Vision Development & Rehabilitation
Latest Publications


TOTAL DOCUMENTS

129
(FIVE YEARS 73)

H-INDEX

1
(FIVE YEARS 1)

Published By College Of Optometrists In Vision Development

2374-6416

2021 ◽  
pp. 235-244

Background: Infants with head tilts are most often diagnosed with torticollis and are referred to a pediatric physical therapist for evaluation and treatment. Determining if the head position is muscular or non-muscular when assessing these infants is key in making the appropriate referrals to other specialists and determining the best treatment approach. Most pediatric physical therapists treat patients with head tilts with manual therapy (i.e. massage, myofascial release, and passive/active range of motion). Many physical therapists only consider a visual etiology as a possibility after other treatment options have been exhausted and the head tilt persists. Although the incidence of torticollis has increased, based on the author’s experience, the number of cases of non-muscular etiology has also increased. There is a lack of current research on the use of prism glasses for treating head tilts in young children and infants carrying a diagnosis of torticollis, especially those presenting without any active/passive motion limitations. Traditionally, these patients undergo years of treatment without resolution of the head tilt. Case Report: A two-year-old patient initially presented with a diagnosis of torticollis with an intermittent and alternating head tilt for physical therapy. After several months of manual therapy, with little improvement in her head posture, the patient’s physical therapist referred her to a behavioral optometrist for a comprehensive vision examination and to pursue alternative treatment options. The optometric evaluation revealed ocular misalignment causing poor depth perception skills and prism glasses were prescribed full-time with the recommendation of continuing physical therapy for gross motor development. Conclusion: Prism glasses are an appropriate treatment consideration for some pediatric patients with persistent head tilts because they can provide immediate improvement in head position and depth perception. It is important to include optometrists in the multi-disciplinary team when working with patients with head tilts. Pediatric physical therapists would benefit from training on how to properly screen visual skills when evaluating children with head tilts. With such training, an appropriate optometric referral could be initiated early on in treatment.


2021 ◽  
pp. 270-278

Background: To evaluate improvements in clinical measures and symptoms in children and young adults with accommodative insufficiency in an open trial of office-based vergence and accommodative therapy. Methods: Major eligibility requirements included ages 9 to 30 years and amplitude of accommodation (AA) ≥2 diopters (D) below Hoffstetter’s minimum. Participants completed 8 weekly, 1-hour sessions of office-based vergence and accommodative therapy. Therapy procedures followed the Convergence Insufficiency Treatment Trial (CITT) therapy protocol with emphasis on accommodative procedures. Clinical measures of accommodation and symptoms (Convergence Insufficiency Symptom Survey [CISS]) were assessed at baseline and after therapy. Results were evaluated using the Student’s t test and Kruskal-Wallis test. Repeatability of CISS scores at baseline was assessed using Bland Altman 95% Limits of Agreement (LoA) and Interclass Correlation Coefficient (ICC). Results: Eighteen participants (mean age 17.4 ± 8.0 years) were enrolled; sixteen completed the study. The mean AA improved significantly from 5.5D OD and OS at baseline to 12.4D OD and 12.8D OS at outcome (p<0.001). Mean monocular accommodative facility (AF) also increased significantly in both eyes from 6.6 cycles per min (cpm) OD and 7.4cpm OS at baseline to 14.2cpm OD and OS at outcome (p≤0.0009). Amplitude-scaled monocular AF also showed significant improvements (p≤0.034 for both). Mean CISS score improved 10.50 points (p=0.0003). Significantly greater improvements in AA were observed in children (9.0D) than in adults (4.3D) in the right eye (p=0.007 for both comparisons). Conversely mean improvement in CISS score was significantly greater in adults than in children (p=0.039). Repeated CISS scores differed by, on average,1.47 points (95% limits of agreement:-5.19, 8.13; p=0.12). The ICC was 0.95 with a 95% confidence interval of 0.87 to 0.98. Conclusion: Eight weekly sessions of office-based accommodative vergence therapy combined with homebased- reinforcement therapy resulted in improvements of symptoms and clinical measures of accommodation in children and young adults with accommodative insufficiency.


2021 ◽  
pp. 233-234
Keyword(s):  

Diana was one of the most incredible individuals I have ever met: smart, insightful, clever, master clinician, social hostess, politically savvy, an adventurer/world traveler, abstract painter, poet, and so much more.


