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Lavrich JB, Hamburger JL, Lee KE, Thuma TBT, Omega ML, Zhang QE, Gunton KB. Creating consistency in the diagnosis of convergence insufficiency: screening methods. J AAPOS 2023; 27:346.e1-346.e6. [PMID: 37931838 DOI: 10.1016/j.jaapos.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE To determine the sensitivity of various clinical tests in the diagnosis of convergence insufficiency. METHODS A total of 254 patients were recruited with complaints consistent with convergence problems but no prior history of strabismus surgery, eye exercises, prism use, recent concussion, or other ocular or neurological diseases. Each patient completed the convergence insufficiency symptom survey (CISS), and the following data were collected: ocular alignment at distance and near, convergence and divergence fusional amplitudes at distance and near, near-point of convergence (NPC) using an accommodative target and red lens, and assessment of quality of convergence movement (QoCM) and quality of fusional movements (QoFM). The sensitivity of each clinical test was calculated. RESULTS Measurement of NPC using red lens and subjective assessment of the QoCM and QoFM were the most sensitive diagnostic tools for near symptoms consistent with convergence insufficiency: 93.3%, 98.4%, and 94.5% respectively. CISS score, convergence fusional amplitude at near, and exophoria at near had lower sensitivities: 62.9%, 46.0%, and 72.0%, respectively. Although the majority of our patients had a heterophoria or heterotropia at distance (96.8%) and/or near (98.8%), most presented with only small phorias. Furthermore, of those who had a deviation at near, only 22% had the near exophoria exceeding the distance exophoria by 10Δ. CONCLUSIONS In our study cohort, NPC with red lens and subjective assessment of QoCM and QoFM proved to be the most sensitive screening tools for near symptoms consistent with convergence insufficiency.
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Affiliation(s)
- Judith B Lavrich
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania.
| | - Jordan L Hamburger
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania; Stony Brook Department of Ophthalmology, East Setauket, New York
| | - Karen E Lee
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Tobin B T Thuma
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology, Weil Cornell Medical College, New York, New York
| | - Michelle L Omega
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Qiang Ed Zhang
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Kammi B Gunton
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania
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2
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Parrington L, King LA, Hoppes CW, Klaiman MJ, Michielutti P, Fino PC, Dibble LE, Lester ME, Weightman MM. Exploring Vestibular Ocular Motor Screening in Adults With Persistent Complaints After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:E346-E354. [PMID: 35067602 DOI: 10.1097/htr.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to (1) explore differences in vestibular ocular motor screening (VOMS) symptoms between healthy adults and adults with persistent symptoms after mild traumatic brain injury (mTBI), and (2) explore the relationships between VOMS symptoms and other measures (self-reported vestibular symptoms, clinical measures of balance and gait, and higher-level motor ability tasks). SETTING Research laboratory setting. PARTICIPANTS Fifty-three persons with persistent symptoms (>3 weeks) following mTBI and 57 healthy controls were recruited. Eligibility for participation included being 18 to 50 years of age and free of medical conditions that may affect balance, with the exception of recent mTBI for the mTBI group. DESIGN Cross-sectional. MAIN MEASURES The primary outcomes were the VOMS symptom scores and near point of convergence (NPC) distance. Secondary outcomes included the Dizziness Handicap Inventory (DHI) total and subdomain scores, sway area, Functional Gait Analysis total score, gait speed, and modified Illinois Agility Task completion time, and Revised High-Level Mobility Assessment Tool total score. RESULTS The mTBI group reported more VOMS symptoms ( z range, -7.28 to -7.89) and a further NPC ( t = -4.16) than healthy controls (all P s < .001). DHI self-reported symptoms (total and all subdomain scores) were strongly associated with the VOMS symptom scores (rho range, 0.53-0.68; all P s < .001). No significant relationships existed between VOMS symptoms and other measures. CONCLUSION Significant group differences support the relevance of the VOMS for mTBI in an age-diverse sample with persistent symptoms. Furthermore, strong association with DHI symptoms supports the ability of the VOMS to capture vestibular complaints in this population.
