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NEURO-OPTOMETRY

BRAIN & VISION

Vision is the skill that allows us to see the world around us. When we observe the world, a complex series of processes takes place between the eye and the brain. The eyes take in the information, while the brain is responsible for processing and interpreting it.

When the brain is injured, the ability to interpret visual information can be affected in different ways.

Visual problems following brain injury can affect both the quality of the information received by the brain and interpretation of the information received.

As a result, brain injury survivors can experience a number of different types of visual problems which can range from mild to severe depending on the nature of the injury. As there are such a wide range of different types of visual problems after brain injury, there is no single way of coping with them. 

WHAT IS THE DIFFERENT TYPES OF TREATMENT AFTER BRAIN INJURY?

Following the initial vision and neurological examination a treatment plan is developed with a goal of restoring essential visual function. Because every injury is unique, treatments will vary by individual.

Below are some types of treatments:

  • Special Prescription Lenses (Glasses) – Lenses can help compensate for damage to the neural system along with enhancing visual clarity and comfort. Lens filters (tints) provide help with light and glare sensitivity.
  • Prism Lenses – These are specialized glasses that change the way light enters the eye. Prisms are frequently prescribed as a component of the treatment for binocular vision problems and to eliminate double vision, as well as to provide comfort for near visual tasks such as reading. In addition, prisms are often used in treating balance issues, a common component in brain injury.
  • Patching – Patching one eye or part of the visual field of one eye is sometimes used to help those with double vision. The patch is placed to eliminate the information that results in the double image from coming into the brain. The patch is frequently placed directly upon the lens surface.
  • Visual Therapy – Visit our site: EYEMIND

SEEING A NEURO-OPTOMETRIST AFTER A BRAIN INJURY

Brain injury can affect a person in many ways. Depending on the extent of the injury, problems with visual information processing may contribute to and/or exacerbate symptoms of things such as eye strain, fatigue, headaches, difficulties with balance and posture, depth perception, and memory loss. Often one type of rehabilitation is not enough to address all of the individual’s needs. An interdisciplinary, integrated team approach can play a vital role in the rehabilitation of patients with concussions, stroke or other neurological deficits.

DIAGNOSING VISUAL PROBLEMS AFTER STROKE OR TRAUMATIC BRAIN INJURIES

Visual problems are often overlooked during initial treatment of a brain injury and in some cases; symptoms may not be present until sometime following the injury. If you notice any changes in your vision following a concussion or some other head trauma, don’t ignore them: Immediately contact your eye care professional. It is important to determine the cause of the vision change. Early diagnosis leads to appropriate treatment and/or referral to a specialist, such as our Deidre de Jongh, who is a Neuro-Optometric Rehabilitation Optometrist.

Left untreated, visual system disorders can have serious consequences, such as the ability to organize and make sense of visual information along with poor depth perception and difficulties concerning balance and posture.

Following are some common vision problems that may occur following brain injury or other medical conditions such as a stroke:

Eye focusing – Blurred vision or ability to shift focus between objects between near and far distances may be compromised.
Eye teaming – Your eyes may not work together properly as a team even to the point of experiencing double vision.
Eye movements – You may experience difficulty with eye movements when reading or trying to follow a moving object (like a ball being thrown). Losing your place while reading is a common complaint.

Motion sensitivity – The integration between the vision and balance system can be disrupted, making it difficult to process motion properly. Symptoms can include discomfort and even dizziness when scrolling on a computer screen or phone, or when in busy environments such as grocery stores, social settings, or sporting events.

Symptoms may vary among individuals, but some typical symptoms include:

  • Visual Field Loss – Partial or complete vision loss can also occur after a head trauma. The area of the brain that has been affected as well as the extent of the damage will determine your field of view. This may cause such problems as bumping into objects, being struck by approaching objects, or sudden falls.
  • Eye Pain and Headaches – Whether it is a stabbing pain, dull ache around the eye, or even redness, burning or itching, you may experience eye discomfort following head trauma. Headaches can be long-lasting, even past one year from injury. These symptoms can make it hard for you to carry out daily activities or can cause you to have more difficulty thinking and remembering things.
  • Sensitivity to Light – Brain injury is often accompanied by increased light sensitivity and general inability to tolerate glare. Photophobia, or sensitivity to light, can be exacerbated by specific light sources, such as bright sunlight and fluorescent lighting. Recent studies have also suggested that LCD screens (such as from computers or smartphone devices) can be particularly bothersome after a concussion.

