1. Research and Academic Activities

2. Retrospective Data Analysis: 38 TBI Patients Diagnosed with VH with Complete Data Sets Average age: 38 years (range 12 – 67 yrs) Female = 66% (25) Male = 34% (13) Average duration of symptoms = 9.9 years ( 3 months to 30 years)

4. 3.66 consults / pt

6. 7 Binocular Vision Questions RankBVDQ question (10) Skip lines while reading (12) Head tilt (21) Pain with eye movement (22) Words run together while reading (23) Double / overlapping vision near (24) Close or cover an eye (25) Double / overlapping vision far You’ll miss this condition if you only look for binocular vision symptoms !

7. Top 10 BVDQ Questions RankBVDQ question (1 ) Shoulder and neck discomfort (2) Headache (3) Glare / sensitivity to bright lights (4) Dizzy / lightheaded (5)Tire easily with close-up tasks (6)Blink to clear up distant objects (7) Unsteady / drift to one side (8) Dizziness with provocative head movements (9) Car rides = uncomfortable / dizzy (10) Do you skip lines while reading

8. Top 10 BVDQ Questions RankBVDQ question (1 ) Shoulder and neck discomfort (2) Headache (3) Glare / sensitivity to bright lights (4) Dizzy / lightheaded (5)Tire easily with close-up tasks (6)Blink to clear up distant objects (7) Unsteady / drift to one side (8) Dizziness with provocative head movements (9) Car rides = uncomfortable / dizzy (10) Do you skip lines while reading

9. Top 10 BVDQ Questions RankBVDQ question (1 ) Shoulder and neck discomfort (2) Headache (3) Glare / sensitivity to bright lights (4) Dizzy / lightheaded (5)Tire easily with close-up tasks (6)Blink to clear up distant objects (7) Unsteady / drift to one side (8) Dizziness with provocative head movements (9) Car rides = uncomfortable / dizzy (10) Do you skip lines while reading You have to ask the right questions to come up with the right answers !

10. New Research Projects

11. Results of Treatment - NPC 11 of 145 patients started at “0” or experienced no change (7.5%) 134 Non 0-0 Patients (92.5%)

12. Results of Treatment - NPC 134 Non 0-0 Patients (92.5%) Before: 10.1 inches After: 5.1 inches 49.4% Reduction

13. Results of Treatment - NPC 134 Non 0-0 Patients (92.5%) Before: 10.1 inches After: 5.1 inches 49.4% Reduction 88% of patients improved (118/134) 12% of patients did not improve (16/134)

14. Results of Treatment – King-Devick 105 Patients

15. Results of Treatment – King-Devick 105 Patients Before: 61.9 secs After: 52.3 secs 15.5% Reduction

16. Results of Treatment – King-Devick 105 Patients Before: 61.9 secs After: 52.3 secs 15.5% Reduction 72.3% of patients improved (76/105) 27.6% of patients did not improve OR no change (29/105)

17. Results of Treatment – King-Devick 105 Patients Before: 61.9 secs After: 52.3 secs 15.5% Reduction 72.3% of patients improved (76/105) 2/3 (51/76) improved >5 secs 27.6% of patients did not improve OR got worse (29/105)

18. Results of Treatment – SSI 273 Patients

19. Results of Treatment – SSI 273 Patients Before: 13.9 After: 5.6 59.5% Reduction

20. Results of Treatment – SSI 273 Patients Before: 13.9 After: 5.6 59.5% Reduction 76% of patients improved (208/273) 23.8% of patients: no change or got worse (65/273)

21. Results of Treatment – Stereopsis 108 Patients

22. Results of Treatment – Stereopsis 108 Patients 39 were 9-9

23. Results of Treatment – Stereopsis 69 Patients 39 were 9-9

24. Results of Treatment – Stereopsis 69 Patients 59% of patients improved (41/69) 41% of patients: Worse (13/69) or no change (15/69)

25. Results of Treatment – Stereopsis 69 Patients 59% of patients improved (41/69) 41% of patients: Worse (13/69) or no change (15/69) Before: After: 4.3 7.6 Before: After: 6.5 4.8 +75% Improvement -26% +3.3 units-1.7 units

26. Conclusions The symptoms of BVD are frequently present but not being recognized as being visual in etiology, despite extensive testing and consultation Binocular vision dysfunction (BVD) appears to be causing post-concussive symptoms in ~ 30% of all TBI / ABI patients with persistent symptoms (>3 months) The TBI / ABI appears to be causing the BVD

27. Conclusions Treatment of the BVD with realigning prismatic lenses reduces post-concussive symptoms 80% BVD Suspects can be easily identified with a validated questionnaire BVD can be firmly diagnosed by the Prism Challenge Technique

28. NeuroVisual Optometry

30. PATIENT Referrals

32. Wrap Up & Final Review

33. Which Patients to Screen for VH and SOP using the BVDQ? Patients who have dizziness, headache, neck ache, visual / reading difficulties, anxiety Patients who have dizziness, headache, neck ache, visual / reading difficulties, anxiety –TBI with symptoms persisting 3 months or longer after injury Those with Physical Findings of VH & SOP Those with Physical Findings of VH & SOP Elderly with difficulty with balance / frequent falls Elderly with difficulty with balance / frequent falls

34. Which Patients to Screen for VH and SOP using the BVDQ? Children with “reading and learning difficulties” (?LD; ?RD) Children with “reading and learning difficulties” (?LD; ?RD) Children with “hyperactivity” (?ADD/ ADHD?) Children with “hyperactivity” (?ADD/ ADHD?) Children with motion sickness / car sickness Children with motion sickness / car sickness Difficulty watching 3D movies Difficulty watching 3D movies Agoraphobia Agoraphobia Panic attacks Panic attacks

35. Who Needs Referral? High score on BVDQ > 15 High score on BVDQ > 15OR Positive answers to any of the RED FLAG questions Positive answers to any of the RED FLAG questions

36. Take Home Messages This represents a large percentage of the general population (5-10%) Standard Binocular Vision tests are not sensitive enough to identify this patient population Know the power in the 5 Minute Cover Test

37. Take Home Messages Have all of your patients fill out the questionnaire before your exam - you will be amazed by what you find! Look for head tilt on all of your patients These patients will not get better until their BVD is recognized and treated This work will give you the gift to change lives

41. “Who, indeed, could “Who, indeed, could have supposed that a have supposed that a mere ocular defect mere ocular defect could have given rise to could have given rise to so serious a train of evils… so serious a train of evils… and who that had not seen and who that had not seen it could believe that the it could believe that the correction by glasses of the eye trouble correction by glasses of the eye trouble could have given a relief so speedy and so could have given a relief so speedy and so perfect that the patient described it as a perfect that the patient described it as a miracle?” miracle?” Dr. S. Weir Mitchell, Headaches and Eye Strain, April 1876