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Affiliation(s)
- Lucy Parrington
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Victoria, Australia (Dr Parrington); Department of Neurology, Oregon Health & Science University, Portland (Drs Parrington and King); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (Drs Hoppes and Lester); Courage Kenny Research Center, Allina Health, Minneapolis, Minnesota (Mr Klaiman and Drs Michielutti and Weightman); Departments of Health and Kinesiology (Dr Fino) and Physical Therapy & Athletic Training (Dr Dibble), University of Utah, Salt Lake City; Department of Physical Therapy, Texas State University, Round Rock (Dr Lester)
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3
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Abbas Farishta R, Farivar R. Montreal Brain Injury Vision Screening Test for General Practitioners. Front Hum Neurosci 2022; 16:858378. [PMID: 35911590 PMCID: PMC9330036 DOI: 10.3389/fnhum.2022.858378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Visual disturbances are amongst the most commonly reported symptoms after a traumatic brain injury (TBI) despite vision testing being uncommon at initial clinical evaluation. TBI patients consistently present a wide range of visual complaints, including photophobia, double vision, blurred vision, and loss of vision which can detrimentally affect reading abilities, postural balance, and mobility. In most cases, especially in rural areas, visual disturbances of TBI would have to be diagnosed and assessed by primary care physicians, who lack the specialized training of optometry. Given that TBI patients have a restricted set of visual concerns, an opportunity exists to develop a screening protocol for specialized evaluation by optometrists—one that a primary care physician could comfortably carry out and do so in a short time. Here, we designed a quick screening protocol that assesses the presence of core visual symptoms present post-TBI. The MOBIVIS (Montreal Brain Injury Vision Screening) protocol takes on average 5 min to perform and is composed of only “high-yield” tests that could be performed in the context of a primary care practice and questions most likely to reveal symptoms needing further vision care management. The composition of our proposed protocol and questionnaire are explained and discussed in light of existing protocols. Its potential impact and ability to shape a better collaboration and an integrative approach in the management of mild TBI (mTBI) patients is also discussed.
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Affiliation(s)
- Reza Abbas Farishta
- McGill Vision Research Unit, Department of Ophthalmology and Vision Sciences, McGill University, Montréal, QC, Canada
- *Correspondence: Reza Abbas Farishta
| | - Reza Farivar
- McGill Vision Research Unit, Department of Ophthalmology and Vision Sciences, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montréal, QC, Canada
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4
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Kontos AP, Eagle SR, Marchetti G, Sinnott A, Mucha A, Port N, Ferris LM, Elbin RJ, Clugston JR, Ortega J, Broglio SP, McAllister T, McCrea M, Pasquina P, Brooks A, Buckley T, Mihalik J, Miles C, Collins MW. Discriminative Validity of Vestibular Ocular Motor Screening in Identifying Concussion Among Collegiate Athletes: A National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research, and Education Consortium Study. Am J Sports Med 2021; 49:2211-2217. [PMID: 33979240 DOI: 10.1177/03635465211012359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vestibular and ocular motor screening tools, such as the Vestibular/Ocular Motor Screening (VOMS), are recognized as important components of a multifaceted evaluation of sport-related concussion. Previous research has supported the predictive utility of the VOMS in identifying concussion, but researchers have yet to examine the predictive utility of the VOMS among collegiate athletes in the first few days after injury. PURPOSE To determine the discriminative validity of individual VOMS item scores and an overall VOMS score for identifying collegiate athletes with an acute sport-related concussion (≤72 hours) from healthy controls matched by age, sex, and concussion history. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Participants (N = 570) aged 17 to 25 years were included from 8 institutions of the National Collegiate Athletic Association-Department of Defense CARE Consortium (Concussion Assessment, Research, and Education): 285 athletes who were concussed (per current consensus guidelines) and 285 healthy controls matched by age, sex, and concussion history. Participants completed the VOMS within 3 days of injury (concussion) or during preseason (ie, baseline; control). Symptoms are totaled for each VOMS item for an item score (maximum, 40) and totaled across items for an overall score (maximum, 280), and distance (centimeters) for near point of convergence (NPC) is averaged across 3 trials. Receiver operating characteristic analysis of the area under the curve (AUC) was performed on cutoff scores using Youden index (J) for