N. Kapoor

Visual impairments in the first year after traumatic brain injury

Background: This article reviews literature regarding individuals with traumatic brain injury who have vision related impairments up to one year, post-injury. Such impairments may impact rehabilitation of activities of daily living and mobility since vision is integral in much of what one does on a daily basis. Methods: Search of Medline, Ovid, and PubMed was performed using terms including: traumatic brain injury, visual deficits after brain injury, vision and traumatic brain injury, and ADLs after brain injury. Results: Eighteen studies were analyzed and reviewed. A range of visual and visual-motor impairments are seen across the severity of traumatic brain injury. Visual impairment negatively impacts independence in mobility and activities of daily living. Common sensorimotor visual symptoms reported by those with traumatic brain injury include blurred vision, reading problems, double vision or eyestrain, dizziness or disequilibrium in visually-crowded environments, visual field defects, light sensitivity, and color blindness. Conclusions: This review should alert the reader to common visual complaints and defects seen after traumatic brain injury. It is important to screen persons who have suffered traumatic brain injury for sensorimotor vision deficits early on in recovery so that these issues may be addressed and recovery of function and independence in the community are not delayed.

Critical flicker frequency and related symptoms in mild traumatic brain injury.

Primary objective: To determine whether critical flicker frequency (CFF) thresholds are abnormal in individuals with mild traumatic brain injury (TBI) and, if so, if they are correlated with the degree of reported motion and light sensitivity. Methods and procedures: The foveal CFF threshold was assessed in individuals with mild TBI (n = 18) having varying degrees of reported light and motion sensitivity. Mean CFF values were obtained using the ascending and descending psychophysical method of limits with binocular viewing at 40 cm. A 7-item, rating-scale questionnaire was used to assess the degree of light and motion sensitivity. These parameters were also assessed in a large visually-normal, non-TBI cohort. Main outcomes and results: CFF in the mild TBI group was not significantly different across age groups from the visually-normal, non-TBI cohort. However, mean CFF among the mild TBI subjects was significantly higher for the ‘light sensitive’ and ‘motion sensitive’ sub-groups when compared to the ‘not light sensitive’ and ‘not motion sensitive’ sub-groups. The majority of TBI subjects manifested both light and motion sensitivity. Conclusion: CFF was found to be related to the reported degree of light and motion sensitivity in individuals with mild TBI. Neurological disinhibition as a result of brain injury may be causal of the subjective hypersensitivity to light and motion in the presence of normal CFF.

Medications prescribed to brain injury patients: a retrospective analysis.

BACKGROUND The purposes of this study were to retrospectively evaluate the frequency of medications used by individuals with either traumatic brain injury (TBI) or cerebrovascular accident (CVA) and to consider the possible relationship between vision symptoms and diagnoses in this sample and the established visual and ocular side effects of the prescribed medications. METHODS Charts of patients examined in the Raymond J. Greenwald Rehabilitation Center at the SUNY State College of Optometry from the years 2000 to 2003 were reviewed. Only TBI (n=160) or CVA (n=60) patients were included. Prescribed medications from 12 possible categories were identified. Patients experiencing blurred vision, diplopia, asthenopia, poor depth perception, and/or light sensitivity were identified. Patients with accommodative dysfunction, vergence dysfunction, versional dysfunction, dry eyes, and/or ptosis were also identified. RESULTS The 4 most common medication categories taken by TBI patients were anti-anxiety/antidepressants (42.5%), anticonvulsants (26.9%), opiate/combination analgesics (23.8%), and cardiac/antihypertensives (23.1%). For the CVA patients, the medications were cardiac/antihypertensives (66.7%), anti-anxiety/antidepressants (31.7%), vitamins/mineral supplements (26.7%), and anticonvulsants (23.3%). Frequency of vision symptoms and diagnoses in the TBI and CVA patients appeared not to be related to medication use in most cases. CONCLUSIONS Anti-anxiety drugs, antidepressants, and anticonvulsants were the overlapping medication categories between the TBI and CVA groups. Medication intake did not affect the frequency of the reported vision symptoms and diagnoses in most cases, suggesting the symptoms and diagnoses were primarily related to either the TBI or CVA itself.