Transcript Power Point Slides - Michigan Audiology Coalition

Research and Academic
Activities
Retrospective Data Analysis:
38 TBI Patients Diagnosed with VH
with Complete Data Sets
Average age: 38 years
(range 12 – 67 yrs)
Female = 66% (25)
Male = 34% (13)
Average duration of symptoms = 9.9 years
( 3 months to 30 years)
BVD Symptoms In TBI Patients
(% of patients )
BINOCULAR VISION SYMPTOMS
**Has a head tilt
**Poor depth perception
**Double vision
**Closing or covering an eye
**Shadowed / overlapping vision
57.9
50
39.5
34.2
34.2
READING SYMPTOMS
**Losing your place while reading
**Fatigue with reading
**Diffficulty w/ reading comp
**Skipping lines while reading
84.2
81.6
73.7
65.8
PAIN SYMPTOMS
Headache
Neck ache
Sinus pain / pressure
**Pain with eye movement
86.8
81.6
52.6
42.1
VISION SYMPTOMS
**Eye strain
Blurred distance vision
Problems w/ refection or glare
Blurred near vision
76.3
68.4
65.8
57.9
VESTIBULAR SYMPTOMS
Dizziness / Lightheadedness
Drifts to one side w/ walking
Nausea
Motion sickness
44.7
ANXIETY SYMPTOMS
Overwhelmed in crowds
Overwhelmed in large spaces
44.7
71.1
63.2
55.3
55.3
0
20
40
60
80
100
Specialists Seen
Prior To VH Diagnosis
(% of Patients)
Neurologist
60.4
PM&R
55.3
Ophtahlmology
44.7
Family Practice
42.1
Psychiatry / Psychology
36.8
ENT
29
Internal Medicine
26.3
Optometry
23.7
ER
23.7
Chiropractor
21.1
Pediatrician
2.6
0
10
20
30
40
3.66 consults / pt
50
60
70
7 Binocular Vision Questions
Rank
(10)
(12)
(21)
(22)
(23)
(24)
(25)
BVDQ question
Skip lines while reading
Head tilt
Pain with eye movement
Words run together while reading
Double / overlapping vision near
Close or cover an eye
Double / overlapping vision far
You’ll miss this condition if you only look for
binocular vision symptoms !
Top 10 BVDQ Questions
Rank
 (1)









(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
BVDQ question
Shoulder and neck discomfort
Headache
Glare / sensitivity to bright lights
Dizzy / lightheaded
Tire easily with close-up tasks
Blink to clear up distant objects
Unsteady / drift to one side
Dizziness with provocative head movements
Car rides = uncomfortable / dizzy
Do you skip lines while reading
Top 10 BVDQ Questions
Rank
 (1)









(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
BVDQ question
Shoulder and neck discomfort
Headache
Glare / sensitivity to bright lights
Dizzy / lightheaded
Tire easily with close-up tasks
Blink to clear up distant objects
Unsteady / drift to one side
Dizziness with provocative head movements
Car rides = uncomfortable / dizzy
Do you skip lines while reading
Top 10 BVDQ Questions
Rank
 (1)









