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A Clinical Diagnostic and Treatment Protocol for the Patient with Visual Snow/Visual Snow Syndrome and Concurrent Binocular Dysfunctions 视觉雪/视觉雪综合征并发双眼功能障碍的临床诊断与治疗方案
Pub Date : 2023-03-01 DOI: 10.31707/vdr2023.9.1.p7
The objective of the present paper is to propose the first comprehensive, clinical protocol for patients having visual snow (VS)/visual snow syndrome (VSS) with respect to diagnostic and therapeutic aspects, including their concurrent non-strabismic, binocular vision/oculomotor dysfunctions which are in high prevalence.
本文的目的是为视觉雪(VS)/视觉雪综合征(VSS)患者在诊断和治疗方面提出第一个综合的临床方案,包括他们并发的非斜视,双眼视觉/动眼力功能障碍,这是一个高发的疾病。
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引用次数: 1
The Role of Neuroplasticity in the Neuro-Optometric Rehabilitation of Traumatic Brain Injury 神经可塑性在创伤性脑损伤的神经视光康复中的作用
Pub Date : 2022-12-01 DOI: 10.31707/vdr2022.8.4.p270
Athletic communities have begun to take pre­ cautions to mitigate traumatic brain injury, such as using protective gear, increasing medical oversight, and establishing better return­to­play rules to protect athletes. As awareness increases, there will be a correspondingly higher frequency of people with traumatic brain injury seeking neuro­optometric evaluation and treatment. Therefore, it is imperative for optometrists to understand the signs, symptoms, and treatment of associated visual sequelae of traumatic brain injury. There are many optometric conditions caused by traumatic brain injury, including, but not limited to: convergence insufficiency, accommodative insufficiency, oculomotor dys­ function, visual motion sensitivity and light sensitivity. In particular, the functional vision problems associated with traumatic brain injury can be addressed with neuro­-optometric rehabilitation therapy. They are often due to diffuse axonal injury throughout the brain caused by shearing and tearing of the axons. People with diffuse axonal injury tend to have slower processing speeds due to impaired function at the synapse and longer neuronal pathways. Neuro­-optometric rehabilitation therapy creates an environment to facilitate neuroplastic changes within the brain, such as axonal sprouting or dendritic plasticity. This article explores possible correlation between improved clinical findings in traumatic brain injury after neuro­ optometric rehabilitation therapy and increased neurophysiological changes in brain activity after vision therapy for convergence insufficiency.
体育界已经开始采取预防措施来减轻创伤性脑损伤,比如使用防护装备,加强医疗监督,建立更好的恢复比赛规则来保护运动员。随着意识的提高,创伤性脑损伤患者寻求神经验光评估和治疗的频率也相应增加。因此,验光师必须了解外伤性脑损伤的体征、症状和相关的视觉后遗症的治疗。外伤性脑损伤引起的视光症状有很多,包括但不限于:会聚功能不全、调节功能不全、动眼力功能不全、视动敏感性和光敏感性。特别是,与创伤性脑损伤相关的功能性视力问题可以通过神经视光康复治疗来解决。它们通常是由于整个大脑的弥漫性轴突损伤引起的轴突剪切和撕裂。弥漫性轴索损伤患者由于突触功能受损和神经通路延长,处理速度往往较慢。神经-视光康复治疗创造了一个环境,以促进大脑内的神经可塑性变化,如轴突发芽或树突可塑性。本文探讨了神经验光康复治疗后创伤性脑损伤患者临床表现的改善与会聚功能不全视力治疗后脑活动神经生理变化的增加之间可能的相关性。
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引用次数: 1
Remediation of Visual Snow (VS) and Related Phenomena in a Neuro-Optometric Practice:A Retrospective Analysis 神经验光术中视雪及相关现象的修复:回顾性分析
Pub Date : 2022-06-30 DOI: 10.31707/vdr2022.8.2.p105
INTRODUCTION: Visual Snow (VS) and the Visual Snow Syndrome (VSS) represent relatively new and important medical and neuro-optometric diagnoses. While there is much information dealing with their defining characteristics and diagnosis, there is a relative paucity of information dealing with therapeutic intervention. Methods: In the present investigation, a retrospective analysis of 27 patients (ages 9-55 years, mean of 28 years) with documented VSS was performed with respect to treatment of the visual snow, palinopsia, and the newly-discovered versional oculomotor dysfunctions in a private, optometric practice setting. Patients were provided a comprehensive neurooptometric and binocular vision examination, as well as completed the VSS Symptom Survey. Treatment: they were given a selection of 5 BPI and FL-41 chromatic tints to assess using a simple clinical comparison protocol for the VS; they were provided a range of saccadic tests to remediate the common finding of palinopsia; and they were given optometric vision therapy to remediate the common, versional oculomotor problems. Results: Chromatic filters were prescribed in 24 of the 27 patients for their VS, with symptom reduction of at least 50%. Reduction of the palinopsia by 50-65% was found in all 23 patients who had palinopsia following the saccadic therapy. 23of the 27 were given oculomotor-based vision therapy for their versional deficits (i.e., OMD), and marked symptom reduction was reported in all. Conclusion: This is the first study to demonstrate that neuro-optometric rehabilitation (NOR) provided successful remediation of the problems of VS, palinopsia, and OMD in symptomatic, clinical patients with VSS.
