Gait is an important human function, and vision is the dominant sensory input used during gait. Vision aids pathfinding decisions and provide ongoing sensory feedback to maintain appropriate balance and prevent falls. Eye care providers who wish to effectively address the impact of vision impairment on the risk of falling will customize their management plan based on specific impairments. This article provides an overview of normal sensory integration as it applies to gait, with an emphasis on vision. It also presents an evidence-based review of visual dysfunctions that cause falls, as well as strategies to reduce falls in adults with visual impairment, with emphasis on patients over age 65.
Background: Amblyopia is characterised by visual impairment along with compromised binocular visual function. Form deprivation amblyopia is a result of opaque media which results in obstruction of light. This obstruction of light prevents visual development. It is has traditionally been managed at early stage of life through occlusion therapy. Case Summary: A 29-year old male presented to us, diagnosed with form deprivation adult strabismic amblyopia and nystagmus. Anterior segment evaluation showed pseudophakia in both eyes, and posterior segment was within normal limits. Stereopsis was absent. In-office vision therapy and homebased vision therapy was undertaken, which included optometric syntonic phototherapy, biofeedback mechanisms to improve nystagmus along with oculomotor skills, monocular fixation in a binocular field (MFBF) and binocular therapies in-office, and Amb-iNet at home. Conclusion: A multi-modality treatment approach in vision therapy is presented, which resulted in improvement of visual acuity, stereopsis and other components of vision for an adult with form deprivation strabismic amblyopia and nystagmus.
Background: As the deaf and hard of hearing population has increased over the last few decades, the prevalence of American Sign Language as a person’s primary language has increased with it. However, many optometrists are unsure as to how to approach an exam, and what the law requires to accommodate these patients. This literature review explores the legal and ethical considerations of examining and communicating with patients who are deaf or hard of hearing. Methods: Through literature review, information was gathered and summarized from many high quality publications and legal cases as to how to properly care for and communicate with a patient who is deaf or hard of hearing, with special attention to the legal and ethical requirements of an optometrist. Results: To optimize the health care environment for patients who are deaf or hard of hearing, the most important step is for optometrists to understand local resources, such as sign language interpreters, legal support, and community agencies, that can benefit both the patients and their chair time. This varies depending on what the deaf/hard of hearing patient needs and should be adjusted accordingly. The supplemental use of pictures or diagrams to illustrate tests or procedures may also help solidify communication between patient and doctor but may not be a substitute for “effective communication” as outlined in the Americans with Disabilities Act. Above all, it is important to meet these legal requirements, as well as address the specific needs of the patient, preferably with preparation before the exam. In addition, this information in this literature review is summarized in pamphlet format for distribution to the optometric community. Conclusion: The Americans with Disabilities Act lays out legal guidelines that physicians must follow when it comes to patients who are deaf or hard of hearing, including optometrists. It is important for optometrists to study these requirements and be aware of them, should the situation arise when a patient who is deaf or hard of hearing schedules or presents in a clinical setting.
Introduction: Children with Global Developmental Delay (GDD) fail to achieve developmental milestones expected for their age range as compared to their peers. They typically have visual problems in addition to poor gross and fine motor skills. Developmental delays extend to speech, language, cognition, and personal-social domains, and impact activities of daily living. Case Summary: A 4-year-old child presented with chief concerns from his parents that he had difficulty making eye contact was unable to stand and walk. He was not making adequate progress in physiotherapy. Neuro-developmental assessment resulted in a diagnosis of GDD. Visual Evoked Potential showed decreased visual acuity, and nystagmus. Comprehensive examination showed that the patient had a face tilt and head turn. Spectacle lenses with prism was prescribed. A therapy treatment plan was recommended and it was divided into three phases, with the primary goal of improving visual functions through vision therapy. At the end of the therapy, the child developed the confidence to stand and walk without any support. Conclusion: This case report demonstrates the importance of vision therapy in improving the patient’s overall visual performance. In particular, it demonstrates the role of visual intervention in aiding motor skills to the extent that standing and walking was enabled without the need for additional support.
Background: Insult to the brain, whether from trauma or other etiologies, can have a devastating effect on an individual. Symptoms can be many and varied, depending on the location and extent of damage. This presentation can be a challenge to the optometrist charged with treating the sequelae of this event as multiple functionalcomponents of the visual system can be affected.Case Report: This paper describes the diagnosis and subsequent ophthalmic management of an acquired brain injury in a 22 year old male on active duty in the US Army. After developing acute neurological symptoms, the patient was diagnosed with a pilocytic astrocytoma of the cerebellum. Emergent neurosurgery to treat the neoplasm resulted in iatrogenic cranial nerve palsies and a hemispheric syndrome. Over the next 18 months, he was managed by a series of providers, including a strabismus surgeon, until presenting to our clinic. Lenses, prism, and in-office and out-of-office neurooptometric rehabilitation therapy were utilized to improve his functioning and make progress towards his goals.Conclusions: Pilocytic astrocytomas are the most common primary brain tumors, and the vast majority are benign with excellent surgical prognosis. Although the most common site is the cerebellum, the visual pathway is also frequently affected. If the eye or visual system is affected, optometrists have the ability to drastically improve quality of life with neuro-optometric rehabilitation.
