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The “Big Five” Visual Phenomena in Acquired Brain Injury
Poster Presentations
Informational Poster 77 The ‘‘Big Five’’ Visual Phenomena in Acquired Brain Injury Tressa Fay Eubank, O.D., Southern College of Optometry, Memphis, Tennessee Summary: Patients who have been referred for a vision rehabilitation evaluation at the Vision Rehabilitation Service (VRS) secondary to acquired brain injury (ABI) due to trauma or CVA (stroke) appear to share commonalities in 5 distinct areas of visual function, regardless of the etiology or severity of the ABI. These areas of concern are often not tested during a routine eye and vision examination. Often times the results of these visual deficiencies impact the patient’s overall rehabilitation therapies provided by their occupational and physical therapists. The primary care practitioner can include basic screening procedures for these visual skills and visual processing deficits and may choose either to provide or refer the patient for optometric vision therapy. Background: Patients seen at the VRS for a vision rehabilitation evaluation post-stroke or trauma are subjected to a battery of tests to evaluate their visual skills and visual perceptual function. The author has discovered similarities across the wide range of patient presentations in 5 specific areas: saccadic ability, binocular posture, visual memory, spatial awareness, and rhythm and timing. Method: Twenty-five patient records (out of a population of 105) were randomly selected to be reviewed in the 5 areas listed above: saccadic abilities using the DEM; binocular posture by performing the cover test at near; visual memory using the Learning Efficiency Test (LET) or the Visual Memory/Visual Sequential Memory subtest of the MVPT/MPVT-V; spatial awareness using the Piaget Right-Left Awareness and/or the Gardner Reversal Frequency II (recognition of reversals); rhythm and timing using the Grooved Pegboard when physically feasible, or by case history and general observation. Differences between the age-norms for each test given versus actual patient performance will be calculated and reported. Results: Regardless of the etiology of the ABI, it is expected that the overall performance on the DEM, Gardner Reversal Frequency II, MVPT/MVPT-V (in general, and visual memory-specifically), and Grooved Pegboard will demonstrate performance below the expected for the patient’s age. The data for the selected 25 patients will presented and discussed. Conclusion: Records review of 25 patients with acquired brain injury will be expected to demonstrate decreased levels of performance in saccadic ability, binocular dysfunction (convergence insufficiency/intermittent alternating exotropia), visual memory, spatial awareness, general motor timing and rhythm and. The results will support the author’s clinical observations that performance levels in the above selected tests are significantly below expected and may even reach performance of a 7- to 9-year-old child. Two questions thus arise: 1) If the primary care optometrist includes a screening battery for the above areas of concern for
379 patients with a history of ABI, can optometric vision therapy assist these patients performance directly affect their daily activities, especially during their rehabilitation processes? 2) What is special about the 7- to 9-year-old brain development? The first question can be addressed by reviewing pre- and post-visual skills and visual processing tests for these individuals of those completing the vision therapy program. The second question will require further investigation. Poster 78 Demonstrate the Distribution of Topography Patterns Among Patients Seeking Corneal Refractive Surgery Marina L. Gorenshteyn, O.D., and Sachie Hase, O.D., Woolfson Eye Institute, Atlanta, Georgia Background: Corneal refractive surgery was first introduced in 1995 when the Food and Drug Administration approved the first excimer laser for treating mild to moderate myopia. The procedure provides an alternative means of correcting patients’ refractive error. Two of the most common ways this procedure can be performed are Laser Assisted In-Situ Keratomileusis (LASIK) and Photorefractive keratectomy (PRK). More recently, screening qualifying candidates for any pre-existing risk factors has become more rigorous to avoid post-LASIK complications, the most serious of which is post-LASIK ectasia, where the cornea is weakened to the point of gradual thinning and bulging. Evaluating corneal topography is getting more critical for those patients seeking corneal refractive surgery. Method: Three hundred patients were randomly selected for a retrospective study to evaluate topography patterns based on 5 categories: Normal/Symmetrical Bow Tie (SBT), Asymmetrical Bow Tie (ABT), Skewed Radial Axis (SRA), Inferior Steepening (IS), and Forme Fruste Keratoconus (FFKC). Results: Two hundred and nineteen (73%) patients out of the 300 were offered LASIK and 35 (12%) patients were offered PRK. One hundred and thirty-two (44%) out of the 300 patients seeking LASIK surgery had normal/SBT patterns, while 114 (38%) had ABT topographic patterns. 54 (18%) patients were not offered corneal refractive surgery, of which 31 (57%) had SRA, 13 (24%) had IS, and 10 (19%) had FFKC topography patterns. Conclusion: Post-LASIK ectasia remains a serious complication following corneal refractive surgery. Thorough review of patient topography patterns during the screening process for potential candidates seeking corneal refractive surgery reduces this incidence rate.