视觉雪(VS)和视觉雪综合征(VSS)是相对较新的和重要的医学和神经验光诊断。虽然有很多关于其定义特征和诊断的信息,但关于治疗干预的信息相对较少。方法:在本研究中,回顾性分析了27例(年龄9-55岁,平均28岁)记录的VSS患者,在私人验光实践环境中进行了视觉积雪,回视和新发现的轮转动眼肌功能障碍的治疗。患者接受了全面的神经验光和双眼视力检查,并完成了VSS症状调查。治疗:选择5种BPI和FL-41色度,使用简单的VS临床比较方案进行评估;为他们提供了一系列的眼跳检查,以纠正palinopsia的共同发现;他们接受了验光视力治疗来治疗常见的眼部运动问题。结果:27例VS患者中有24例使用了彩色滤光剂,症状减轻了至少50%。在所有23例斜视患者中,斜视在跳眼治疗后减少了50-65%。27人中有23人接受了基于动眼力的视觉治疗,以治疗他们的版本缺陷(即OMD),所有人的症状都有明显的减轻。结论:这是第一个证明神经验光康复(NOR)对有症状的VSS临床患者的VS、palinopsia和OMD问题提供了成功的补救的研究。
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引用次数: 4
Multi-modal Treatment Approach Incorporating Vision Therapy and Syntonics for Combined Organic and Functional Amblyopia 结合视觉治疗和综合疗法的多模式治疗器质性和功能性弱视
Pub Date : 2022-06-30 DOI: 10.31707/vdr2022.8.2.p89
Background: Amblyopia is characterized by reduced visual acuity along with compromised binocular visual function. Form deprivation amblyopia is obstruction of light which prevents visual development. It is has traditionally been managed at anearly stage of life through occlusion therapy.Case Summary: A 32-year-old male was diagnosed with acquired form deprivation strabismic amblyopia. Ocular trauma resulted in post pupilloplasty with membranectomy surgery of the right eye, and pseudophakia of the right eye, while the posterior segment was within normal limits. Stereopsis was absent. In-office and home vision therapy was implemented, which included syntonic phototherapy, space fixator, and monocular fixation in binocular field and Ambi-iNet.Conclusion: A multi-modality approach in treatment improved vision and stereopsis for an adult with acquired form deprivation strabismic amblyopia secondary to traumatic cataract, occlusio pupillae, and traumatic angle closure glaucoma.
