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Fixation dysfunction with intermittent saccadic intrusions managed by yoked prisms: a case report.
E Weissberg1, S A Lyons, J E Richman
1New England College of Optometry, Boston, Massachusetts, USA.
Optometry (St. Louis, Mo.)
|September 2, 2000
Summary
This case study highlights how prisms can effectively manage visual disturbances like "jumping letters" after traumatic brain injury. This approach offers a functional cure for fixational instability when medication provides only minimal relief.
Area of Science:
- Neuro-ophthalmology
- Vision Science
Background:
- A patient presented with visual disturbances, specifically "jumping letters," following a traumatic brain injury.
- Previous diagnoses included fixational instability secondary to saccadic intrusions, with limited response to Gabapentin.
Observation:
- Saccadic intrusions, characterized by inappropriate saccades disrupting fixation, were identified.
- Myopic anisometropia was noted, and symptoms reduced with eye occlusion and in superior gaze.
- A plano spectacle with a six-prism diopter-yoked base down was prescribed to optimize eye positioning.
Findings:
- Electro-oculography confirmed visual improvements after prism application.
- The patient's anisometropia facilitated monocular function under binocular viewing.
- The study suggests uninhibited brainstem circuits may underlie these fixational problems.
Implications:
- This case demonstrates the efficacy of prism spectacles in managing post-traumatic brain injury visual dysfunction.
- Optometrists play a key role in achieving functional recovery for such patients.
- Alternative applications of prism prescriptions offer a viable treatment for fixation dysfunctions.