Below is a collection of articles written by William V. Padula, OD, SFNAP, FAAO, FNORA

Eye Disease, Aging & Human Visual Function

By William V. Padula, OD, SFNAP, FAAO, FNORA

Demographic studies consistently show that age is the best predictor of visual impairment and blindness (Hatfield, 1973, NEI 2004). Aging contributes to visual impairment through both normal deterioration of eye tissues and increased incidence of eye pathology. According to the National Eye Institute, statistics from a study by their Eye Disease Prevalence Research Group show age-related macular degeneration (AMD), glaucoma, cataract, and diabetic retinopathy are the most common eye diseases in Americans age 40 and over. It is estimated that in 2004, AMD with associated vision loss affected 1.8 million, glaucoma 2.2 million, diabetic retinopathy 4.1 million, and cataract 20.5 million. All of these diseases are expected to increase substantially by 2020 as the population ages. At that time it is projected that nearly 3 million persons will have AMD with associated vision loss. (read more)

Post Trauma Vision Syndrome & Visual Midline Shift Syndrome

By William V. Padula, OD, SFNAP, FAAO, FNORA, Stephanie Argyris

Following a neurological event such as a traumatic brain injury (TBI), cerebrovascular accident (CVA), Multiple Sclerosis (MS), etc. Vision imbalances can occur between the focal and ambient visual process that can affect balance, posture, ambulation, reading, attention, concentration and cognitive function in general. Post Trauma Vision Syndrome (PTVS) and Visual Midline Shift Syndrome (VMSS) can be the cause of these difficulties. This paper discusses the symptoms and characteristics of these syndromes as well as methods of treatment. (read more)

Visual evoked potentials (VEP) evaluating treatment for post-trauma vision syndrome (PTVS) in patients with traumatic brain injuries (TBI)

By William V. Padula, OD, SFNAP, FAAO, FNORA, S. Argyris and J. Ray

Post-trauma vision syndrome (PTVS), which is characterized by binocular function problems, may be caused by dysfunction of the ambient visual process which is part of the sensory-motor feedback loop, rather than by a specific oculomotor disturbance. Clinically, PTVS frequently presents with symptoms of diplopia, blur, seeing movement in the spatial environment, vertigo, and hallucination-like experiences. Visual evoked potentials (P100) were used to evaluate an experimental group (n = 10) of subjects who suffered a traumatic brain injury, and a control group (n = 10). A new treatment using prisms and bi-nasal occluders, which affected amplitude responses of the VEP, was evaluated. The results demonstrate that the amplitude of the VEP is a function of cortical binocular integration, and that this is influenced by dysfunction of the ambient visual process. The results also demonstrate that base-in prism and bi-nasal occluders are an effective means to treat ambient vision disturbances resulting from head trauma induced PTVS. (read more)

Modifying postural adaptation following a CVA through prismatic shift of visuospatial egocenter

By William V. Padula, OD, SFNAP, FAAO, FNORA ab; Christine A. Nelson a; William V. Padula ac; Raquel Benabib a; Taygan Yilmaz c; Steven Krevisky d
a) Padula Institute of Vision, Guilford, CT, USA

b) Pennsylvania College of Optometry, PA, USA

c) Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA

d) Middlesex Community College, Middletown, CT, USA

Following a cerebrovascular accident (CVA), individuals initially tend to lean toward the side of the hemiparesis. A long-term effect of this condition has been termed Pusher Syndrome. Johannsen et al.[1] showed that there is a severely disturbed perception of body orientation unrelated to vestib-ular dysfunction (e.g. a sensorimotor mismatch without vestibular dysfunction affecting position sense). This study suggests that it is caused by a disturbed representation of body-space orientation (e.g. spatial organization to maintain upright body position against gravity), in turn affecting leg-trunk orientation and causing a lean into the affected side and a ‘push’ away from the functional side. However, within the first few weeks many will develop compensations causing a tendency to lean away from the hemiparetic side. (read more)

Risk of fall (RoF) intervention by affecting visual egocenter through gait analysis and yoked prisms

By William V. Padula, OD, SFNAP, FAAO, FNORA*, Prem Subramanian**, April Spurlinga*, William V. Padula, OD, SFNAP, FAAO, FNORA*** and Jonathan Jennessa*

*Padula Institute of Vision Rehabilitation, Guilford, CT, USA
**Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
***Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Falls are a major public health risk (Centers for Dis-ease Control, 2004). Each year over 37 million people seek medical attention for a fall related injury costing 19 billion dollars for injuries sustained in the year 2000 (Stevens, Corso, Finkelstein, & Miller, 2006). In the U.S., 25% of all hospital admissions are for injuries secondary to falls (Centers for Disease Control, 2004). One in three people over age 65 will sustain a fall each year (Trump, Pluijm, & Smit, 2001). Considering older adults, falls are the most common cause of injuries and hospital admissions for trauma which accounts for 87%of all fractures in patients who are 65 years and older (Fife & Barancik, 1985). Added to this concern is that 53% of those adults discharged from medical care for fall-related hip fractures will experience another fall within 6 months, developing increased risk for chronic morbidity according to Creditor (Creditor, 1993). Neurologic events such as traumatic brain injuries (TBI), cerebrovascular accidents (CVA), and chronic neurological conditions including Parkinson’s disease,multiple sclerosis, and cerebral palsy can directly affect posture, balance and spatial orientation; thus, these con-ditions significantly increase patients’ risk of fall (RoF)(National Hospital Ambulatory Medical Survey, 2015). The prevalence of TBI and CVA is increasing rapidly in the United States, with an estimated 50 million people suffering from CVA, and an additional 10 million from TBI (Padula, Argyris, & Ray, 1994). (read more)