Vision can improve without visual rehabilitation: an optometrist’s perspective
Many times, visual symptoms are present following a head injury, however these symptoms are not always solely related to vision. Although it is important to have the visual system assessed after a head injury or concussion, multidisciplinary care is often needed. That’s what allowed our 35-year-old Caucasian female patient to heal so quickly from her concussion. Here’s some perspective on the background of our patient and why it’s so important to trust the process.
On May 11, 2018, our patient fell from the deck she was building, and hit the left side of her head on a wooden joist. Her injury was accompanied with short term memory loss. She was taken to the hospital, where she was diagnosed with a concussion and whiplash. Over the next few days, she began experiencing symptoms of light sensitivity, headaches, noise sensitivity, and neck pain.
She ended up in my chair on August 7, 2018 for a visual assessment. Her presenting symptoms included: daily headaches, dizziness, difficulty with balance, reduced spatial awareness when driving, blurred and double vision at near, slow shift of focus between distance and near, a pulling sensation around her eyes, difficulty with reading, difficulty with concentration and attention, light sensitivity, difficulty with busy and/or crowded environments, and difficulty with short term memory. She was actively receiving chiropractic treatment, which did help reduce the tension in her head and neck.
I diagnosed our patient with Post-Concussion Vision Syndrome, with visual findings of convergence insufficiency, accommodative excess, oculomotor dysfunction (ie difficulty with saccades and pursuits), and light sensitivity. For treatment, I prescribed glasses containing prism and tint, and referred the patient to our concussion program at York Region Concussion Clinic. Vision therapy was initiated in the interim, with activities focusing on spatial awareness, vergences, and accommodation. It was estimated the patient would likely require 24 sessions of vision therapy for visual rehabilitation to occur.
Her first assessment with our clinic was on August 22, 2018, after which vision therapy was put on hold. Through extensive assessments, in addition to her visual difficulties, she was found to have motion sensitivity, visual motion intolerance, sensory mis-weighting, autonomic dysfunction, and postural imbalance. Over the next 3 months, her therapies included cervical treatment, energy and symptom management, biofeedback, and vestibular therapy.
After 3 months in the program, our patient was deemed ready to re-initiate vision therapy. Most of her symptoms had resolved, except for a dull headache at the end of her day or when her heart rate was too high. The same vision therapy exercises, which were introduced 3 months prior, were used during her first session. Surprisingly, the patient no longer had difficulty with these activities, indicating improved vergence and accommodative function, despite receiving no visual rehabilitation.
A visual re-assessment was completed, and it was found that our patient no longer required the glasses containing prism and tint. The light sensitivity and oculomotor dysfunction had completely resolved, and the vergence and accommodation systems were near normal. She is currently enrolled in vision therapy, and we are estimating a total of 5 vision therapy sessions until her visual system is completely rehabilitated.
The moral of the story
Each patient is different, however in some cases other types of therapy (such as vestibular therapy, cervical therapy, or biofeedback) can actually help in a quicker visual recovery. With these therapies, the patient described above was able to reduce her visual symptoms (including blurred and double vision), and her visual system was almost normal without even one session of vision therapy! The entire body really is connected, and with the right team, rehabilitation is possible!
Written by: Dr. Mona Ubhi
Last update: February 2019