背景:弱视的特征是视敏度降低,双眼视功能受损。形式剥夺性弱视是一种阻碍视觉发育的光线障碍。传统上,它是在生命的早期阶段通过闭塞治疗来管理的。病例总结:一名32岁男性被诊断为获得性形体剥夺性斜视弱视。眼外伤导致右眼瞳孔成形术后伴膜切除手术,右眼假性晶状体,而后段视力正常。立体视觉缺失。在办公室和家庭视力治疗实施,包括syntonic光疗,空间固定,单眼固定在双眼视野和ambii - inet。结论:采用多模式治疗外伤性白内障、瞳孔闭塞和外伤性闭角型青光眼继发的成人获得性形体剥夺性斜视弱视,可改善视力和立体视觉。
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引用次数: 0
The Application of Binasal Occlusion in the Treatment of Visual Motion Sensitivity 鼻闭锁术在视觉运动敏感症治疗中的应用
Pub Date : 2022-06-30 DOI: 10.31707/vdr2022.8.2.p75
BACKGROUND: A traumatic brain injury (TBI) occurs when there is neurological damage to the brain or spinal cord resulting from an external insult to the head. TBIs can range from mild to severe (severe cases include more serious bruising, extended loss of consciousness, or seizures). In cases of a mild TBI (mTBI) symptoms such as headaches,nausea, photophobia, asthenopia, intermittent diplopia, or blurred vision are often reported. Another common symptom associated with mTBI is nausea and dizziness associated with motion-related tasks such as walking in a busy environment or scrolling an electronic device, known as visual motion sensitivity (VMS). VMS and its associated symptoms often persist for months following the initial brain injury but may be alleviated with appropriate treatment.CASE SUMMARY: KL, a 47-year-old woman, presented for a binocular vision assessment to investigate persistent symptoms consistent with visual motion sensitivity. KL had sustained a mTBI two months prior after falling and hitting her head against her daughter’s head. Throughout the exam, KL reported increased ocular discomfort, headaches, and anxiety with visually stimulating or motion-related testing, includingOKN testing and tandem walks. Exam findings showed a reduction in stereopsis and a high lag of accommodation. KL was diagnosed with accommodative insufficiency and visual motion sensitivity secondary to her TBI. She was prescribed in-office vision therapy and binasal occlusion (BNO) to reduce motion stimulation. Application of BNO provided immediate relief of KL’s symptoms associated with VMS.CONCLUSION: Binasal occlusion should be considered an adjunct treatment option in cases of VMS secondary to mTBI in providing patients with immediate relief of visual symptoms associated with activities of daily living.
背景:外伤性脑损伤(TBI)是由于头部受到外部损伤而导致的脑或脊髓神经损伤。创伤性脑损伤可从轻微到严重(严重的病例包括更严重的瘀伤、长时间的意识丧失或癫痫发作)。在轻度TBI (mTBI)的病例中,通常会出现头痛、恶心、畏光、视疲劳、间歇性复视或视力模糊等症状。与mTBI相关的另一个常见症状是与运动相关的任务(如在繁忙的环境中行走或滚动电子设备)相关的恶心和头晕,称为视觉运动敏感性(VMS)。VMS及其相关症状通常在初始脑损伤后持续数月,但经适当治疗可减轻。病例总结:KL,一名47岁的女性,提出双目视力评估,以调查与视觉运动敏感一致的持续症状。两个月前,KL摔倒后头部撞到了女儿的头部,导致mTBI。在整个检查过程中,KL报告视觉刺激或运动相关测试(包括ingokn测试和串联行走)增加了眼部不适、头痛和焦虑。检查结果显示立体视觉下降,适应滞后。KL被诊断为适应性不足和视觉运动敏感继发于她的TBI。医生给她开了视力治疗和鼻塞(BNO)来减少运动刺激。应用BNO可立即缓解KL与VMS相关的症状。结论:在mTBI继发VMS病例中,应考虑将鼻塞作为一种辅助治疗选择,为患者提供与日常生活活动相关的视觉症状的即时缓解。
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引用次数: 0
Readalyzer as a Novel Approach in the Visual Biofeedback Treatment of Congenital Nystagmus: A Case Study Readalyzer作为一种视觉生物反馈治疗先天性眼球震颤的新方法:一个案例研究
Pub Date : 2022-06-30 DOI: 10.31707/vdr2022.8.2.p81
BACKGROUND: The treatment of nystagmus remains a clinical enigma. While many non-surgical therapeutic options have been advanced, and tried with success, relatively few are typically offered to most patients.CASE STUDY: We present a multi-phase, detailed case study of an adult with congenital nystagmus, and later an acquired visual field defect, in which three distinct forms of vision-based, biofeedback therapy were incorporated: the primary one was a novel useof the Readalyzer eye movement system, in conjunction with conventional oculomotor-based visual scanning therapy and yoked prisms.CONCLUSION: After completion of the multi-phase treatment, the patient’s nystagmus reduced, and both visual acuity and ambulation improved. The present findings are consistent with earlier results, which suggested a multi-modal therapeutic approach in those with nystagmus.