2021 ◽  
pp. 279-292

Background: Vestibular and vision functions are important contributors to posture control and fall avoidance. This review examines how the vestibulo-ocular reflex can be rehabilitated to help restore postural control. Methods: PubMed searches (7th April 2021) using the terms ‘vestibulo-ocular reflex’, ‘imbalance and vestibular dysfunction’, ‘vestibular dysfunction and dizziness’, ‘dynamic visual acuity’, ‘vestibular dysfunction rehabilitation’, and ‘gaze stabilization exercises’ yielded 4986, 495, 3576,1830, 3312, and 137 potentially useful publications respectively. Selections of those which were found to be the most relevant and representative of a balanced and current account of these topics, as well as selections from the most relevant reports referenced in those publications, were included in this review. Results: Just as there are age-related losses of static visual acuity even when there are no specific visual pathologies diagnosed, patients may also present with age-related loss of vestibular functions in the absence of specific vestibular pathologies. For example, cases of dizziness which are diagnosed as idiopathic might be usefully classified as age-related as the basis for the initiation of rehabilitation exercises. Conclusions: Apart from age-related loss of vestibular functions, cases diagnosed as having a particular form of vestibular pathology may have that condition exacerbated by age-related losses of vestibular functions. The effects of vestibular rehabilitation gaze stability exercises in patients with vestibular dysfunction are well established and include both improved dynamic acuity and postural stability. Improvements in posture control following rehabilitation of the vestibulo-ocular reflex are apparently due to improved peripheral and/or central vestibular balance control which has occurred in conjunction with enhanced gaze stability. The complex nature of increased fall risk suggests that an interdisciplinary approach to rehabilitation that includes vestibulo-ocular reflex rehabilitation appears likely to be associated with optimum outcomes for both pathological and age-related cases.


2021 ◽  
pp. 293-301

Background: The present study was designed to assess a protocol for investigating normative trends of kinetic color visual field sizes and reproducibility of such utilizing the Automated Functional Color Field Tester (FCFTester). Methods: The participants were recruited at three clinical sites. The participants were screened for the study based on a questionnaire designed by the authors to help assess the inclusion and exclusion criteria. There were 116 adult-only participants, however, only those reporting White race (n = 106) were used for statistical analysis. The mean age was 35.8 (std = 14) and nearly 70% of the sample was female. Results: This study demonstrated that kinetic visual field sizes across all four color isopters are not influenced by gender (p = 0.96) nor eye tested (p = 0.46). Only a slight difference in mean visual field sizes was found between the three clinical sites ranging from less than 2.5 degrees when the target was blue or green to less than 1.5 degrees for white or red targets. Overall, age had limited, yet significant, influence on kinetic field sizes likely related to the relatively young age of our participants. A significant difference in mean field size existed when comparing the four color isopters with an ascending order of green, red, blue, and white. This pattern was consistent across the three testing sites. Variability in field size for each color isopter was slight across the three clinical sites. Conclusion: The present pilot study shows promise that a protocol can be established to provide reproducible data and normative trends in kinetic color visual field testing. The authors recognize that this should be achievable with further refinement of the current testing protocol.


2021 ◽  
pp. 245-253

Background: Children with cerebral visual impairment (CVI) and/or developmental delay (DD) have a higher incidence of oculomotor dysfunction and visual perceptual challenges, in addition to challenges with motor control and body awareness. Such disorders could negatively impact one’s quality of life. Case Summary: This case demonstrates the efficacy of modified vision therapy (VT) activities in a 5-year-old child with CVI and DD. She completes roughly 50 sessions of VT and shows significant improvements in visual tracking and visual perceptual (VP) skills. Conclusions: This case emphasizes that children with CVI and/ or DD can benefit from VT. The progress of therapy may be affected by other motor and cognitive challenges; therefore, visual modifications to standard VT procedures can improve therapy success in these patients.


2021 ◽  
pp. 254-268

Background: Rod-Cone Dystrophies (RCDs) are characterized by the dominant clinical features of rods manifestation predominantly over the cones such as night blindness and peripheral vision worsening that leads to restricted activities of daily living. There are no medical or surgical treatments available for this disease. A combined approach of syntonic phototherapy along with the vision therapy may be a viable treatment option for the improvement in visual efficiency skills and visual function of RCD patients. Case Reports: Case 1: A female, aged 47 years old, diagnosed with severe RCD and complained of poor sight and difficulty in seeing at night in both eyes along with progressive diminution of vision for the past ten years. Case 2: A boy, 11 years of age, diagnosed with severe RCD and presented with major complaints of progressive vision loss, photophobia and falling short in school performance. Both patients were recommended for a combined treatment approach of syntonic phototherapy combined with vision therapy to be completed in our centre. Conclusion: These two patients showed significant improvement in visual acuity, oculomotor motility and visual field. Further research is recommended to enrich our understanding on the use of syntonic phototherapy along with vision therapy in managing patients with RCD which otherwise lacks in specific medical or surgical treatment.