Animated images courtesy of Nielsen Vision Development Center (Selma, TX).


MIGRAINES

Ocular migraine symptoms generally include a small blind spot (scotoma) that affects your central vision in one eye. This blind spot gets larger, making it impossible for you to drive safely or read with the affected eye.

In some cases, the entire visual field of one eye may be affected. Generally, the episode lasts less than an hour.

Visual migraine symptoms can vary, and may include:

Visual migraines often appear suddenly and may create the sensation of looking through a cracked window. The visual migraine aura usually moves across your field of view and disappears within 30 minutes. 

  1. A flickering blind spot in the center or near the center of your field of view
  2. A wavy or zigzag ring of colored light surrounding a central blind spot
  3. A blind spot that slowly migrates across your visual field

The symptoms of a visual migraine typically affect both eyes and last 30 minutes or less. A migraine headache may occur shortly after the symptoms of a visual migraine subside or no headache may occur.

If you’re experiencing a blind spot or other visual disturbance and you’re not sure if it’s an ocular migraine or a visual migraine, then cover one eye at a time. If the visual disturbance is occurring in just one eye, it’s likely that it’s an ocular migraine. If it affects both eyes, it’s probably a visual migraine.

But don’t take chances. If you suddenly experience any sort of blind spot in your field of vision, please contact the practice immediately to book an appointment with our Deidre de Jongh  to determine if it’s harmless or possibly a sign of something more serious, such as a retinal detachment.

TYPES OF OCULAR MIGRAINES:

This phenomenon can be a little confusing, because the same term is often used to mean different things, some of which are more serious. Let’s take a look at each of the three conditions the term is commonly associated with.

PAINLESS OCULAR MIGRAINE

This type of ocular migraine usually involves a widening blurry spot in your vision, surrounded by bright, flickering lights. Visual disruptions could be the only symptoms, but sometimes they are accompanied by problems with other senses, speech, or motor skills. The effect can be very disorienting, but it should only last a few minutes to half an hour before going away on its own.

Painless ocular migraines might be alarming the first time they happen, but they are usually harmless. If one happens while you’re driving, pull over until it passes. If possible, lie down and relax until it goes away, and it’s worth scheduling an eye exam just to make sure nothing else is going on.

MIGRAINE WITH AURA

Sometimes the same visual disruptions can accompany a migraine headache, usually between the premonitory and peak pain phases of the migraine.

If you experience these types of migraines, see a doctor if you haven’t already. Also be on the lookout for migraine triggers, such as sudden bright light, stress, and certain foods. Oral contraceptives and smoking can be triggers as well.

A migraine aura is a neurological phenomenon most commonly associated with visual disturbances before the onset of a headache. You may see things like zig zag lines, flashing lights, or other visual effects before your migraine begins.

Migraines with aura include additional visual and non-visual symptoms that can provide a useful warning that a headache is on its way.

The visual aura symptoms may include:
  • Geometric patterns
  • Flashing lights
  • Stars and spots
  • Zig zag lines
  • Sparkles
  • A shimmering effect (similar to heat waves)

These may appear in the center of your field of vision and gradually spread outward. Some people also experience blind spots or tunnel vision.

Non-visual aura symptoms may include:

  • Tingling or numbness in the hands or face
  • Dizziness or vertigo
  • Muscle weakness
  • Difficulty with speech and/or hearing
  • A sense of fear or confusion (rare)
  • Partial paralysis or fainting (rare)

Auras usually develop over the course of five to 20 minutes and last fewer than 60 minutes. The head pain and other symptoms associated with classic migraines typically come after the aura, but might begin during the auras well.

The cause of migraines with aura isn’t fully understood.  Like migraines without aura they are considered a neurovascular disorder. As nerve cell activity increases within the brain, inflammatory chemicals are released, causing swelling of the cranial blood vessels. As the blood vessels swell, they activate the surrounding pain receptors, which ultimately transmit pain signals to the brain.

RETINAL MIGRAINE

The most dangerous (but also the rarest) thing “ocular migraine” could refer to is a retinal migraine. A person who has experienced other migraine symptoms could experience repeated, temporary bouts of diminished vision or blindness in one eye. Be sure to see an optometrist or doctor right away if you experience a retinal migraine.

WHAT TO DO NEXT

No matter what kind of ocular migraine you’re experiencing, we strongly encourage you to book an appointment in order for our Deidre de Jongh to confirm that there isn’t a more serious underlying cause.

Read more about Neuro-Optometry on our sister site: http://eyemind.co.za/brain-injury/