University of MichiganA latest study highlights that symptoms of headache, dizziness and anxiety in some patients with traumatic brain injury may potentially increase or may be completely discarded with the help of particular eyeglass lenses that contain prisms. The experts included doctors from three southeast Michigan hospitals and one in private practice. They involved 43 patients with TBI for the study. It was revealed that TBI causes misalignment of the visual image or vertical heterophoria.

The study reveals that TBI supposedly causes visual image misalignment or vertical heterophoria. in order to correct this misalignment and restrict double vision the eye muscles are used to force the eyes back into proper alignment. Due to this the eye muscles get overworked, strained and fatigued. This accounts for numerous post-concussive symptoms, including headaches, dizziness, anxiety and neck pain. It was observed that using prismatic eyeglass lenses led to a 71.8 percent reduction of patient’s symptoms.

“This represents a new approach to the treatment of post-concussive symptoms,” says Mark S. Rosner, M.D., adjunct clinical instructor in the Department of Emergency Medicine at the University of Michigan Medical School and Emergency Department staff physician at St. Joseph Mercy Hospital in Ann Arbor. “Vision was known to be affected by TBI, but now it appears that the vision abnormalities caused by the TBI are causing the other post-concussive symptoms.”

About 15 to 20 percent of servicemen and women returning from Iraq and Afghanistan are affected by TBI which is mainly due to explosions. Generally 2 million people per year in the U.S are affected by TBI which occurs due to falls, auto accidents and sports injuries. It is identified that 10 to 25 percent of TBI patients have post effect even after one year of the injury.

“Treatment involves a multifaceted approach, including physical therapy, occupational therapy and multiple medications, and can take years to complete,” says Jennifer E. Doble, M.D., a physiatrist at St. Joseph Mercy Hospital, Ann Arbor. “Prismatic lens treatment seems to allow the other therapies to be effective more quickly. And as a result, patients get better quicker, reducing the time and cost of caring for this patient population.”

In 2005 two co-authors of the study Doble and Debby L. Feinberg, identified the first TBI patient with vertical heterophoria. The overlap of TBI and vertical heterophoria symptoms was significant to headaches, neck ache, upper back pain, dizziness, and nausea, anxiety and reading difficulties. As of now the only unifying reason for TBI symptoms has not yet been identified.

“A retrospective analysis of the data from these patients was performed, and 43 patients were diagnosed with vertical heterophoria and included in the study,” says Feinberg O.D., an optometrist at Vision Specialists of Birmingham, Birmingham, Mich. “These patients had persistent post-concussive symptoms despite receiving standard treatments and medications for an average of 3.5 years.”

Patients with TBI were initially observed by Doble and as time passed patients detected with vertical heterophoria were referred to Feinberg for further assessment. Feinberg developed a diagnostic and therapeutic process which was seemingly used to identify and treat vertical heterophoria. Prism lenses were added to the patient’s baseline prescription which resulted in a 71.8 percent reduction of symptoms in an average of 3.5 months.

“Our study concluded that in this group of patients who developed post-concussive symptoms and vertical heterophoria symptoms because of their TBI, malfunctioning of the binocular visual system was found to be a single common factor shared by all patients,” says Arthur J. Rosner, M.D., an otolaryngologist at the Department of Otolaryngology, William Beaumont Hospital, Troy, Mich.

J. Rosner, M.D observed that the treatment of the vertical heterophoria with prismatic eyeglass lenses was found to be effective and helped in reducing symptoms associated with both TBI and vertical heterophoria. The physicians who contributed to this study were Mark Rosner, Doble, Feinberg and Arthur Rosner.

This study was published in the April 2010 issue of Physical Medicine and Rehabilitation.