背景:眼球震颤的治疗仍然是一个临床谜。虽然许多非手术治疗方案已经取得了进展,并取得了成功,但对大多数患者来说,通常提供的方法相对较少。案例研究:我们提出了一个多阶段,详细的成人先天性眼球震颤,后来获得性视野缺陷的案例研究,其中三种不同形式的基于视觉的生物反馈疗法被纳入:主要是一种新的使用Readalyzer眼动系统,结合传统的基于动眼力的视觉扫描疗法和交叉棱镜。结论:完成多期治疗后,患者眼球震颤减轻,视力和行走能力均有改善。目前的研究结果与早期的结果一致,这表明了眼球震颤患者的多模式治疗方法。
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引用次数: 0
Increased Screen Time and Severity of Asthenopic and Ocular Dryness Symptoms During COVID-19 Pandemic 在COVID-19大流行期间,屏幕时间增加和视弱和眼干症状的严重程度
Pub Date : 2022-06-30 DOI: 10.31707/vdr2022.8.2.p98
BACKGROUND: The sudden increase in screen time usage during the COVID-19 pandemic has also resulted in a significant increase in visual symptoms. The majority of these symptoms are consistent with those reported from patients who experience dry eyes and non-strabismic binocular vision abnormalities (NSBVA). Thus, the aim of this study was to investigate the impact of increased screen time during COVID-19 pandemic in the severity of dry eye and asthenopia.METHODS: Subjects with age group 18-35 years with no previous episodesof symptoms associated with dry eyes and asthenopia prior to COVID-19 were recruited. All the subjects underwent a comprehensive binocular vision assessment followed by dry eye evaluation. SPEED and CISS scores were computed to assess the severity of symptoms.RESULTS: 44 subjects with asthenopia and dry eye symptoms met the inclusion criteria, They had a mean (SD) age of 27 (+/- 4) years. A statistically significant difference was noted for all the measured parameters except for negative fusional vergence (p=0.059). Strong positive correlation was noticed between the CISS scores and the screen time usage (r=0.78, p<0.001 Spearman correlation coefficient), and a moderate positive correlation between the SPEED scores and the screen time usage (r=0.56, p=0.01 Spearman correlation coefficient)CONCLUSION: Dry eyes and non-strabismic binocular vision problems post COVID-19 pandemic have risen significantly, due to the significant increase in the screen time usage. Incorporating an adequate binocular vision and dry eye evaluation in conjunction with a comprehensive ocular examination would help the patients through earlier diagnosis, and provide a plan for better management.
背景:在2019冠状病毒病大流行期间,屏幕使用时间的突然增加也导致视觉症状的显著增加。这些症状大多数与报告的干眼和非斜视双眼视力异常(NSBVA)的患者一致。因此,本研究的目的是调查COVID-19大流行期间屏幕时间增加对干眼和视疲劳严重程度的影响。方法:招募年龄在18-35岁之间,在COVID-19之前没有与眼睛干涩和视弱相关症状发作的受试者。所有受试者进行了全面的双眼视力评估,随后进行了干眼评估。计算SPEED和CISS评分来评估症状的严重程度。结果:44例有弱视和干眼症状的患者符合纳入标准,平均(SD)年龄为27(±4)岁。除负融合收敛外,所有测量参数的差异均有统计学意义(p=0.059)。CISS评分与屏幕时间使用呈强正相关(r=0.78, p<0.001 Spearman相关系数),SPEED评分与屏幕时间使用呈中度正相关(r=0.56, p=0.01 Spearman相关系数)。结论:新冠肺炎大流行后,由于屏幕时间使用的显著增加,干眼和非斜视双眼视力问题显著增加。结合充分的双眼视力和干眼评估,结合全面的眼科检查,将有助于患者通过早期诊断,并提供更好的治疗计划。
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引用次数: 0
Never Too Late 永远不会太迟
Pub Date : 2022-04-01 DOI: 10.31707/vdr2022.8.1.p8
Something just didn’t add up. This is what optometrist Angela Dobson thought as she examined a patient she had treated for years. Her patient, now fifty years old, had amblyopia and had always had very poor sight in her left eye. Yet, the woman had recently lost vision in her right eye, and – was it a miracle? – her left eye rose to the challenge. She not only could see well through her amblyopic eye, she could even drive with it.
