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Neuroplasticity and Vision Therapy for Adults; A Case Series

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This poster was presented at the American Optometric Association's Annual meeting in Boston, MA 06/2016

The bottom line:

The 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.

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Neuroplasticity and Vision Therapy for Adults; A Case Series

  1. 1. 3241 South Michigan Avenue, Chicago, Illinois 60616 BACKGROUND Optometric 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 SERIES The 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-A Illinois College of Optometry 3241 S. Michigan Ave. Chicago, Il 60616 dmaino@ico.edu TABLE 1: Vision Therapy Sequence DISCUSSION The 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. CONCLUSION Clinicians 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. Table 1 Vision Therapy Sequence Monocular 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 Table 2 Symptoms/Problems LM Initial Symptoms/Problems Eye strain while reading, falls asleep while reading, intermittent blur, diplopia, loses place while reading, headaches, must use large print books, fatigue, may lose job because of errors made due to poor vision function, Attention problems Post Vision Therapy All areas improved or problems eliminated, uses normal sized print, job going well (Last evaluation 3 years post vision therapy. All improvements maintained) MP Initial Symptoms/Problems Cannot judge distance well, blurred vision, headache, cannot see 3D in 3D movies, Post Vision Therapy All symptoms/problems eliminated or improved, Can see 3D when watching 3D movies, Better depth perception while driving, No HA’s (Last evaluation 2 years post vision therapy. All improvements maintained) SP SB Initial Symptoms/Problems Diplopia, struggles to keep eyes straight, does not like her appearance when eye turns outward Post Vision Therapy All problems eliminated or improved, eyes now straight most of the time, no diplopia, cosmetic appearance improved significantly (Last evaluation 3 years post vision therapy. All improvements maintained) Table 2 Case History LM MP SP OCD Birth control No meds Sleep apnea No allergies No allergies Prilosec No previous VT No previous VT Environmental allergies Vitamins, Omega-3, Supplements Treated previously for CI TABLE 2: Symptoms/Problems TABLE 2: Case History TABLE 3: Examination Findings Table #3 LM Examination Findings (not all tests were given at all evaluations. (Ocular health unremarkable) Initial Findings BVA (OD/OS) Refractive Error Stereo/W4D EOMS/Pursuits/Saccades CT NPC Phoria (N) Vergences (N) Acc 20/20-;20/20 +.50-.50x010 - Random Dot Full/+4/+4 undershoots 10-20 XOP near 24/26” RL 11BI near BI X/25/12 +.50-.75x145 4-5 W4D near IAXT near BO X/35/30 Suppression ? Post Vision Therapy 20/20; 20/20 +0.25 -0.50 x 132 +Random Dot Full/+4/+4 -undershoot 10 XOP near To Nose RL 12 BI near BI 20/18 +0.75 -0.25 x 139 9/10 Wirt Circles No strab noted BO 20/18 4 W4D Dist/Near MP Examination Findings (not all tests were given at all evaluations. (Ocular health unremarkable) BVA (OD/OS) Refractive Error Stereo/W4D EOMS/Pursuits/Saccades CT NPC Phoria (N) Vergences (N) Acc 20/20; 20/20 +1.00 -0.25 x 005 -Random Dot Full/+4/+4 6PD IET To Nose 6 BO Suppression MEM AM +1.00 0/10 Wirt Circles BI/BO Facility Blur +/- Variable/Suppression W4D Post Vision Therapy 20/20; 20/20 +1.50 -0.25 x 010 + Random Dot Full/+4/+4 3 EP To Nose 3 BO BI 14/12 MEM PL OD +1.50 -0.25 x 165 3/10 Wirt Circles BO Off Scale +.50 OS 4 W4D Dist/Near (No suppression) Facility 8 CPM (+/-2.00) SP Examination Findings (not all tests were given at all evaluations. (Ocular health unremarkable) BVA (OD/OS) Refractive Error Stereo/W4D EOMS/Pursuits/Saccades CT NPC Phoria (N) Vergences (N) Acc 20/20; 20/15 -6.25 -1.00 x 100 + Random Dot Full/+3/+3 15 XOP Dist To Nose 10 BI Suppression MEM -5.00 -1.00 x 160 5/10 Wirt Circles 25 BI IXT Near Variable 4 W4D Dist Facility 2 W4D Near Blur (-) Post Vision Therapy 20/20;20/20 -6.25 -0.75 x 100 + Random Dot Full/+4/+4 8 XOP To Nose 8 BI BI/BO MEM -5.00 -0.75 x 180 10/10 Wirt Circles Off Scale +.75 OD/OS 4 W4D Dist/Near No Suppression An adult patient using the Brock String to improve positive fusional vergence.

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