(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
BVDQ question
Shoulder and neck discomfort
Headache
Glare / sensitivity to bright lights
Dizzy / lightheaded
Tire easily with close-up tasks
Blink to clear up distant objects
Unsteady / drift to one side
Dizziness with provocative head movements
Car rides = uncomfortable / dizzy
Do you skip lines while reading
You have to ask the right questions to come
up with the right answers !
New Research Projects
Results of Treatment - NPC
11 of 145 patients
started at “0” or
experienced no
change (7.5%)
134
Non 0-0
Patients
(92.5%)
Results of Treatment - NPC
134
Non 0-0
Patients
(92.5%)
Before:
10.1 inches
After:
5.1 inches
49.4%
Reduction
Results of Treatment - NPC
134
Non 0-0
Patients
(92.5%)
Before:
10.1 inches
After:
5.1 inches
49.4%
Reduction
88% of patients
improved
(118/134)
12% of patients
did not improve
(16/134)
Results of Treatment – King-Devick
105
Patients
Results of Treatment – King-Devick
105
Patients
Before:
61.9 secs
After:
52.3 secs
15.5%
Reduction
Results of Treatment – King-Devick
105
Patients
Before:
61.9 secs
After:
52.3 secs
15.5%
Reduction
72.3% of patients
improved
(76/105)
27.6% of patients
did not improve OR
no change (29/105)
Results of Treatment – King-Devick
105
Patients
Before:
61.9 secs
After:
52.3 secs
15.5%
Reduction
72.3% of patients
2/3
27.6% of patients
improved
(51/76) did not improve OR
(76/105)
improved got worse (29/105)
>5 secs
Results of Treatment – SSI
273
Patients
Results of Treatment – SSI
273
Patients
Before:
13.9
After:
5.6
59.5%
Reduction
Results of Treatment – SSI
273
Patients
Before:
13.9
After:
5.6
59.5%
Reduction
76% of patients
improved
(208/273)
23.8% of patients:
no change or got
worse (65/273)
Results of Treatment – Stereopsis
108
Patients
Results of Treatment – Stereopsis
108
Patients
39 were 9-9
Results of Treatment – Stereopsis
69
Patients
39 were 9-9
Results of Treatment – Stereopsis
69
Patients
59% of patients
improved (41/69)
41% of patients:
Worse (13/69) or
no change (15/69)
Results of Treatment – Stereopsis
69
Patients
59% of patients
improved (41/69)
Before: After:
4.3
7.6
+75%
Improvement
+3.3 units
41% of patients:
Worse (13/69) or
no change (15/69)
Before: After:
6.5
4.8
-26%
-1.7 units
Conclusions

The symptoms of BVD are frequently present
but not being recognized as being visual in
etiology, despite extensive testing and
consultation

Binocular vision dysfunction (BVD) appears
to be causing post-concussive symptoms in
~ 30% of all TBI / ABI patients with
persistent symptoms (>3 months)

The TBI / ABI appears to be causing the BVD
Conclusions

Treatment of the BVD with realigning
prismatic lenses reduces post-concussive
symptoms 80%

BVD Suspects can be easily identified with
a validated questionnaire

BVD can be firmly diagnosed by the Prism
Challenge Technique
NeuroVisual Optometry
PATIENT
Referrals
Wrap Up & Final Review
Which Patients to Screen for VH
and SOP using the BVDQ?

Patients who have dizziness, headache,
neck ache, visual / reading difficulties,
anxiety
– TBI with symptoms persisting 3 months or
longer after injury
Those with Physical Findings of VH & SOP
 Elderly with difficulty with balance /
frequent falls

Which Patients to Screen for VH
and SOP using the BVDQ?
Children with “reading and learning
difficulties” (?LD; ?RD)
 Children with “hyperactivity” (?ADD/
ADHD?)
 Children with motion sickness / car sickness
 Difficulty watching 3D movies
 Agoraphobia
 Panic attacks

Who Needs Referral?
High score on BVDQ > 15
OR
 Positive answers to any of the RED FLAG
questions

Take Home Messages
 This
represents a large percentage of
the general population (5-10%)
 Standard Binocular Vision tests are not
sensitive enough to identify this patient
population
 Know the power in the 5 Minute Cover
Test
Take Home Messages
 Have
all of your patients fill out the
questionnaire before your exam - you
will be amazed by what you find!
 Look for head tilt on all of your patients
 These patients will not get better until
their BVD is recognized and treated
 This work will give you the gift to
change lives
“Who, indeed, could
have supposed that a
mere ocular defect
could have given rise to
so serious a train of evils…
and who that had not seen
it could believe that the
correction by glasses of the eye trouble
could have given a relief so speedy and so
perfect that the patient described it as a
miracle?”
Dr. S. Weir Mitchell, Headaches and Eye Strain, April 1876