1. 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

2. 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

3. 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);

4. 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

5. 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

6. 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

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

8. 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

9. 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

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

11. 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

12. Summary & Questions

13. Contact Charmaine Wright, MRC, CRC Vision Therapy Administrator