each VOMS item, overall VOMS score, and NPC distance average. A logistic regression was conducted to identify which VOMS scores identified concussed status. RESULTS A symptom score ≥1 on each VOMS item and horizontal vestibular/ocular reflex ≥2 significantly discriminated concussion from control (AUC, 0.89-0.90). NPC distance did not significantly identify concussion from control (AUC, 0.51). The VOMS overall score had the highest accuracy (AUC, 0.91) for identifying sport-related concussion from control. Among the individual items, vertical saccades ≥1 and horizontal vestibular/ocular reflex ≥2 best discriminated concussion from control. CONCLUSION The findings indicate that individual VOMS items and overall VOMS scores are useful in identifying concussion in collegiate athletes within 3 days of injury. Clinicians can use the cutoffs from this study to help identify concussion in collegiate athletes.
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Affiliation(s)
- Anthony P Kontos
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn R Eagle
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gregory Marchetti
- Duquesne University, Pittsburgh, Pennsylvania, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aaron Sinnott
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne Mucha
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas Port
- Indiana University, Bloomington, Indiana, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lyndsey M Ferris
- Indiana University, Bloomington, Indiana, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - R J Elbin
- University of Arkansas, Fayetteville, Arkansas, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James R Clugston
- University of Florida, Gainesville, Florida, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Justus Ortega
- Humboldt State University, Arcata, California, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven P Broglio
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas McAllister
- Indiana University, Indianapolis, Indiana, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael McCrea
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paul Pasquina
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alison Brooks
- University of Wisconsin, Madison, Wisconsin, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas Buckley
- University of Delaware, Newark, Delaware, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason Mihalik
- University of North Carolina, Chapel Hill, North Carolina, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher Miles
- Wake Forest University, Winston-Salem, North Carolina, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael W Collins
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Yammouni R, Evans BJW. Is reading rate in digital eyestrain influenced by binocular and accommodative anomalies? JOURNAL OF OPTOMETRY 2021; 14:229-239. [PMID: 33115619 PMCID: PMC8258174 DOI: 10.1016/j.optom.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Symptoms experienced when using digital devices are known as digital eyestrain (DES) or computer vision syndrome. They can be categorised as either external (associated with dry eye) or internal (related to refractive, accommodative or binocular vision anomalies). In a large cohort of adults with DES, we investigate the prevalence of binocular and accommodative anomalies, contrasting different diagnostic approaches, to evaluate potential mechanisms for the benefit from +0.75D addition lens that has been previously reported. METHODS Participants (20-40y) were selected using the Computer Vision Syndrome Questionnaire (CVS-Q) tool as suffering with DES. A comprehensive eye examination was given to each participant, and this paper concentrates on "internal factors", detected with a refraction and comprehensive testing of binocular and accommodative functions. The effects of low-powered addition lenses (+0.50D, +0.75D, +1.25D; and plano controls) were assessed by double-masked testing with the Wilkins Rate of Reading Test (WRRT) and by subjective preference. RESULTS As previously reported, most participants showed a subjective preference for one of the three convex lenses we used, with +0.75D chosen most frequently. Performance at the WRRT was significantly improved with +0.50D and +0.75D, but not +1.25D. Using a variety of diagnostic criteria, there were no strong associations between WRRT results or CVS-Q scores and any binocular or accommodation functions. The one finding of significance is that a disproportionate number of participants who benefited from adds had an eso-fixation disparity on the near Mallett unit, although this only affected 5% of the population. CONCLUSIONS DES is a collection of diverse symptoms that have a multifactorial aetiology. In the sample described here, binocular and accommodative anomalies do not seem to be a major cause of DES. Nevertheless, in view of the multifactorial aetiology it is recommended that patients with the symptoms of DES are assessed with a comprehensive eye examination. Patients with an esophoric fixation disparity on the near Mallett unit are particularly likely to benefit from near additions.
