Page Utilities
Victoria Tilney McDonough, BrainLine (page 3 of 3) Page 3 of 3
BrainLine: How do visual deficits influence quality of life?
Dr. Goodrich: Having visual deficits after a brain injury can definitely interfere with a person’s quality of life. Visual problems often go hand-in-hand with cognitive or physical problems and also with psychological problems like depression. If a person cannot see well, he may isolate himself because he doesn’t want to be out in the world bumping into people or losing his way. He may have a fear of crowds or may feel embarrassed that he can’t read the expressions on his friends’ faces. This social isolation can be devastating and can then lead to depression, anxiety, and substance abuse.
BrainLine: What research is being done to help people with TBI-related vision dysfunction?
Dr. Goodrich: There are some studies in the works, but frankly, it is very difficult to conduct large-scale studies of people with similar visual deficit symptoms after TBI. The expression, “If you’ve seen one TBI patient, you’ve seen one TBI patient,” is never more accurate than in this case. Visual dysfunctions after TBI are so diverse and variable that it is hard to conduct a conclusive study. And until the problems of TBI and TBI-related vision problems are more widely recognized, getting funding will continue to be challenging.
That said, I am involved in a delayed treatment trial at the VA. We are looking at three different rehab techniques to treat hemianopsia. Basically, we are looking to see which of these three treatments is more effective than doing nothing. The techniques include:
- an established technique to teach scanning in which a person is taught to use an alternative area of the retina.
- a device from NovaVision that may be able to take advantage of brain plasticity to increase the visual field it sees. This is done by stimuli administered in the intact field of vision and in the damaged field, basically, shrinking the border between the two to reduce the area of hemianopsia.
- a device from NeuroTechnology (NVT) Systems in Australia that uses a light board with rows of colored lights. The light board and NVT system uses a behavioral technique to use head motions to look into the lost visual area.
BrainLine: What advice would you give someone after a TBI who is experiencing visual problems?
Dr. Goodrich: I would say if following a brain injury the person has any visual symptoms at all — even a little blurriness or fuzziness, eyes that fatigue easily, difficulty reading, or frequent bumping into things on one side more than the other — he should get a comprehensive eye examination by an ophthalmologist or optometrist. A comprehensive test would include testing the visual field and acuity, contrast sensitivity, and binocular vision. Make sure to find out if the symptoms are related to the visual system or something else … that is, are the symptoms a result of the brain injury or is it a simple need for a new pair of glasses? Try to find an optometrist or ophthalmologist who has experience working with people with brain injury. And keep persisting until you get the help you need.
Footnotes
1 Gianutsos, R. (1991). Computerized screening: Visual field deficits after brain injury. Journal of Behavioral Optometry, 2(6), 143-150.
2 Kerkoff, G. (2000). Neurovisual rehabilitation: recent developments and future directions. Journal of Neurology, Neurosurgery, and Pscyhiatry, 68, 691-706.
Gregory Goodrich, PhD
BrainLine sat down with Dr. Gregory Goodrich to talk about the problems with vision that can arise after a traumatic brain injury. Dr. Goodrich began his career with the U.S. Department of Veterans Affairs (VA) in 1974 and is currently supervisory research psychologist (Psychology Service) assigned to the Western Blind Rehabilitation Center in Palo Alto, California. He also serves as the program coordinator for the Optometric Research Fellowship Program at the VA hospital in Palo Alto. His primary areas of research are low-vision reading and mobility. Most recently, his research has focused on the treatment of polytrauma veterans with visual loss returning from Iraq and Afghanistan.
The opinions expressed are those of Dr. Goodrich and not those of the Department of Veterans Affairs.
BrainLine
Comments [4]
Thank you for highlighting this issue. Thanks to hearing an expert in the field at a Brain Injury Assoc. caregivers conference, I was able to obtain vision therapy from a qualified optometrist for my husband who has global eschemia from hypoxia. The results so far are subtle but encouraging.
Thank you for sharing this article. I was wondering why there was not more discussion on the cognitive/perceptual deficits that are related to TBI?
Bravo for this article on vision issues after TBI. I have struggled with this since sustaining mTBI in 1994 (and 1998). But I have found that my best compensatory strategy has been my sense that part of the difficulty I encounter in the community is TBI related and the other part is the lack of knowledge on the part of the general public of the role played by environmental issues. I thought I could no longer read, until I learned that I could read pages that were "ragged right" (not fully justified). I advocated with BI organizations to make their print material more TBI-friendly. And I ask the state office of legislative services to print proposed legislation for me in a ragged right fashion. Although I can find science on what TBI does to vision, and what vision impairments contribute to reading difficulties, I cannot find the authoritative statement that puts them together (if I could, I could effect more change). Accommodating print colors, styles, line widths (and other practices of good design for print material) goes a long way to reduce the "I can'ts" that come with vision problems (aagh - filling out forms). Please do not ignore advocacy and civil rights issues when it comes to helping people learn to accommodate the impairments that come with vision disturbances following TBI! I wish that some group would come up with guidelines for print (and web) material to make the most readable materials for people with TBI vision impairments (and just for folks who are plain getting older). The CDC has been the BEST in this area; but unfortunately some organizations serving TBI populations need to develop awareness and make changes! I am glad vision issues have been brought out of the darkness. In vision, as well as other TBI-affected impairments to resuming life as best we can, self-advocacy and a good healthy sense of the American with Disabilities Act goes a VERY LONG WAY. And for those folks who participate in surveys about disabilities: speak up when a survey asks about vision impairments that are solely eye-ball related. Explain vision issues you experience so that future survey questions can be broadened (Surveys usually imply problems are with dimness; my problem is with glare!) Education and advocacy may not provide a "cure," but getting accommodations sure goes a long way in helping us see the light!
See All TBI Topics
It should be noted that in many TBI patients with symptomatic epilepsy, the treatment is anterior temporal lobectomy. As the optic nerve travels through the temporal lobe (Myer's loop) it is often damaged by the surgery, resulting in permanent quadrantopsia.
Apr 1st, 2010 11:36am