Primary Care Poster 79 Amiodarone-Induced Keratopathy: A Case Report Eileen M. Bush, O.D., Christine L. Burke, O.D., Sean C. McLoughlin, O.D., and Maria I. Diaz, O.D., EnVision, East Haven, Connecticut Background: Amiodarone is a potassium channel blocking antiarrhythmia drug used to treat recurrent ventricular
Informational Poster 77 The ‘‘Big Five’’ Visual Phenomena in Acquired Brain Injury Tressa Fay Eubank, O.D., Southern College of Optometry, Memphis, Tennessee Summary: Patients who have been referred for a vision rehabilitation evaluation at the Vision Rehabilitation Service (VRS) secondary to acquired brain injury (ABI) due to trauma or CVA (stroke) appear to share commonalities in 5 distinct areas of visual function, regardless of the etiology or severity of the ABI. These areas of concern are often not tested during a routine eye and vision examination. Often times the results of these visual deficiencies impact the patient’s overall rehabilitation therapies provided by their occupational and physical therapists. The primary care practitioner can include basic screening procedures for these visual skills and visual processing deficits and may choose either to provide or refer the patient for optometric vision therapy. Background: Patients seen at the VRS for a vision rehabilitation evaluation post-stroke or trauma are subjected to a battery of tests to evaluate their visual skills and visual perceptual function. The author has discovered similarities across the wide range of patient presentations in 5 specific areas: saccadic ability, binocular posture, visual memory, spatial awareness, and rhythm and timing. Method: Twenty-five patient records (out of a population of 105) were randomly selected to be reviewed in the 5 areas listed above: saccadic abilities using the DEM; binocular posture by performing the cover test at near; visual memory using the Learning Efficiency Test (LET) or the Visual Memory/Visual Sequential Memory subtest of the MVPT/MPVT-V; spatial awareness using the Piaget Right-Left Awareness and/or the Gardner Reversal Frequency II (recognition of reversals); rhythm and timing using the Grooved Pegboard when physically feasible, or by case history and general observation. Differences between the age-norms for each test given versus actual patient performance will be calculated and reported. Results: Regardless of the etiology of the ABI, it is expected that the overall performance on the DEM, Gardner Reversal Frequency II, MVPT/MVPT-V (in general, and visual memory-specifically), and Grooved Pegboard will demonstrate performance below the expected for the patient’s age. The data for the selected 25 patients will presented and discussed. Conclusion: Records review of 25 patients with acquired brain injury will be expected to demonstrate decreased levels of performance in saccadic ability, binocular dysfunction (convergence insufficiency/intermittent alternating exotropia), visual memory, spatial awareness, general motor timing and rhythm and. The results will support the author’s clinical observations that performance levels in the above selected tests are significantly below expected and may even reach performance of a 7- to 9-year-old child. Two questions thus arise: 1) If the primary care optometrist includes a screening battery for the above areas of concern for
379 patients with a history of ABI, can optometric vision therapy assist these patients performance directly affect their daily activities, especially during their rehabilitation processes? 2) What is special about the 7- to 9-year-old brain development? The first question can be addressed by reviewing pre- and post-visual skills and visual processing tests for these individuals of those completing the vision therapy program. The second question will require further investigation. Poster 78 Demonstrate the Distribution of Topography Patterns Among Patients Seeking Corneal Refractive Surgery Marina L. Gorenshteyn, O.D., and Sachie Hase, O.D., Woolfson Eye Institute, Atlanta, Georgia Background: Corneal refractive surgery was first introduced in 1995 when the Food and Drug Administration approved the first excimer laser for treating mild to moderate myopia. The procedure provides an alternative means of correcting patients’ refractive error. Two of the most common ways this procedure can be performed are Laser Assisted In-Situ Keratomileusis (LASIK) and Photorefractive keratectomy (PRK). More recently, screening qualifying candidates for any pre-existing risk factors has become more rigorous to avoid post-LASIK complications, the most serious of which is post-LASIK ectasia, where the cornea is weakened to the point of gradual thinning and bulging. Evaluating corneal topography is getting more critical for those patients seeking corneal refractive surgery. Method: Three hundred patients were randomly selected for a retrospective study to evaluate topography patterns based on 5 categories: Normal/Symmetrical Bow Tie (SBT), Asymmetrical Bow Tie (ABT), Skewed Radial Axis (SRA), Inferior Steepening (IS), and Forme Fruste Keratoconus (FFKC). Results: Two hundred and nineteen (73%) patients out of the 300 were offered LASIK and 35 (12%) patients were offered PRK. One hundred and thirty-two (44%) out of the 300 patients seeking LASIK surgery had normal/SBT patterns, while 114 (38%) had ABT topographic patterns. 54 (18%) patients were not offered corneal refractive surgery, of which 31 (57%) had SRA, 13 (24%) had IS, and 10 (19%) had FFKC topography patterns. Conclusion: Post-LASIK ectasia remains a serious complication following corneal refractive surgery. Thorough review of patient topography patterns during the screening process for potential candidates seeking corneal refractive surgery reduces this incidence rate.
Primary Care Poster 79 Amiodarone-Induced Keratopathy: A Case Report Eileen M. Bush, O.D., Christine L. Burke, O.D., Sean C. McLoughlin, O.D., and Maria I. Diaz, O.D., EnVision, East Haven, Connecticut Background: Amiodarone is a potassium channel blocking antiarrhythmia drug used to treat recurrent ventricular