Brain injury can cause a variety of visual related disorders. In a study that evaluated the visual dysfunctions of active duty war fighters diagnosed with blast-induced mild traumatic brain injury, it revealed many had receded near point of convergence. In some circumstances of brain trauma, concurrent visual dysfunctions such as tracking errors and or decreased accommodative function can also occur with convergence insufficiency. This case report demonstrates how vision therapy can help improve the near convergence response in an adult with mild traumatic brain injury.
LC, a 43 year old female presented to our clinic for a complete eye exam. Her medical history was remarkable for falling off a performing stage in 2006 causing mild traumatic brain injury as a result of a concussion, and a severe car accident that caused a whiplash in 1999. Apart from physical injuries that resulted in her having difficulty walking, LC also reported diplopia, eyestrain, and headaches whenever she performed tasks at near. LC also reported a history of fibromyalgia. During the eye exam, we found that her near point of convergence was significantly decreased with no improvement using base-in prism (plus lenses were also attempted to rule out a pseudo-convergence insufficiency). A diagnosis of convergence insufficiency was given and vision therapy was decided upon as the treatment for LC's symptoms. Vision therapy was initiated for 90 minutes per week of in office training focusing only on fusional vergence type training. A pair of brock string was given to her for 30 minutes of home training per day. Vision therapy was discontinued after the fifth session as LC was able to fuse readily any object at near and reported no diploplia after 45 minutes of reading.
This case report shows how in-office and home fusional-vergence type training can help alleviate the symptoms of convergence insufficiency of an adult patient after experiencing traumatic brain injury.