In our January blog post we reviewed some of the visual issues that can arise with vestibular disorders. So to continue this topic further, we thought it’d be a good time to review treatment options that help address these challenging visual issues.
An exam by a developmental optometrist is the first place to start to determine what visual issues are present and what treatment options are appropriate. The results of the exam will reveal any deficiencies in functional vision, such as fixation and tracking, central-peripheral integration, or binocularity. From there recommendations can be made for the specific vision-related conditions identified, which may include neuro-optometric rehabilitation and/or prescription lenses.
Neuro-optometric rehabilitation is a therapeutic program consisting of specialized activities used to strengthen the connection between the brain and our visual system. Therapeutic activities are incorporated to reduce or eliminate eye fixation and oculomotor deficiencies, improve focusing abilities, enhance central-peripheral visual field integration, and improve binocularity (eye-teaming). Activities are chosen to provide a “just-right” challenge for each patient with the proper amount of cognitive loading when working on each visual skill area. This allows the individual to develop these skills so they become automatic and reliable in various environments and scenarios while the brain is having to simultaneously process other sensory input.
Treatment for visual-vestibular disorders may involve the use of corrective lenses, which can include prisms and filters. When considering glasses as a part of treatment, it’s important to keep in mind that corrective lenses alter the size of images. Sometimes bifocals, trifocals, or progressive lenses are considered for those that need different correction at various distances – distance, reading, and computer work. However, this does require more processing by the brain to adjust to the various levels of magnification. Depending on the situation, your optometrist might recommend two pairs of single vision glasses, one for near and one for distance, along with lenses that have a smaller diameter to reduce visual distortion. Contact lenses are another alternative since they reduce image distortion by sitting directly on the cornea. Lenses can be a powerful tool for addressing certain visual issues, but they require a thorough exam by a developmental optometrist as well as patience to adjust to a new prescription.
Some helpful coping strategies for visual-vestibular disorders may include using sunglasses to reduce glare, replacing fluorescent lighting with incandescent bulbs, replacing mini-blinds with solid curtains, and reducing busy patterns in your home such as removing distracting throw rugs.
Vestibular physical therapy is another important aspect of treatment for addressing the other symptoms caused by an impaired vestibular system including dizziness, impaired gait, and poor balance. Vestibular physical therapy utilizes exercises to improve gait instability and reduce fall risk in various environments and activities. The collaboration between a developmental optometrist and physical therapist specializing in vestibular disorders offers a comprehensive treatment that addresses both systems. Each treatment helps to enhance the effects of the other.
Revisiting the photographer/camera analogy in our first post of this series, the photographer (vestibular system) needs to be stable to hold the camera steady and the camera (visual system) needs to have a properly functioning focusing system in order to take successful pictures. The combination of addressing oculomotor function and binocularity through neuro-optometric rehab along with balance and gait through vestibular rehab results in the most effective long-lasting treatment outcomes.
For additional information and resources, please visit the College of Optometrists in Vision Development at covd.org and the Vestibular Disorders Association at vestibular.org.
Vestibular Disorders Association. (2009). Vision challenges with vestibular disorders. Retrieved from https://vestibular.org/sites/default/files/page_files/Documents/Vision%20Challenges.pdf