Research and Research and Academic ActivitiesAcademic Activities

Retrospective Data Analysis: Retrospective Data Analysis:

38 TBI Patients Diagnosed with 38 TBI Patients Diagnosed with VH VH with Complete Data Setswith Complete Data Sets

Average age: 38 yearsAverage age: 38 years(range 12 – 67 yrs)(range 12 – 67 yrs)

Female = 66% (25)Female = 66% (25)

Male = 34% (13)Male = 34% (13)

Average duration of symptoms = 9.9 yearsAverage duration of symptoms = 9.9 years( 3 months to 30 years)( 3 months to 30 years)

Specialists Seen Prior To VH Diagnosis

(% of Patients)

2.6

21.1

23.7

23.7

26.3

29

42.1

44.7

55.3

60.4

36.8

0 10 20 30 40 50 60 70

Pediatrician

Chiropractor

ER

Optometry

Internal Medicine

ENT

Psychiatry / Psychology

Family Practice

Ophtahlmology

PM&R

Neurologist

3.66 consults / pt

7 Binocular Vision Questions

Rank BVDQ question(10) Skip lines while reading (12) Head tilt (21) Pain with eye movement (22) Words run together while reading (23) Double / overlapping vision near (24) Close or cover an eye (25) Double / overlapping vision far

You’ll miss this condition if you only look for binocular vision symptoms !

Top 10 BVDQ Questions Rank BVDQ question (1) Shoulder and neck discomfort (2) Headache (3) Glare / sensitivity to bright lights (4) Dizzy / lightheaded (5) Tire easily with close-up tasks (6) Blink to clear up distant objects (7) Unsteady / drift to one side (8) Dizziness with provocative head

movements (9) Car rides = uncomfortable / dizzy

(10) Do you skip lines while reading

Top 10 BVDQ Questions Rank BVDQ question (1) Shoulder and neck discomfort (2) Headache (3) Glare / sensitivity to bright lights (4) Dizzy / lightheaded (5) Tire easily with close-up tasks (6) Blink to clear up distant objects (7) Unsteady / drift to one side (8) Dizziness with provocative head

movements (9) Car rides = uncomfortable / dizzy (10) Do you skip lines while reading

Top 10 BVDQ Questions Rank BVDQ question (1) Shoulder and neck discomfort (2) Headache (3) Glare / sensitivity to bright lights (4) Dizzy / lightheaded (5) Tire easily with close-up tasks (6) Blink to clear up distant objects (7) Unsteady / drift to one side (8) Dizziness with provocative head movements (9) Car rides = uncomfortable / dizzy (10) Do you skip lines while reading

You have to ask the right questions to come up with the right answers !

New Research Projects

Results of Treatment - NPC11 of 145

patients started at “0” or

experienced no change (7.5%)

134Non 0-0 Patients (92.5%)

Results of Treatment - NPC134

Non 0-0 Patients (92.5%)

Before:10.1 inches

After:5.1 inches

49.4% Reduction

Results of Treatment - NPC134

Non 0-0 Patients (92.5%)

Before:10.1 inches

After:5.1 inches

49.4% Reduction

88% of patients improved (118/134)

12% of patients did not improve

(16/134)

Results of Treatment – King-Devick

105 Patients

Results of Treatment – King-Devick

105 Patients

Before:61.9 secs

After:52.3 secs

15.5% Reductio

n

Results of Treatment – King-Devick

105 Patients

Before:61.9 secs

After:52.3 secs

15.5% Reductio

n

72.3% of patients

improved (76/105)

27.6% of patients did not improve OR no change

(29/105)

Results of Treatment – King-Devick

105 Patients

Before:61.9 secs

After:52.3 secs

15.5% Reductio

n

72.3% of patients

improved (76/105)

2/3 (51/76) improve

d >5 secs

27.6% of patients did not improve OR got worse

(29/105)

