Head Trauma Vision Problems

Welcome to the TBI-HELP Live Chat

Today's topic is: "Head Trauma Vision Problems in Traumatic Brain Injury"

Our Guest is: Dr. Neera Kapoor, OD, MS, Assistant Clinical Professor, Director of Unit Operations, Head Trauma Vision Rehabilitation Unit, SUNY School of Optometry.

[19:00:54] Mod: Good Evening and welcome to our chat session! Tonight we have Dr. Neera Kapoor, OD, MS, Assistant Clinical Professor, Director of Unit Operations, Head Trauma Vision Rehabilitation Unit, SUNY School of Optometry. Welcome Dr, Kapoor
[19:02:06] DrK: Thank you. It is a pleasure to be here..
[19:02:59] Mod: Rail: Given the variety of Head Injuries in TBI-what is the most common vision problem encountered?..
[19:03:35] DrK: That is a good question, Rail. Most commonly, people experience troubles with reading, in terms of reduced speed of reading and loss of place while reading..
[19:05:28] Mod: What vision rehabilitation is necessary after someone suffers a TBI?
[19:07:27] DrK: In response to Mod, the type and frequency of vision rehabilitation post-TBI depends on the individual's vision complaints. In response to Rail, blurred vision is not typically the primary complaint post-TBI..
[19:09:03] Mod: Rail: I would have thought that blurred vision or reduced acuity would have been first on the list-given the general neurological disruption of TBI
[19:10:33] DrK: Further, in response to Rail's comment about blurred vision and general neurological disruption, typically eye movement problems, double vision, loss of peripheral vision, balance problems and photosensitivity are more common than framnk blurred vision..
[19:10:11] Mod: Rail: Can the early diagnosis of TBI give some clue as to the type of vision problems, and rehabilitation that will be encountered?
[19:13:11] DrK: Rail, early diagnosis of TBI permits a better idea of the prognosis of the vision deficit because you have evaluated it from the start. This permits a better means of determining progress over time. It does not specify the type of vision problems that will be encountered..
[19:11:32] Mod: Do insurance companies pay for visual rehabilitation?
[19:14:12] DrK: Mod. Insurance companies will cover vision rehabilitation if the vision problem is secondary to the TBI. Often several letters of medical necessity are required as well..
[19:15:36] Mod: What happens if inappropriate or mismatched signals are sent after a TBI/
[19:18:06] DrK: Mod, when inappropriate or mismatched signals are sent in TBI patient with respect to the visual and vestibular system, this may result in dizziness, nausea, motion sensitivity, vertigo, and/or disequilibria. Improving how one uses one's eyes together as a team may help decrease these symptoms..
[19:18:51] Mod: If the TBI patient doesn't recognize a family member - how often is that attributed to vision disruption rather than cognitive damage?
[19:19:59] DrK: Rail, it is often a combination of vision and cognition rather than just one or the other. Frequent reinforcement on both fronts may improve the ability to recognize family members..
[19:22:06] Mod: James: I'm in Hong Kong - is there a good history of proper treatment for TBI over here, especially when vision is the primary problem visual. I have a friend that was in a motorcycle crash and now is almost blind, but his eyes were not injured in any way.
[19:22:27] DrK: James, I am not familiar with the overall care of TBI in Hong Kong. I will tell you that the actual eye ball need not be directly injured in order to result in reduced visual function. I do not know if this completely answers your question..
[19:23:15] Mod: Max welcome: Max has a question...What are some of the most common causes of vision problems in the TBI patient?..
[19:24:52] DrK: Max, in the absence of cranial nerve damage, open head wounds, and/or frank damage to the eye ball or eye muscles, we are not certain of the exact pathophysiology. It appears to be due to diffuse axonal injury which is basically shearing of the nerve fibers in the brain..
[19:25:34] Mod: Rail: Are Stroke patients more likely to have vision problems - or is this a diagnostic for the site of the stroke?
[19:27:25] DrK: Rail, stroke patients have similar vision problems to TBI, in terms of the eye movement deficits, double vision, peripheral field loss, blurred vision, and photosensitivity. However, their visual memory, visual recognition, and type of field loss are diagnostic of the type of stroke..
[19:27:45] Mod: James: My friend seems to have relatively normal interactions with us - but he cannot see except for shadowy forms in a dark background. Can this be addressed with Rehabilitation or is his sight gone?..
[19:29:33] DrK: James, your friend needs to undergo a complete evaluation, including a visual acuity assessment, contrast sensitivity testing, dilated fundus examination-for a start. The results of those tests will let us kmnow whether or not vision rehabilitation will benefit him..