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Affiliation(s)
- Robert Yammouni
- Neville Chappell Research Clinic, Institute of Optometry, 56-62 Newington Causeway, London, SE1 6DS, UK.
| | - Bruce J W Evans
- Neville Chappell Research Clinic, Institute of Optometry, 56-62 Newington Causeway, London, SE1 6DS, UK; Division of Optometry & Visual Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
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6
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Moser RS, Schatz P, Mayer B, Friedman S, Perkins M, Zebrowski C, Islam S, Lemke H, James M, Vidal P. Does time since injury and duration matter in the benefits of physical therapy treatment for concussion? JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211020896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine if there are differences in post-concussion symptom levels depending on 1) when physical therapy treatment is begun after the concussion and 2) the length of treatment. Method Retrospective chart review yielded 202 patients who sustained concussions and were referred for physical therapy. Participants/patients were assigned to independent groups based on time elapsed between concussion and physical therapy (0–14, 15–30, 31–60, 61–120, 121–365 days), and on months spent in treatment (1–4). Pre- and post- treatment scores were documented for the following measures: Sport Concussion Assessment Tool (SCAT), Convergence Insufficiency Symptom Survey (CISS), Dizziness Handicap Inventory (DHI), and Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) using ANOVAs, with a Bonferroni-corrected p-value of p < .005. Results All patients demonstrated improvements with treatment, with no significant differences in outcomes for time elapsed since injury (SCAT Symptom Score ( p = .80), SCAT Symptom Severity Score ( p = .97), CISS ( p = .61), DHI ( p = .65), mCTSIB ( p = .13)); or for months in treatment (SCAT Symptom Score ( p = .23), SCAT Symptom Severity Score ( p = .04), CISS ( p = .41), DHI ( p = .37), mCTSIB ( p = .50)). Conclusions Improvements were similar for all patients receiving post-concussive physical therapy, regardless of time between injury and treatment onset, and regardless of time spent in treatment. These results may have implications for clinical decision-making and for third party payors’ coverage of post-concussion treatment. Longer periods of treatment may not necessarily be of greater benefit and application of treatment if delayed may also be beneficial. Limitations to the study, such as its retrospective nature, lack of randomization, and convenience sample size are discussed.
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Affiliation(s)
| | - Philip Schatz
- Department of Psychology, Saint Joseph’s University, Philadelphia, PA, USA
| | - Bridget Mayer
- Sports Concussion Center of New Jersey, Princeton, NJ, USA
| | - Sarah Friedman
- Sports Concussion Center of New Jersey, Princeton, NJ, USA
| | | | | | - Siffat Islam
- Sports Concussion Center of New Jersey, Princeton, NJ, USA
| | - Hannah Lemke
- Sports Concussion Center of New Jersey, Princeton, NJ, USA
| | | | - Paul Vidal
- Specialized Physical Therapy, Princeton, NJ, USA
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7
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Sherry N, Trbovich A, Holland C, Eagle S, Bitzer H, Kontos AP. Predictors of poor reading performance in student-athletes following sport-related concussion. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:364-372. [PMID: 33428451 DOI: 10.1080/21622965.2020.1850449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The goal of the current study was to determine which sport/recreation-related concussion (SRC) assessments predict academic reading performance following SRC. The study included 70 concussed students aged 14-22 years (M = 16.21, SD = 1.90) evaluated 2-30 days (M = 8.41, SD = 5.88) post-injury. SRC assessments included: Post-Concussion Symptom Scale, Immediate Post-Concussion Assessment and Cognitive Testing, Vestibular/Ocular Motor Screening, and King-Devick test. The Nelson-Denny Reading Test (NDRT) comprehension subtest measured academic reading accuracy and rate. Pearson correlations examined relationships among SRC assessments and reading accuracy/rate; those assessments that significantly correlated with the NDRT were included in multiple regressions (MRs) predicting reading accuracy and reading rate. Results supported positive correlations between visual motor speed and reading accuracy (r = .31, p = .01), and near point of convergence (NPC) and reading rate (r = .30, p = .01). The MRs for reading accuracy (F = 4.61, p = .01) and reading rate (F = 4.61, p = .01) were significant, and predicted approximately 40% of the variance, with visual motor speed and NPC as the only significant predictors in both models. Symptoms were not predictive of reading accuracy or rate. The present study indicates that visual motor speed and NPC are predictive of academic reading performance after SRC, suggesting clinicians should consider these clinical outcomes to better inform academic accommodations.
