Photosensitivity in mild traumatic brain injury (mTBI): a retrospective analysis.

PRIMARY OBJECTIVE: To determine whether photosensitivity (PS) changes over time and, if so, what factors may be related to the change; furthermore, to determine whether tint density changes over time, all in mild traumatic brain injury (mTBI). DESIGN AND METHODS: A retrospective analysis of 62 patient records (aged 18-40 years) with mTBI and PS was conducted. All charts were obtained from the SUNY/College of Optometry clinics from 2004-2011. RESULTS: Fifty per cent demonstrated reduced PS over time, with most occurring after year 1 post-injury (40%). Promotion of PS reduction appears to be associated with the lack of spectacle tint usage (p = 0.01) and the use of contact lenses (p = 0.03). Inhibition of PS reduction appears to be associated with tinted lenses (p = 0.06), hyperacusis (p = 0.03), dry eye (p = 0.04), migraines (p = 0.03) and loss of consciousness at the time of injury (p = 0.05). Concerning tint density changes over time, 71% (p = 0.002) maintained the same degree over time, while 27% (p = 0.002) reduced and 2% waxed and waned. CONCLUSION: Neural adaptation to PS appears to be a long-term process. Tint usage may act to inhibit this adaptive process, while the use of contact lenses may act to promote it. These findings may provide guidance in the clinical management of photosensitivity in the mTBI population.

Medications prescribed to brain injury patients: a retrospective analysis.

BACKGROUND: The purposes of this study were to retrospectively evaluate the frequency of medications used by individuals with either traumatic brain injury (TBI) or cerebrovascular accident (CVA) and to consider the possible relationship between vision symptoms and diagnoses in this sample and the established visual and ocular side effects of the prescribed medications. METHODS: Charts of patients examined in the Raymond J. Greenwald Rehabilitation Center at the SUNY State College of Optometry from the years 2000 to 2003 were reviewed. Only TBI (n=160) or CVA (n=60) patients were included. Prescribed medications from 12 possible categories were identified. Patients experiencing blurred vision, diplopia, asthenopia, poor depth perception, and/or light sensitivity were identified. Patients with accommodative dysfunction, vergence dysfunction, versional dysfunction, dry eyes, and/or ptosis were also identified. RESULTS: The 4 most common medication categories taken by TBI patients were anti-anxiety/antidepressants (42.5%), anticonvulsants (26.9%), opiate/combination analgesics (23.8%), and cardiac/antihypertensives (23.1%). For the CVA patients, the medications were cardiac/antihypertensives (66.7%), anti-anxiety/antidepressants (31.7%), vitamins/mineral supplements (26.7%), and anticonvulsants (23.3%). Frequency of vision symptoms and diagnoses in the TBI and CVA patients appeared not to be related to medication use in most cases. CONCLUSIONS: Anti-anxiety drugs, antidepressants, and anticonvulsants were the overlapping medication categories between the TBI and CVA groups. Medication intake did not affect the frequency of the reported vision symptoms and diagnoses in most cases, suggesting the symptoms and diagnoses were primarily related to either the TBI or CVA itself.

The frequency of occurrence, types, and characteristics of visual field defects in acquired brain injury: a retrospective analysis.

BACKGROUND: The purpose of this retrospective study was to determine the frequency of occurrence of visual field defects in a sample of visually symptomatic, ambulatory outpatients who have acquired brain injury (ABI), either traumatic brain injury (TBI) or cerebral vascular accident (CVA). METHODS: The medical records of 220 individuals with TBI (n=160) or CVA (n=60) were reviewed retrospectively. This was determined by a computer-based query spanning the years 2000 through 2003. The individuals' records were reviewed to determine the frequency of targeted visual field defects that were classified as scattered, restricted, homonymous, nonhomonymous, and visual neglect. The altitudinal and lateral characteristics of these defects were also determined. RESULTS: In the total ABI sample of 220, some 102 (46.36%) individuals had 1 of the targeted defects diagnosed. These defects were present in 62 (38.75%) of the TBI subgroup and in 40 (66.67%) of the CVA subgroup. The most frequent defects in the TBI group were scattered (58.06%) followed by homonymous (22.58%). In the CVA group, the most numerous were homonymous (47.5%), with scattered and nonhomonymous accounting for 20% each. CONCLUSION: The uniqueness of the current study is that it reports the frequency of occurrence of specified visual field defects in the total ABI sample and in the TBI and CVA subgroups. This enabled comparisons with other studies that generally have reported on just 1 of these groupings. The current results are in accord with most of the other studies that are reviewed. The findings of this study should alert the reader to the high frequency of occurrence of visual field defects in the ABI population, and make the reader aware of the adverse effects they can have on quality of life and rehabilitation.

Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective analysis.

BACKGROUND: Oculomotor dysfunctions are among the most common abnormalities found in the brain-injured population. The purpose of the current study was to determine retrospectively the effectiveness of conventional optometric vision therapy for oculomotor disorders of vergence and version in a sample of ambulatory, visually symptomatic, predominantly adult outpatients who had either mild traumatic brain injury (TBI) or cerebrovascular accident (CVA). METHODS: A computer-based query for acquired brain injury patients examined between the years of 2000 and 2003 was conducted in our clinic. This yielded 160 individuals with mild TBI and 60 with CVA. Of these patients, only those for whom vision therapy was prescribed and who completed an optometric vision therapy program for remediation of their oculomotor dysfunctions were selected. This included 33 with TBI and 7 with CVA. The criterion for treatment success was denoted by marked/total improvement in at least 1 primary symptom and at least 1 primary sign. RESULTS: Ninety percent of those with TBI and 100% of those with CVA were deemed to have treatment success. These improvements remained stable at retesting 2 to 3 months later. CONCLUSION: Nearly all patients in the current clinic sample exhibited either complete or marked reduction in their oculomotor-based symptoms and improvement in related clinical signs, with maintenance of the symptom reduction and sign improvements at the 2- to 3-month follow-up. These findings show the efficacy of optometric vision therapy for a range of oculomotor abnormalities in the primarily adult, mild brain-injured population. Furthermore, it shows considerable residual neural plasticity despite the presence of documented brain injury.

Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis.

BACKGROUND: The purpose of this retrospective study was to determine the frequency of occurrence of oculomotor dysfunctions in a sample of ambulatory outpatients who have acquired brain injury (ABI), either traumatic brain injury (TBI) or cerebrovascular accident (CVA), with associated vision symptoms. METHODS: Medical records of 220 individuals with either TBI (n = 160) or CVA (n = 60) were reviewed retrospectively. This was determined by a computer-based query spanning the years 2000 through 2003, for the frequency of occurrence of oculomotor dysfunctions including accommodation, version, vergence, strabismus, and cranial nerve (CN) palsy. RESULTS: The majority of individuals with either TBI (90%) or CVA (86.7%) manifested an oculomotor dysfunction. Accommodative and vergence deficits were most common in the TBI subgroup, whereas strabismus and CN palsy were most common in the CVA subgroup. The frequency of occurrence of versional deficits was similar in each diagnostic subgroup. CONCLUSION: These new findings should alert the clinician to the higher frequency of occurrence of oculomotor dysfunctions in these populations and the associated therapeutic, rehabilitative, and quality-of-life implications.

Occurrence of ocular disease in traumatic brain injury in a selected sample: a retrospective analysis.

PRIMARY OBJECTIVE: To determine retrospectively the relative risk of ocular disease in a selected, visually-symptomatic sample of clinic patients having traumatic brain injury (TBI; n=160) vs. cerebrovascular accident (CVA; n=60), with all initially presenting at the clinic with symptoms and/or signs of vision dysfunction. METHODS AND PROCEDURES: To review retrospectively 220 medical records of individuals with TBI (n=160) vs. CVA (n=60), as determined by a computer-based query spanning the years 2000-2003, to ascertain the frequency of occurrence of ocular disease in the two major sub-groups of acquired brain injury. MAIN OUTCOMES AND RESULTS: Conditions with high relative risk unique to TBI included corneal abrasion, blepharitis, chalazion/hordeolum, dry eye, traumatic cataract, vitreal prolapse and optic atrophy. This is distinct from those ophthalmic conditions unique to CVA, which included sub-conjunctival haemorrhage and ptosis. CONCLUSION: These new findings should alert clinicians to the potential increased frequency of occurrence of specific ocular diseases in a selected, visually-symptomatic population with TBI and their associated rehabilitative and quality-of-life implications.

A primer for the optometric management of unilateral spatial inattention.

BACKGROUND: Unilateral spatial inattention (USI) (a.k.a. neglect, unilateral neglect, visual neglect) is a common occurrence after stroke. It can also occur subsequent to traumatic brain injury. Insult to the right inferior (posterior) parietal cortex is the structure that is virtually always involved, although other brain areas have been implicated. The major consequence of USI is that the patient is unaware of one side of the body, and/or one side of visual space. Current literature expresses this as USI in the individual's personal, peri-personal, and extra-personal spaces. METHODS: We discuss the condition's natural history, occurrence and behavioral consequences. CONCLUSIONS: We propose a system for the optometric management of USI in extra-personal and peri-personal spaces.