Neuro-Optometric Rehabilitation Case Study

William V. Padula, OD, DPNAP, FAAO, FNORA

 

Mr. L. was referred for a Neuro-optometric rehabilitation examination by doctors from a rehabilitation hospital.  He suffered a severe whiplash when his automobile was struck from behind. He is 45 years old and he was in normal health prior to his injury.

Initially, Mr.L. was taken to a hospital but was not admitted. Within 24 hours of the accident he lost the ability to balance and began to have significant speech and cognitive function problems.  Physical and occupational therapy were initiated but his progress remained limited.

Mr. L. was unable to respond to most of the questions asked of him but appeared to stare at the examiner and looked to his wife in order to ask her to help him respond to the questions.  His entering visual acuity with best distance correction was 20/60 right eye, left eye and both eyes.  He had a very difficult time developing pursuit tracking and demonstrated facial contortions indicating that he was in considerable discomfort when attempting to track an object toward his face.  The examination determined that he had the characteristics of Post Trauma Vision Syndrome which included convergence insufficiency, accommodative dysfunction, oculomotor dysfunction, and photophobia (glare sensitivity).  Upon treating him, using his habitual distance correction and adding low amounts of base in prism and binasal occlusion, his distance acuity responded within minutes and improved to 20/25 right eye, left eye and both eyes.  Improvements were also demonstrated in his ability to track objects and to improve fixation on an object moved toward his face without losing eye alignment and without experiencing the excessive discomfort and eye strain.  Speech patterns also began to improve as his discomfort minimized, and he was able to answer questions that were related to this.  He reported that he was frequently having double vision but that with the lenses and occlusion he experienced a singular binocular world that slowly improved in three dimensions, enabling him to perceive depth in his environment.

It was also determined that he had a significant shift in his concept of visual midline to the right.  When walking, he leaned heavily to the right and began to drift to the right while scissor-stepping across with his left foot.  Utilizing an additional yoked prism to shift the midline back to center, he was immediately able to weight bear on his left side while walking in a straight line and maintaining his balance and posture.  Prism glasses were designed for him for use full time and separate therapeutic yoked prisms were designed to be used in conjunction with physical therapy.

Mr. L. returned to the hospital where he was an inpatient and continued rehabilitation through prescribed physical, occupational and cognitive rehabilitation programs.  The reports from the therapists documented the significant improvement with balance, ambulation, attention and concentration. He returned for a follow-up visit six weeks thereafter.  He reported that he had been discharged from the hospital and was an outpatient.  His speech patterns and cognitive functioning had improved. His balance also had improved considerably. He continued to use the yoked prisms for the prescribed two hours per day.

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