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Neuroplasticity and Vision Therapy for Adults; A Case Series
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Transcript of Neuroplasticity and Vision Therapy for Adults; A Case Series
3241 South Michigan Avenue, Chicago, Illinois 60616
BACKGROUNDOptometric Vision Therapy is considered a viable treatment option for children with various binocular vision disorders (strabismus, amblyopia and other dysfunctions of the binocular vision system). Unfortunately, children with these disorders, if left untreated, become adults with strabismus, amblyopia, convergence insufficiency, etc. Adults can also acquire biocular vision dysfunctions through decompensated phorias and various medical disorders such as stroke, concussion and mild traumatic brain injury.
Current research suggests that the human visual system retains a good deal of neuroplasticity into adulthood and that even senior individuals can learn new ways of seeing. Unfortunately, optometrists are less likely to suggest vision therapy to their adult patients even though it has been shown to be effective for various groups within the adult population.
CASE SERIESThe diagnostic data, therapy utilized and treatment outcomes are presented for 3 adults with strabismus. Case #1: LM is a 69 y/o WM who presented with severe symptoms associated with one or more vision dysfunctions (intermittent exotropia at near, convergence insufficiency, diplopia) that adversely impacted his quality of life and interfered with his ability to work efficiently. After participating in a program of optometric vision therapy it was noted (even 3 years post therapy), that all the symptoms were improved or eliminated and that all the clinical findings were at or near expected levels.
Case #2: MP is a 24 y/o WF with a post-surgical (surgery at age 5 years) intermittent esotropia, convergence excess (variable), accommodative insufficiency and suppression. Assessments up to 2 years after active vision therapy was concluded showed an elimination or improvement of symptoms, clinical findings at expected levels and an improved quality of life. She could even see the “3D” in 3D movies.
Case #3: The final patient (SP) is a 29 y/o BF with a 90PD IAXT, diplopia, accommodative excess and oculomotor dysfunction. Once again upon concluding an active program of vision therapy and even after 3 years had passed since participating in vision therapy, all symptoms were eliminated and clinical findings were at expected levels. She was no longer concerned about the cosmetic aspect of the eye turn as well.
Depending upon the patient noted above, anywhere from 29 to 42, 45 minute in office vision therapy sessions with out of office home vision therapy resulted in significant improvement in vision function and relief of symptoms for up to 3 years post therapeutic intervention.
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A +,#; Stephanie Lyons, OD+; Kelsey Frederick OD+; Rachael Barker, OD+
# Illinois College of Optometry, + Lyons Family Eye Care, Chicago, IL
Neuroplasticity and Vision Therapy for Adults: A Case Series
CONTACT INFORMATION
Dominick M. Maino, OD, MEd, FAAO, FCOVD-AIllinois College of Optometry3241 S. Michigan Ave. Chicago, Il [email protected]
TABLE 1: Vision Therapy Sequence
DISCUSSIONThe visual cortex has the capacity for experience dependent change (neuroplasticity) throughout life. Unfortunately, when it comes to the adult with binocular vision problems, this is not always recognized as being true even though there is strong clinical evidence to suggest a high level of adult neuroplasticity. Current research shows that adults tend to have numerous anomalies associated with the binocular vision system especially within certain populations. This case series demonstrates how those even approaching 70 years of age can benefit from optometric vision therapy.
CONCLUSIONClinicians have repeatedly noted that adults can benefit from an active program of optometric vision therapy. The improvement or elimination of symptoms associated with various binocular vision disorders such as convergence insufficiency, strabismus, and amblyopia; improve the patient’s quality of life and ability to function. As the Baby Boomer generation moves into a retirement that is often unlike that of past generations, they will pursue active interventions that allow them to do all they wish to in an easy and comfortable manner.
Conditions frequently associated with aging, such as stroke, concussion and mild traumatic brain injury, adversely affect vision function in the adult. These individuals will seek out optometric vision therapy to improve their overall function and quality of life. As we proceed into this millennium, the fastest growing population that need vision therapy will be adults.
There is a growing body of research that clearly demonstrates that vision function in the adult amblyope can be improved. There is also mounting evidence that those adults who have an acquired brain injury and vision function anomalies can also benefit from vision therapy as well.
This case series supports the concept that adults from 20 to 70 years of age benefit from optometric vision therapy. As a provider of primary eye and vision care, it is your responsibility to diagnose, treat or refer for treatment these individuals so that their quality of life is maintained and ability to function within an increasingly complex world enhanced.
