One of the most missed and under-treated symptoms of Post-Concussion Syndrome (PCS) is light sensitivity, trouble reading, and driving at night especially when only whiplash has been diagnosed. This symptom can last from months to years following an undiagnosed concussion. The National Center for Biotechnology Information1 (NCBI) has case studies about how prevalent misdiagnosis is and the serious physiologic and psychologic consequences for the undiagnosed individuals.
In PCS, people may experience a change in visual acuity almost instantly and if they report this to the emergency room staff or their physician, they have a greater chance of being properly diagnosed with a Functional MRI. But because this is often unreported at the time of injury, it is important to watch for ANY unusual sensory disturbance even weeks after because the injury can cause an accommodative convergence center in the injured mid-brain or brain stem, which causes double vision or be attributed to premature presbyopia.
The reason a fMRI can detect the injury affecting vision (in most cases) is that it is focused on the mid-brain and brain stem areas of the brain – not just the eye itself and the occipital lobe which processes the visual input from the eye. “An fMRI examination is performed by positioning the cervical spine in approximately 40 different positions such that the pathological movement patterns and injuries to the ligaments and the joint capsules can be detected. These injuries cannot be demonstrated without systematically assuming the different positions.” NCBI -1
The first 2 vertebrae are the Atlas (holds the skull) and the Axis which has a pivot that allows for the head to turn, the 3rd to 7th are visible on the back of the neck. The ligaments that hold the vertebrae (somewhat like rubber bands that hold dental braces), which can be loosed after whiplash and make the head unstable on the neck section of the spine. This instability is almost certain to cause other symptoms affecting vision, hearing, and concentration, along with pain and impaired sleep.
A neuro-ophthalmologist is specialized in proper diagnosis of head-injury related visual changes. They are able to perform visual field testing, ocular motility testing, and other cranial nerve tests in order to provide the appropriate corrective or accommodative treatment plan. Specialized tests include Visual evoked potential (VEP) which tests the optic nerve and the electroretinography (ERG) which tests the function of the retinal cells. This includes the photoreceptors, inner retinal cells and ganglional cells.
Neuro-Ophthalmologist Dr. Jody Abrams of Sarasota Retinal Institute in Florida explains, “When you shift your focus from distance to near three things have to happen: your eyes have to cross (converge), your lens has to focus (accommodate) and your pupils need to constrict to increase your depth of focus (miosis). This is known as the near reflex (think f stop of a camera lens). It’s a reflex, you cannot control it, and it controls you. . . after a head injury or concussion, one or all of these mechanisms may become dysfunctional.” 2
Occupational Therapists (OTs) are the allied health professionals that become specialized in neurologic visual dysfunctions following a head injury, stroke, or due to a disease process such as M.S. (Multiple Sclerosis), diabetes, and other conditions. They work with patients whose Neuro-Ophthalmologists have prescribed special prisms or colored lenses to correct the dysfunction. Unfortunately, this medical specialty is so limited in practitioners (our nearest neuro-ophthalmologist is in Federal Way). Because of this, OTs often work in schools to help children with impaired reading, attention, and light-sensitivity issues that are affecting their learning capability in school and at home.
In my practice, I primarily treat light sensitivity as one of several post-concussion symptoms by trials of special lenses and recommend Irlen colored film overlays to accommodate or correct the visual disturbance that interferes with a patient’s ADLs (activities of daily living) such as reading, driving, attention, and symptom management. The Irlen Method3 is the only method outside of wearing special prism lenses that is effective in treating visual impairments due to brain injuries. A therapist must be certified by the Irlen Foundation to screen and administer Irlen overlays.
It’s important to be a strong self-advocate because many healthcare practitioners are too quick to dismiss what they are not trained in. For NOW, we have a choice in who we choose as a healthcare provider and it is up to us to find a good match for us as OUR PARTNER in our health and well-being. A good practitioner will rarely have all the answers, but they will listen to their patients and refer to other practitioners who may be able to solve the symptoms we are struggling with.
For a brief phone consult and to be instructed on how to REINTEGRATE YOUR LIFE TODAY, call Integrative Therapeutic Solutions at 243-514-6842. You can call 24/7 and leave a message, we will return your call on the next business day!
The National Center for Biotechnology Information –
Dr. Jody Aronson of Sarasota Retinal Institute in Florida - http://www.sarasotaretinainstitute.com/2013/03/concussion-and-your-vision-part-1/
The Irlen Foundation –