The brain and eyes work together to give us vision. If something in the brain’s visual cortex isn’t working properly, due to either a Cerebral Visual Impairment (CVI) or a concussion, vision is affected. Since the eyes work normally, these kinds of vision issues don’t show up as a result of a standard eye exam. So, what can be done for persons with these kinds of vision issues? Work done at the New England College of Optometry (NECO) and the New Jersey Institute of Technology (NJIT) is providing insights about these conditions and developing treatments that improve vision.
NECO optometrist provide treatment to children with CVI at the CVI Center at the Perkins School for the Blind in Boston. CVI is the leading cause of low vision and blindness in children. What makes CVI so challenging is that many times there are coinciding conditions, such as autism, that can make to diagnosis and treatment difficult. In addition, many medical professionals receive little to no training in the identifying and treatment of this condition.
While CVI presents differently in each person, common behaviors include difficulty with:
Visual clutter
Recognizing faces
Depth perception
Hand, eye, foot coordination
NECO’s partnership with Perkins School has led the development of testing practices to better diagnose and treat those with CVI. Nicole Ross, OD, MSc, FAAO, DAAO (LV), an attending optometrist at NECO Center for Eye Care at Perkins and Jem Martin, OD FAAO, Assistant Professor of Optometry at NECO and an Attending Optometrist at the NECO Center for Eye Care at Perkins have done research that focused on the Teach-CVI screening tool. This tool identifies behaviors related to CVI that aren’t seen in traditional exams. Another NECO doctor, Barry Kran OD, FAAO, now retired, developed with D. Luisa Mayer, PhD, vision scientist and visual field specialist, the Mayer-Kran Double Happy Contrast Cards. These cards assess contrast sensitivity in patients who are nonverbal.
The diagnosis of CVI requires a collaborative approach, since there is no test that can pinpoint CVI. That is what makes the partnership NECO has with Perkins, so valuable. In addition to diagnosing and treating children with CVI, NECO doctors are working to bridge the knowledge gap with other medical and educational professionals with articles and presentations, so that they know what to be on the lookout for and when to refer patients to specialist. The doctors at NECO and the professionals at Perkins are working together to research the development of assistive technology to enhance vision, tele-rehab methods to improve access to care and remote assessment methods for those who can’t easily access care.
Of course, there are times when injury, like a concussion, will lead to problems with vision. Many people who experience a concussion complain of blurred vision, headaches and trouble concentrating. These symptoms make it difficult to read, work on a computer and delay a return to driving and work. Is there anything that can successfully treat post-concussion disorders? Yes, and it was developed at the New Jersey Institute of Technology (NJIT).
Tara Alvarez, a professor of biomedical engineering at NJIT and her colleagues were able to show that there is a way to treat post-concussion disorders, such as convergence insufficiency (a condition that cause double vision when a person is doing near work, like reading) and accommodation insufficiency (a condition where objects appear blurry).
Four years ago, Alvarez collected data to establish guidelines to help doctors diagnose and treat patients with post-concussion disorders. These guidelines would facilitate decisions about the timing, dosing and need for treatment. She worked engineers, optometrists, vision researchers, sports medicine doctors and biostatisticians to develop best practices to improve therapy for patients, as well as being able to verify the results.
The team enrolled 106 patients, age 11 to 25, that have one to multiple concussions and symptoms that persisted from one to six months after the injury. After 12 weeks of vision therapy, almost 90 percent of patient were able to see normally, compared to less than 10 percent in a group that monitored symptoms to see if they would go away over time.
This study shows that someone with concussion-related vision condition shouldn’t wait to start treatment. Also, researchers learned that methods used to treat patient who don’t have concussions, such as exercises to strengthen and coordinate eye muscles, worked for persons with head injuries.
Alvarez is currently working on a virtual reality vision therapy that tracks eye movements and can be performed at a home computer. Results would be sent to a physician and would help inform decisions about returning children to school, sports and other activities. The hope is by using virtual reality technology in the patient’s home, there will be improvements with compliance.
Vision isn’t just with our eyes. The eyes and brain work together to process the images that enter through the eyes. It is no wonder that the eyes are considered the front of the brain. When either a disorder or injury leads to problems with vision, that’s when treatments are necessary. Thanks to the work of NECO optometrists who work at the Perkins School for the Blind and researchers like the team led Tara Alvarez at NJIT, treatments are available, new ones are being developed, and information is being shared with medical professionals on how to treat persons with CVI or concussion related vision issues. Once again research is expanding knowledge about vision and helping to improve treatment outcomes.
Sources:
https://www.neco.edu/news/cvi/
https://www.neco.edu/research-innovation/research/low-vision/
https://www.neco.edu/news/neco-perkins-school-for-the-blind-continue-joint-low-vision-clinic/