Table1
VisionTherapySequenceMonocular Biocular Binocular Integration/Stabilization
Oculomotor Oculomotor Oculomotor Oculomotor+Accommodative+
Accommodation Accommodation Accommodation vergence+Hand-eye
Hand-eye Hand-eye Hand-eye simultaneously
Anti-suppression Anti-suppression
Vergence
Table2
Symptoms/Problems
LM
InitialSymptoms/Problems
Eyestrainwhilereading,fallsasleepwhilereading,intermittentblur,diplopia,losesplacewhilereading,headaches,mustuselargeprintbooks,fatigue,maylosejobbecauseoferrorsmadeduetopoorvisionfunction,Attentionproblems
PostVisionTherapy
Allareasimprovedorproblemseliminated,usesnormalsizedprint,jobgoingwell(Lastevaluation3yearspostvisiontherapy.Allimprovementsmaintained)
MP
InitialSymptoms/Problems
Cannotjudgedistancewell,blurredvision,headache,cannotsee3Din3Dmovies,
PostVisionTherapy
Allsymptoms/problemseliminatedorimproved,Cansee3Dwhenwatching3Dmovies,Betterdepthperceptionwhiledriving,NoHA’s(Lastevaluation2yearspostvisiontherapy.Allimprovementsmaintained)
SP
SBInitialSymptoms/Problems
Diplopia,strugglestokeepeyesstraight,doesnotlikeherappearancewheneyeturnsoutward
PostVisionTherapy
Allproblemseliminatedorimproved,eyesnowstraightmostofthetime,nodiplopia,cosmeticappearanceimprovedsignificantly(Lastevaluation3yearspostvisiontherapy.Allimprovementsmaintained)
Table2
CaseHistory
LM MP SP
OCD Birthcontrol Nomeds
Sleepapnea Noallergies Noallergies
Prilosec NopreviousVT NopreviousVT
Environmentalallergies
Vitamins,Omega-3,Supplements
TreatedpreviouslyforCI
TABLE 2: Symptoms/Problems
TABLE 2: Case History
TABLE 3: Examination Findings Table#3
LMExaminationFindings(notalltestsweregivenatallevaluations.(Ocularhealthunremarkable)
InitialFindings
BVA(OD/OS) RefractiveError Stereo/W4D EOMS/Pursuits/SaccadesCT NPC Phoria(N) Vergences(N) Acc
20/20-;20/20 +.50-.50x010 -RandomDot Full/+4/+4undershoots 10-20XOPnear 24/26”RL 11BInear BIX/25/12
+.50-.75x145 4-5W4Dnear IAXTnear BOX/35/30
Suppression?
PostVisionTherapy
20/20;20/20 +0.25-0.50x132 +RandomDot Full/+4/+4-undershoot10XOPnear ToNoseRL 12BInear BI20/18
+0.75-0.25x139 9/10WirtCircles Nostrabnoted BO20/18
4W4DDist/Near
MPExaminationFindings(notalltestsweregivenatallevaluations.(Ocularhealthunremarkable)
BVA(OD/OS) RefractiveError Stereo/W4D EOMS/Pursuits/SaccadesCT NPC Phoria(N) Vergences(N) Acc
20/20;20/20 +1.00-0.25x005 -RandomDot Full/+4/+4 6PDIET ToNose 6BO Suppression MEMAM
+1.00 0/10WirtCircles BI/BO FacilityBlur+/-
Variable/Suppression
W4D
PostVisionTherapy
20/20;20/20 +1.50-0.25x010 +RandomDot Full/+4/+4 3EP ToNose 3BO BI14/12 MEMPLOD
+1.50-0.25x165 3/10WirtCircles BOOffScale +.50OS
4W4DDist/Near (Nosuppression)Facility
8CPM(+/-2.00)
SPExaminationFindings(notalltestsweregivenatallevaluations.(Ocularhealthunremarkable)
BVA(OD/OS) RefractiveError Stereo/W4D EOMS/Pursuits/SaccadesCT NPC Phoria(N) Vergences(N) Acc
20/20;20/15 -6.25-1.00x100 +RandomDot Full/+3/+3 15XOPDist ToNose 10BI Suppression MEM
-5.00-1.00x160 5/10WirtCircles 25BIIXTNear Variable
4W4DDist Facility
2W4DNear Blur(-)
PostVisionTherapy
20/20;20/20 -6.25-0.75x100 +RandomDot Full/+4/+4 8XOP ToNose 8BI BI/BO MEM
-5.00-0.75x180 10/10WirtCircles OffScale +.75OD/OS
4W4DDist/Near NoSuppression
An adult patient using the Brock String to improve positive fusional vergence.