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Significant visual issues caused by brain injuries

About 30 per cent of stroke survivors will drive again, heard a session on the ocular complications of acquired brain injury during the ICO Annual Conference.

Ms Carmel Noonan, Consultant Ophthalmologist, Aintree University Hospital NHS Foundation Trust, told delegates that at least 40 per cent of the brain is involved in processing vision, and following a brain injury several factors can affect the ability to read.

“Also patients are not going to volunteer information about some of the symptoms – you have to ask. For example, if there is a problem seeing movement or tilt they are not going to tell you that. You have to ask if they are seeing anything unusual,” she told MI.

Discussing visual field defects following a brain injury, Ms Noonan said about 10 per cent will recover within two weeks, about 40 per cent have partial recovery within a few months and about half do not recover.

Patients can take a year to adapt to a visual field defect following a brain injury. Doctors must take the time to explain this to patients and their carers, and the strategies that can help, so as to enable them to manage issues as best they can, Ms Noonan said.

Unlike in Ireland, people in the UK who suffer visual field loss but who adapt to it, can sit a “rigorous, specialised driving test” and receive a driving license if proven safe to drive.

Also speaking during the session was Dr Fiona Rowe, Reader in Orthoptics and Health Services Research, NIHR Fellow, University of Liverpool.

During her comprehensive presentation, Dr Rowe outlined the various ocular motility disorders and strabismus types that have been documented to occur following acquired brain injury.

Ocular motility disorders are inclusive of cranial nerve palsy, horizontal and/or vertical gaze palsy, nystagmus and vergence disorders, whilst strabismus types comprise acquired horizontal and/or vertical deviations inclusive of skew deviation. Some occur commonly whilst others are seen rarely, she explained.

Meanwhile, Mr Ian Marsh, Consultant Ophthalmic Surgeon, Aintree University Hospital NHS Foundation Trust, outlined the various treatment options for these patients. He recommended a multidisciplinary approach, with a full assessment of visual apparatus as well as determination of mental capacity. Basic treatment for visual issues in brain injury patients includes prisms, contacts, intraocular lenses and occlusion, as well as surgery.

He stressed the need for realistic expectations about surgical outcomes, in both doctors and patients, and for informed consent.

Mr Marsh explained that botox injections also have significant therapeutic and diagnostic uses, particularly in the treatment of the various nerve palsies and in pre-surgical simulation and post-operative diplopia testing.

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