2021 ◽  
pp. 195-200

Background: Micro-esotropia is a small-angle esodeviation typically less than nine prism diopters. Patients with this ocular condition often develop amblyopia due to the presence of a constant unilateral strabismus and an anisometropic refractive error in the deviated eye. Current treatment methods for strabismic and refractive amblyopia include spectacle correction, patching, and vision therapy (VT). Case Summary: A 9-year-old Asian female presented with a constant left primary micro-esotropia with unsteady eccentric fixation, contributing to mild amblyopia and frequent suppression in the left eye. She also had a hyperopic anisometropic refractive error. Combination treatment of in-office VT with short-term patching therapy (two hours per day) was administered, with the goal of improving her binocularity, fixation, and visual acuity. Conclusions: Amblyopia results from binocular dysfunction, therefore monocular patching therapy alone will not improve the underlying issue. VT is necessary to actively treat binocularity and subsequently improve visual acuity, while short-term patching can be used in combination to effectively target monocular accommodation and fixation.


2021 ◽  
pp. 166-175

More than 3.8 million Americans sustain a concussion or mild traumatic brain injury each year. Over 70 percent (2.66 million) of these patients suffer consequential vision dysfunctions. Research has shown that optometric vision therapy can provide significant improvement in post-concussion vision problems. However, assessing and managing post-concussion visual dysfunctions can be challenging for the optometrist. This difficulty is primarily due to the complex and diffuse damage the brain incurs from concussion, resulting in a unique clinical profile for each individual patient. When vision-based dizziness or imbalance complaints are included in the post-concussion patient’s presentation, the evaluation and management process becomes more complicated. This challenge is exacerbated by the plethora of comorbid, non-vision-based causes for dizziness/imbalance (D/I) that might also be present. According to the Center of Disease Control and Prevention, more than one-third of adults aged 65 years and older suffer falls each year, many of which are secondary to D/I. At least half of the U.S. population is affected by a balance or vestibular disorder sometime during their lives. The purpose of this article is to introduce The Dizziness Wheel. It is a graphic tool, developed and utilized by this author, to help assess and triage a concussed patient’s D/I. It also aids the identification of links amongst multisystem disruptions. This is especially helpful because D/I almost always represent a complex combination of overlapping symptoms. The Dizziness Wheel is not intended to be used as a formal diagnostic tool. Rather it is a differentiation graphic for use throughout the patient’s therapeutic experience. This author has found it to be helpful during initial exams, follow-ups, and in-office therapy. The Dizziness Wheel also can serve as a helpful guide for referral to other types of healthcare providers. Many D/I patients present to the neuro-rehabilitation optometrist without having been comprehensively assessed and treated for non-visual causes of D/I. The Dizziness Wheel can help the optometrist ensure the patient’s safety and access to effective integrated management of dizziness and imbalance.


2021 ◽  
pp. 201-214

Background: Loss of balance and falls are the primary cause of accidental death in persons over 65 years of age. This review examines the role of visual functions in the maintenance of a balanced posture and associated fall avoidance, including how visual functions interact with proprioceptive, tactile, vestibular and cognitive factors under a range of environmental circumstances and conditions. Methods: Reference to relevant articles from a wide range of sources were used to examine how vision functions are usually integrated with other senses in avoiding falls. Results: Under most conditions vision can make an important contribution to posture control and fall avoidance although such contributions have not always been recognized in the past. However, successful balance training has been shown to be associated with multi-component programs. Conclusions: Given the complexity of posture control and the multiple changes (physiological- and disease-related) which occur with age, as well as the capacity for different professional groups to contribute more or less dissimilar fall prevention strategies, it is not surprising that there appears to be great potential for improved interdisciplinary coordination of remedial interventions which reduce the risk of fall-related injuries and death. Similarly, overcoming age- or frailty-related difficulties in standing from a seated position can be best handled by interdisciplinary approaches.


Sign in / Sign up

Export Citation Format

Share Document