Results of Treatment – SSI273

Patients

Results of Treatment – SSI273

Patients

Before:13.9

After:5.6

59.5% Reductio

n

Results of Treatment – SSI273

Patients

Before:13.9

After:5.6

59.5% Reductio

n

76% of patients improved (208/273)

23.8% of patients:

no change or got worse (65/273)

Results of Treatment – Stereopsis

108Patients

Results of Treatment – Stereopsis

108Patients

39 were 9-9

Results of Treatment – Stereopsis

69Patients

39 were 9-9

Results of Treatment – Stereopsis

69Patients

59% of patients improved (41/69)

41% of patients: Worse (13/69) or

no change (15/69)

Results of Treatment – Stereopsis

69Patients

59% of patients improved (41/69)

41% of patients: Worse (13/69) or

no change (15/69)

Before: After:4.3 7.6

Before: After:6.5 4.8

+75% Improvement

-26%

+3.3 units -1.7 units

Conclusions The symptoms of BVD are frequently

present but not being recognized as being visual in etiology, despite extensive testing and consultation

Binocular vision dysfunction (BVD) appears to be causing post-concussive symptoms in ~ 30% of all TBI / ABI patients with persistent symptoms (>3 months)

The TBI / ABI appears to be causing the BVD

Conclusions Treatment of the BVD with realigning

prismatic lenses reduces post-concussive symptoms 80%

BVD Suspects can be easily identified with a validated questionnaire

BVD can be firmly diagnosed by the Prism Challenge Technique

NeuroVisual Optometry

PATIENT Referrals

Wrap Up & Final Review

Which Patients to Screen for Which Patients to Screen for VH and SOP using the BVDQ?VH and SOP using the BVDQ?

Patients who have dizziness, Patients who have dizziness, headache, neck ache, visual / reading headache, neck ache, visual / reading difficulties, anxietydifficulties, anxiety– TBI with symptoms persisting TBI with symptoms persisting 3 months or 3 months or

longerlonger after injury after injury Those with Physical Findings of VH & Those with Physical Findings of VH &

SOPSOP Elderly with difficulty with balance / Elderly with difficulty with balance /

frequent fallsfrequent falls

Which Patients to Screen for Which Patients to Screen for VH and SOP using the BVDQ?VH and SOP using the BVDQ?

Children with “reading and learning Children with “reading and learning difficulties” (?LD; ?RD)difficulties” (?LD; ?RD)

Children with “hyperactivity” (?ADD/ Children with “hyperactivity” (?ADD/ ADHD?)ADHD?)

Children with motion sickness / car Children with motion sickness / car sicknesssickness

Difficulty watching 3D moviesDifficulty watching 3D movies AgoraphobiaAgoraphobia Panic attacksPanic attacks

Who Needs Referral?Who Needs Referral?

High score on BVDQ High score on BVDQ >> 15 15

OROR Positive answers to Positive answers to anyany of the RED of the RED

FLAG questionsFLAG questions

Take Home Messages

This represents a large percentage of the general population (5-10%)

Standard Binocular Vision tests are not sensitive enough to identify this patient population

Know the power in the 5 Minute Cover Test

Take Home Messages

Have all of your patients fill out the questionnaire before your exam - you will be amazed by what you find!

Look for head tilt on all of your patientsThese patients will not get better until

their BVD is recognized and treated This work will give you the gift to

change lives

“ “Who, indeed, could Who, indeed, could

have supposed that a have supposed that a

mere ocular defect mere ocular defect

could have given rise to could have given rise to

so seriousso serious a train of evilsa train of evils……

and who that had not seen and who that had not seen

it could believe that the it could believe that the

correction by glassescorrection by glasses of the eye trouble of the eye trouble

could have given a reliefcould have given a relief so speedy and so so speedy and so

perfect perfect that the patient described it as a that the patient described it as a

miracle?miracle?””Dr. S. Weir Mitchell, Dr. S. Weir Mitchell, Headaches and Eye Strain, Headaches and Eye Strain, April April

1876 1876