[19:30:00] Mod: Max: What are some of the treatments that can be used to correct these types of problems?..
[19:32:09] DrK: Max and Cathy, in terms of rehabilitation, for eye movement problems, we train one eye at a time with slow tracking as well as faster. Then we train the two eyes together. We work on tracking exercises to increase the accuracy and speed of reading eye movements. For double vision, we sometimes use special prism glasses for the in-office training..
[19:35:03] Mod: Rail: I've read that the Eye is the most exposed portion of the Brain - is it really the case that the retina and the optic nerve are considered part of the Brain? Or is this just a metaphor?
[19:35:51] DrK: Rail, the eye is part of the brain. In fact, out of the twelve cranial nerves, cranial nerves II, III, IV, V, and VI are directly involved with vision..
[19:37:19] Mod: Cathy: Are there any surgical techniques that have been successful in restoring sight to those patients with anoxia damage?..
[19:39:28] DrK: Cathy, if an individual has suffered a brain injury due to anoxia and they have a vision deficit, I am not likely to recommend any surgical procedure that would require them to go under general anesthesia again-unless, the vision problem is life threatening or sight threatening and the procedure has a very high success rate. I will refer for a consult but I doubt anyone would perform surgery unless it is life-threatening..
[19:40:46] Mod: Farrell: If one of the cranial nerves is damaged due to TBI can it be repaired or can the other nerves be taught to take up the function of the damaged nerve?..
[19:42:19] DrK: Farrell, I am not a neuro-surgeon, neuro-ophthalmologist, or a neurologist, therefore I am unable to comment on the "repair" of the cranial nerves. However, if the damage resulted in double vision, we are often able to address this problem with special prism glasses..
[19:42:39] Mod: Can a vision deficit cause psychological problems for the person who sustained the TBI?..
[19:44:45] DrK: Good question, Mod. Any deficit in function (physical, speech, memory, vision, etc.) decrease a person's self esteem and their level of independence. This negatively impacts their psychological state. Therefore, positive reinforcement in conjunction with individual counseling is often needed..
[19:45:17] Mod: How do these glasses work?..
[19:46:21] DrK: Farrell, the special prism glasses for people with double vision move the image of the world to where their eye is aimed. That way, instead of seeing two images, they will see one..
[19:48:01] Mod: Rob: How are the families supported from a psychological perspective in dealing with the issue of sight impairment for their relative?..
[19:48:56] DrK: Rob, often, the families have been receiving little support pertaining to vision, if any at all. That is why, at the SUNY-College of Optometry, we routinely offer individual counseling and support offered by our Social Work service specifically for our TBI/stroke patients and their family members..
[19:49:14] Mod: what are the treatment options for patients with field deficits?..
[19:52:23] DrK: For patients with field deficits, the treatment is dependent on their awareness of this deficit. If they are aware of the defect, the defect should be monitored every 6 months and scanning training into the missing field should be incorporated. If they are unaware of the defect, often yoked prism spectacles can benefit the patient in conjunction with scanning techniques and monitoring the field defect every 6 months..
[19:52:37] Mod: Rob: Can patients wear these glasses all the time or are they for training the eyes?..
[19:53:57] DrK: Rob, in response to the prism glasses for people with double vision, they typically wear the prisms full-time. People with field defects may be recommended to wear the yoked prism glasses in-office only..
[19:56:55] Mod: Rail: How often is the visual deficit the major component of TBI? and How early would introduction of other communication tools be introduced - like braille and such?..
[19:59:34] DrK: Rail, it is not very common that vision is the primary finding post-TBI. It is more likely to be primary post-stroke (for example, loss of peripheral vision, constant double vision, and inability to recognize objects visually). Early intervention is always appropriate-usually if after 6 months of rehab there is no improvement, then I recommend alternative modalities such as auditory and tactile (i.e.braille) interventions..
[19:59:56] Mod: Well, it looks like we have run out of time. I want to thanks Dr. Kapoor for a very stimulating chat session and welcome her to participate in the near future. Good night to all, thank you and be safe!