Treatment of vertical heterophoria ameliorates persistent post-concussive symptoms: A retrospective analysis utilizing a multi-faceted assessment battery

Brain Inj. 2016;30(3):311-7. doi: 10.3109/02699052.2015.1113564. Epub 2016 Feb 1.

Abstract

Primary objective: To examine the effectiveness of neutralizing prismatic lenses for reduction of headache, dizziness and anxiety in patients with persistent post-concussive symptoms and vertical heterophoria (VH).

Background: Approximately 5-10% of patients with traumatic brain injury (TBI) develop persistent post-concussive symptoms. Many rehabilitation/treatment modalities are tried, but are largely unsuccessful, indicating a need for more effective treatment.

Design and method: This retrospective study included 38 patients with persistent post-concussive symptoms, who were diagnosed by an optometric binocular vision sub-specialist with VH (a sub-set of binocular vision dysfunction [BVD] that manifests as vertical eye and image misalignment). Data was collected both before and after prism application and included validated survey instruments for headache, dizziness, anxiety and BVD symptom burden; subjective rating (0-10 scale) of headache, dizziness and anxiety severity; and a sub-analysis of the BVD survey instrument questions that pertain specifically to headache, dizziness and anxiety. Upon conclusion of treatment, subjective assessment of overall improvement of heterophoria symptoms was obtained utilizing a 10 cm visual analogue scale.

Outcomes: Results demonstrated marked reduction in all measures of headache, dizziness and anxiety (19.1-60.8%) and an overall subjective improvement of VH symptoms of 80.2%.

Conclusions: Neutralizing prismatic lenses are an effective treatment of headache, dizziness and anxiety in patients with persistent post-concussive symptoms and VH.

Keywords: Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD); TBI; anxiety; binocular vision dysfunction; convergence insufficiency; dizziness; headache; post-concussive symptoms; prism lenses; reading or learning disability; vertical heterophoria.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety / therapy
  • Brain Concussion / physiopathology
  • Brain Concussion / therapy*
  • Child
  • Eyeglasses*
  • Female
  • Headache / therapy
  • Humans
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Post-Concussion Syndrome / diagnosis*
  • Post-Concussion Syndrome / therapy*
  • Retrospective Studies
  • Strabismus / etiology
  • Strabismus / physiopathology
  • Strabismus / therapy*
  • Treatment Outcome
  • Vision Disparity / physiology
  • Young Adult