BLOG: New technology for concussion and visual function
by Charles Shidlofsky, OD, FCOVD
We are fortunate that new technology is lowering the barriers to testing and treating patients with brain injuries and other visual function problems.
Here, I’ll review some of the creative technologies that optometrists, vision therapists and neuro-optometric rehabilitation specialists might want to consider for their practices.
Among the most useful new assessment tools is the RightEye EyeQ platform, with four different tests geared towards reading, sports vision, functional vision and brain health. These quick tests, which include horizontal and vertical pursuits and saccades, circular pursuits, fixation and sensory motor evaluation, are objective tests for eye movement that rely on precise eye tracking in free space. They provide the clinician with immediate analytics that are helpful in guiding therapy, measuring progress and educating patients. The Brain Health EyeQ test, for example, provides an overall functional score, color-coded visual skills grading (green = normal, yellow = below normal levels, red = significantly below normal levels), as well as an indication of which eye muscles and/or parts of the brain may be affected.
Another new tool I’m excited about is BTrackS from Balance Tracking Systems. This posturography device helps isolate the three components of balance (vestibular, visual and tactile) using a balance board with firm and soft surfaces. Although I have been using posturography for 20 years, this new tool is about one-seventh of the cost of earlier systems, making it much more accessible. It also measures changes electronically, making it easier to quantify how yoke prism lenses or other therapeutic lenses or occlusion techniques can improve balance.
With the explosion of virtual reality (VR) consumer technology, many optometrists are also looking at VR for the office. There are two virtual reality training systems to consider: Vivid Vision and Optics Trainer. Although there are some pros and cons to each, both of these systems are excellent training tools for vergence, acuity, stereopsis, antisuppression and perceptual learning. They can be used with children and adults with amblyopia or brain injury.
I also like CBS Health, from Cambridge Brain Sciences, a web-based platform for assessment of cognitive function. Although it is qualitatively similar to concussion testing programs like ImPACT and CNS Vital Signs that are used by schools and primary care physicians, CBS Health can be customized to patients’ and practitioners’ needs. For example, I can select specific visual-spatial tasks from the 12 tests offered and see the patient’s performance compared to population norms.
Finally, Neurolenses are prescription lenses that add a contoured prism to bring the eyes into alignment. It's a game-changing technology for patients suffering from headache, eye fatigue, neck/shoulder pain and other symptoms related to trigeminal dysphoria, including those with post-concussion syndrome. The breakthrough Neurolens measurement device can objectively and accurately detect and measure eye alignment to identify subtle misalignments that overstress the trigeminal nerve and provide a prescription for spectacle lenses. The lenses have a contoured prism, which is ideal for patients with different prism demands at distance and near. This includes many “normal” patients with computer vision syndrome, but also concussed patients with acquired convergence insufficiency. The Neurolenses can reduce the severity of the acquired symptoms so that patients can go back to work while they continue to recover. Although the measurement tool is a significant investment, the treatment concept and its applicability to routine patients makes it easier to reap a return on the investment.
These are all promising technologies, and there are additional ones in the pipeline. In a future post, we’ll look at some devices from the sports vision world that cross over to neuro-optometric rehabilitation for brain injury patients.
For more information:
Charles Shidlofsky, OD, FCOVD, is clinical director of Neuro-Vision Associates of North Texas, a multi-office specialty clinic serving children and adults with neurological-based vision issues. He is a member of the medical staff at Baylor Institute for Rehabilitation in Frisco and Ft. Worth as well as Encompass Health in Plano. Shidlofsky also serves as a consultant for several Texas-based rehabilitation centers, including the Centre for Neuro Skills and Pate Rehabilitation. In addition, he is secretary/treasurer of the Neuro-Optometric Rehabilitation Association and a founding member and vice president of the International Sports Vision Association.
Disclosure: Shidlofsky reports no relevant financial disclosures.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.