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BLOG: What does the neck have to do with vision?
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by June Chiang, OD
It might seem surprising that an optometrist is interested in the biomechanics of the neck, shoulders and cervical spine — but these can be integral to solving problems related to the visual system, especially following a stroke, concussion or other form of brain injury.
Stroke patients often present with a visual field inattention or visual field loss to one side, which often leads to a head turn. The head turn can result in chronic tightness of certain muscle groups and weakness of others, eventually leading to chronic neck pain and cervical spine or disc damage.
In terms of concussion or blunt force trauma, a vertical deviation can occur if cranial nerve IV is affected. This can lead to a compensatory head tilt, which can also cause imbalance in the neck muscles and chronic neck pain and cervical tissue damage.
Neuro Vision treatment in the form of special lenses and vision therapy can bring pain relief and also help the patient become more visually aware of the neglected side. It can also improve proprioception of head centering. If your head is well centered, it makes sense that you’ll be able to pay better attention to visual stimuli from all directions and get the most benefit from other rehabilitation therapies (physical, occupational and speech).
Thus, addressing the untreated visual dysfunction can, by itself, make the head and shoulders straighter. Neuro Vision treatment may help the patient avoid or reduce other cervical treatments, such as pain medications (opioids), injections and surgery. It can facilitate better performance and learning in other rehab therapies. These are a couple good reasons for addressing head and neck biomechanics as Neuro Vision practitioners.
The impact of cervical mechanics works in the reverse direction as well. As the head is posturing and moving, there are a myriad of complicated feedback loops via the thalamus and basal ganglia, which help inform the sensory systems. The motor systems inform the sensory systems and vice versa. Improved head and neck control will help provide improved proprioceptive and spatial information for the visual system to process and interpret. Then the visual system can integrate and process the peripheral visual stimulus along with the central visual stimulus. This is the core issue for so many brain injury patients who lose the ability to process both peripheral and central visual stimuli simultaneously.
For all my colleagues, whether or not your practice involves brain injury patients, I would encourage being aware of this special population’s needs and risks. A good first step is taking a thorough history and being alerted to a possible history of brain injury, such as stroke or concussion. Then ask about related symptoms such as fatigue while reading, double vision, difficulty navigating high stimulus environments (big box stores), headache, neck or back pain, dizziness or balance problems, or difficulty processing multiple sources of information. If these symptoms are present, these patients should undergo a thorough Neuro Vision evaluation to rule out visual field loss/inattention, vertical deviations, visual midline shift, convergence insufficiency or saccadic dysfunction.
What has helped me the most for this special population is to take a step back and get the big picture, the whole picture of the patient. Consider what other body systems and social systems are affected and what other treatments or referrals might be beneficial to the healing process.
Working with the brain injury patient is truly a collaborative effort. Simply by pointing a patient in the right direction, you could play a critical role in helping them increase independence, get back to work, perform better or interact socially in the way they want.
For more information:
June Chiang, OD, works with brain injury patients in Los Angeles. She also owns a Pilates studio that complements her interest in neurosensory integration and movement training. Her workshop at the NORA annual conference, Sept. 19-22, 2019 in Scottsdale, Ariz., will include relaxing breathing and neck exercises, as well as educate participants on the relationship between cervical biomechanics and visual-spatial dysfunction. For schedule and registration, visit https://noravisionrehab.org/about-nora/annual-conference.
Disclosure: Chiang reports no relevant financial disclosures.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.