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Affiliation(s)
- Natalie Sherry
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia Trbovich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cyndi Holland
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn Eagle
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hannah Bitzer
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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8
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Changes in Vestibular/Ocular-Motor Screen Scores in Adolescents Treated With Vestibular Therapy After Concussion. Pediatr Phys Ther 2020; 32:331-337. [PMID: 32773522 DOI: 10.1097/pep.0000000000000729] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine interrelationships among Vestibular/Ocular-Motor Screen (VOMS) items and to characterize the recovery of VOMS performance in a sample of adolescents treated with vestibular physical therapy (VPT) after concussion. METHODS Seventy-seven patients with concussion and 77 participants without concussion completed the study. Adolescents with concussion received an individualized VPT intervention consisting of targeted exercises for gaze stability, postural stability, ocular-motor control, habituation, and aerobic activities. The exercises were performed during a weekly clinic visit and via a home exercise program. RESULTS Except for near-point convergence distance, all VOMS items were significantly interrelated. Over the course of VPT, significant improvements in VOMS performance were observed, and discharge scores were similar to scores observed in adolescents without concussion. CONCLUSIONS The VOMS measured moderately related functions and captured changes over the course of VPT. Clinicians should consider the contextual risk of "false positive" in their interpretation of VOMS.
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Barton JJS, Ranalli PJ. Vision therapy: Occlusion, prisms, filters, and vestibular exercises for mild traumatic brain injury. Surv Ophthalmol 2020; 66:346-353. [PMID: 32827496 DOI: 10.1016/j.survophthal.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
A number of treatment approaches have been advocated for persistent visual complaints following mild traumatic brain injury. These include devices such as binasal occlusion, yoked prisms, vertical prisms, and filters, as well as vestibular training. We discuss the rationale and the evidence for each of these approaches. Binasal occlusion has been advocated for visual motion sensitivity, but it is not clear why this should help, and there is no good evidence for its symptomatic efficacy. Base-in prisms can help manage convergence insufficiency, but there are few data on their efficacy. Midline shift is an unproven concept, and while the yoked prisms advocated for its treatment may have some effect on egocentric neglect, their use in mild traumatic brain injury is more questionable. A wide variety of posttraumatic symptoms have been attributed to vertical heterophoria, but this is an unproven concept and there are no controlled data on the use of vertical prisms for mild traumatic brain injury symptoms. Filters could plausibly ameliorate light intolerance but studies are lacking. Better evidence is emerging for the effects of vestibular therapy, with a few randomized controlled trials that included blinded assessments and appropriate statistical analyses. Without more substantial evidence, the use of many of these techniques cannot be recommended and should be regarded as unproven and in some cases implausible.
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Affiliation(s)
- Jason J S Barton
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, Psychology, University of British Columbia, Vancouver, Canada.
| | - Paul J Ranalli
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, Otolaryngology, University of Toronto, Toronto, Canada
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