visual system

Common Visual Signs & Symptoms of TBI Balance and coordination issues Vertigo Diplopia (double vision) Light sensitivity Headaches Blurry vision Dizziness Nausea Motion sickness

Current Optometric Diagnostic Strategies Oculomotor testing (DEM or KD Test) Binocular testing Balance testing (out of chair) Visual Midline Shift test Visual motor skills (writing, catching) Visual Information Processing Battery (TVPS-3) VO Star (visual spatial and visual organization) Ocular health Refraction Photosensitivity Posture/Gait evaluation (out of exam room) Primitive reflexes Bilateral integration

Treatment & Management Strategies Optometric Vision Therapy Low plus lenses (for non- presbyopes) Base-in prism lenses Binasal occlusions Sector occlusions Yoked prism lenses Field awareness prism lenses Tinted lenses Syntonics phototherapy Primitive reflex integration

Patients Who Can Benefit From a Neuro-Optometric Vision Evaluation Traumatic Brain Injury Stroke Multiple Sclerosis Cerebral Palsy Brain Tumor Others

Neuro-Optometric Vision Therapy Evaluation Part I Complete eye health exam Visual field awareness Eye muscle testing Part II Performed with Vision Therapist Motor reflexes Visual Information Processing Consult Findings Plan for treatment

Summary & Questions

Contact Charmaine Wright, MRC, CRC Vision Therapy Administrator cwright@advancedeyecenter.com 225-769-6010