有些事情不太对劲。这是验光师安吉拉·多布森(Angela Dobson)在检查一位她治疗多年的病人时的想法。她的病人现年50岁,患有弱视,左眼视力一直很差。然而,这位女士最近右眼失明了,这是一个奇迹吗?——她的左眼起身迎接挑战。她的弱视眼睛不仅看得清楚,甚至还能开车。
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引用次数: 0
Perspectives on Vision and Learning in the Educational System 教育系统中的视觉与学习透视
Pub Date : 2022-04-01 DOI: 10.31707/vdr2022.8.1.p19
On the evening of September 22nd, 2021, five diversely talented experts joined a cohortof eight educators enrolled in the graduate course Perspectives on Vision and Learningoffered through Pacific University College of Education. The lineup included Dr. LeonardPress, Dr. Nancy Torgerson, Katie Johnson – author of Red Flags for Elementary Teachers,Emily Cherkin – an internationally recognized screen time consultant, and Justin Ryan – aschool psychologist in California. The energy and enthusiasm generated by the panel discussion on Zoom that evening was transformative, and a model for future platforms was born. Before expanding on the ins and outs of what made this gathering so remarkable, I’d first like to share a little back story.
2021年9月22日晚,五位才华横溢的专家加入了由太平洋大学教育学院提供的研究生课程“视野与学习视角”的八位教育工作者队伍。与会人员包括莱纳德·普雷斯博士、南希·托格森博士、凯蒂·约翰逊(《小学教师的红旗》一书的作者)、艾米丽·切尔金(国际公认的屏幕时间咨询师)和贾斯汀·瑞恩(加州的一名学校心理学家)。那天晚上关于Zoom的小组讨论所产生的能量和热情具有变革性,未来平台的一个模式就此诞生。在详细介绍这次聚会的来龙去脉之前,我想先分享一个小背景故事。
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引用次数: 0
The Correlation between Reduced Binocular Vision Function and Reading Ability in Elementary School Students in Greece 希腊小学生双眼视觉功能减退与阅读能力的相关研究
Pub Date : 2022-04-01 DOI: 10.31707/vdr2022.8.1.p41
BACKGROUND: This study aimed to identify the correlation between visual performance and reading fluency, accuracy, and speed in elementary school students in Greece.METHODS: Examination procedures were approved by the Ministry of Education for the optometric team to enter the school premises and perform the assessments. The researchers performed optometric testing according to standard protocols to evaluate near point of convergence, oculomotor function, visual acuity, stereopsis, and accommodation and vergence facility. All results were compared with the reading abilityusing objective measurements of reading speed, number of fixations, and number of regressions while reading standardized Greek text. Results were analyzed with IBM SPSS Statistics 25.0 setting a value of p <0.05 as the level of statistical significance.RESULTS: The 834 students that were examined came from a total number of 14 schools to enable socioeconomic stratification of high, medium, and low living standards. Study results showed a significant difference in reading speed between students who passed all visual performance tests and those who failed at least one. The number of failed vision tests was directly correlated with reading ability. Reduced reading speed and efficiency was directly correlated to the number of visual tests failed.CONCLUSION: Poor reading performance in elementary school students in Greece was correlated with reduced visual function. Results demonstrated undiagnosed binocular and oculomotor visual deficiencies impact reading ability. A high correlation was identified between the number of visual deficiencies identified with both reading speed and regressions.
背景:本研究旨在确定希腊小学生的视觉表现与阅读流畅性、准确性和速度之间的相关性。方法:验光团队进入学校进行评估时采用教育部批准的检查程序。研究人员根据标准方案进行了验光测试,以评估近会聚点、动眼力功能、视力、立体视觉、调节和会聚设施。所有结果都与阅读能力进行比较,使用客观测量阅读速度、注视次数和阅读标准化希腊语文本时的回归次数。采用IBM SPSS Statistics 25.0进行统计学分析,p <0.05为差异有统计学意义的水平。结果:被调查的834名学生来自14所学校,以实现高、中、低生活水平的社会经济分层。研究结果显示,通过所有视觉表现测试的学生和至少有一项测试不及格的学生在阅读速度上存在显著差异。视力测试失败的次数与阅读能力直接相关。阅读速度和效率降低与视觉测试失败次数直接相关。结论:希腊小学生阅读能力差与视觉功能下降有关。结果显示未确诊的双眼和动眼性视力缺陷影响阅读能力。在阅读速度和视力退化之间发现了高度相关的视觉缺陷数量。
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引用次数: 0
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Vision Development &amp; Rehabilitation
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