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During our last blog "Oculomotor Dysfunction Following an Acquired Brain Injury," we discussed an article that reported 90% of traumatic brain injury patients and 86.7% of stroke patients experienced vision problems classified as oculomotor dysfunction. This week we will discuss how the various types of oculomotor dysfunction can be treated and rehabilitated.  Fortunately there are multiple treatment options available to patients, some of which you may already be familiar with and others that you may not have heard of yet.

The eye care community has known for decades that acquired brain injuries affect the visual system, however assessment of oculomotor abilities, eye teaming, and eye focusing are not evaluated by every eye care provider. The first step in successfully managing the visual effects of your acquired brain injury is to make sure you are evaluated by a doctor who is familiar with the visual repercussions of an acquired brain injury. At Advanced Vision Therapy Center we recommend that all of our acquired brain injury patients be evaluated by Dr. Ryan Johnson. Dr. Johnson completed his residency training in neuro-optometry, binocular vision, and vision therapy at the University of California, Berkeley. He has both the knowledge and experience to diagnose and treat the visual conditions caused by an acquired brain injury.

If an oculomotor dysfunction is identified during your Neuro-Optometric Assessment, the doctor will then be able to discuss the treatment options available to you. Treatment options include:

An updated glasses prescription: It may seem quite simple, but a precise spectacle prescription that maximizes clarity can help stabilize your visual system. Your visual system is fragile following an acquired brain injury and this means that minor imperfections in your prescription that you didn't notice before the injury are now quite bothersome. A prescription that is too strong can tax your weakened eye focusing system. A prescription that is imbalanced can create visual discomfort, headaches, or dizziness. A prescription that is inaccurate can be more blurry than before the accident. For contact lens wearers, an increase in dry eye can result in reduced comfort and clarity of contact lenses and increase dependence on glasses for daily wear.

Prismatic Correction: Prism is a component that can be added to lenses to assist eye teaming abilities. Prism can be used to relieve near symptoms following an acquired brain injury; such as double vision, eyestrain, fatigue, and difficulties reading. Prism is also a great treatment option for people who have a cranial nerve palsy following the injury (which can result in double vision).

Vision Therapy: Thanks to neuroplasticity, individuals of any age can improve their abilities through the development of new neural connections. When performed one-on-one with a trained therapist and under the direction of an optometrist with residency-training, vision therapy is an excellent treatment option following an acquired brain injury. As discussed in last week's blog, the most common types of oculomotor dysfunction in the acquired brain injury population are:

• Convergence Insufficiency (reduced ability to use eyes together at near)

• Deficits of saccades (eye movements that are fast “jumps”)

• Accommodative insufficiency (reduced eye focusing abilities)

• Strabismus (eye turn)

• Accommodative infacility (inability to quickly shift focus with eyes)

The reason why vision therapy is so often used following an acquired brain injury is because it can address ALL of these conditions. Glasses can address accommodative insufficiency and infacility, but not the other conditions. Prismatic correction can address strabismus and to a certain extent convergence insuffciency, but not the other conditions. Deficits in eye movements cannot be addressed by any other treatment options. In-office vision therapy can provide both objective and subjective improvements for patients in a relatively short time. Success with vision therapy increases when performed under the direction of an optometrist with residency-training in the area of vision therapy and when performed one-on-one with a trained therapist. Vision therapy should not be confused with orthoptics or other training programs that are performed in group settings or with the use of a computer program. The computer is the source of headaches, double vision, eyestrain, and fatigue; it is not the answer to those problems.

Interactive Metronome Therapy: This is a research-based training program that is used by individuals of all ages to improve visual processing speed, attention, working memory, and coordination limitations. Our therapist uses the Interactive Metronome to address the cognitive and visual perceptual aspects of your acquired brain injury. While vision therapy will give you the skills to move your eyes across the page efficiently, Interactive Metronome will allow you to interpret the information on the page for improved comprehension and fluency.

Advanced Vision Therapy Center offers all of these treatment options to patients and our team of experts can determine which treatment approaches are most appropriate for you and your goals.