BLOG: A look back, a look ahead at neuro-optometry
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In 1977, as a graduate student from University of California, Berkeley, I coauthored the first paper on neuro-optometry. My mentor, a neurologist, and I were very excited about the intersection of neurology and optometry.
Since then, and especially in the past 20 years, the field of neuro-optometry – or neuro-optometric rehabilitation – has blossomed. In part this has been due to societal developments, including rising public awareness about sports-related concussions and U.S. involvement in the wars in Afghanistan and Iraq. Thousands of soldiers survived roadside bombs in these wars but were left with significant traumatic brain injury (TBI). The need to address their injuries served as the impetus for research into understanding, preventing and treating TBI, which in turn has helped to further the understanding that optometry has a key role to play in the rehabilitation of visual motor execution, visual information processing and visual-perceptual function.
I suspect that the next 10 years will take our field in many interesting directions. In particular, I see three trends emerging.
More technology
As in every area of health care, neuro-optometric technology is getting better, more accessible and less expensive. Three years ago, I purchased a system to measure dynamic posturography. Today, the same kind of system costs about one-fourth of what it did then.
We are also seeing better technology for evaluating eye movements and visual motor activities and exciting new virtual reality and augmented reality tools. The availability of devices that are lower cost (or higher cost but reimbursable) and easier to use is essential for broader integration into clinical practice, outside of academic research centers.
More use of objective recording techniques
The development of objective techniques, as an adjunct to clinical observation, has been one of my life’s goals. Most patients with TBI have eye movement problems; difficulty reading is one of the most commonly experienced TBI symptoms. To help these patients, neuro-optometry has developed therapeutic techniques and appliances (eg, lenses, prisms, tints).
Today, miniaturization of video technology is greatly facilitating the development of advanced eye movement video systems such as RightEye, Optovue’s iScan and others. These devices can also help us demonstrate that, after treatment, there are fewer abnormal eye movements, and the eyes are appropriately tracking the words on the page, leading to improved reading speed and comprehension.
More use of feedback techniques
Biofeedback is a powerful tool with a long history outside of neuro-optometry. In our field, it involves the use of external forms of feedback, which can be visual (ie, an after-image), tactile or auditory, to help the patient recognize when their eyes are moving.
More than 40 years ago, when I helped develop an early protocol for treating patients with large nystagmoid eye movements, I was highly skeptical of this concept. But we found that even one session of auditory feedback, during which patients were instructed to listen to a tone and strive to make the tone less “jerky,” could achieve noticeable improvements in the eye movements the tones were linked to.
Auditory and other forms of biofeedback are now used or explored to help patients with TBI, strabismus, visual-motor dysfunction and other conditions. There are many areas where these lessons can be applied.
The future is bright for neuro-optometry, with new tools and techniques to help our patients.
For more information:
Kenneth Ciuffreda, OD, PhD, is a distinguished teaching professor at the SUNY State College of Optometry in New York. For the past 42 years, he has focused on investigating a full range of visual conditions and dysfunctions involving the goal of visual system diagnosis and remediation using objective approaches. Over the past 15 years, his focus has been in acquired brain injury, with an emphasis on TBI. He has written more than 400 publications, many dealing with the theme of objectively based diagnosis and treatment, as well as 10 books, including one on acquired brain injury.
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.
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