Vision

Question: My son had a traumatic brain injury and was in a drug induced coma for 3 weeks, but since out of the coma he cannot see anything. I am trying to find out if anything can be done to help his vision. From what I have been told he does have damage to the occipital lobe, so are there doctors that specialize in this that he can see to find out if anything can be done? He is 22 years old and I hate for him to be blind the rest of his life, plus rehabilitation is much harder without his vision! 

Answer: I am sorry to hear of your son's traumatic brain injury. Have you consulted with a neuro-optometrist? These are eye doctors that specialize in the connection that the eyes make with the brain. There is an organization called NORA or Neuro-optometric rehabilitation association that can help you find a provider in your area. The organization's website is:

https://nora.cc/

This of course, is not a "cure all" but it may be able to provide you with some answers regarding your son's blindness.

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Question: My 10 month old baby boy seems to have vision problem due to Neonatal Brain injoury in occipital region of right cerebral as per the MRI report. The symptoms he is showing are as follows:
1. Less eye contact. When called he doesn't look towards the person who is calling. even if he looks at the person it lasts for few seconds only.
2. His neck movement doesn't seem to be flexible.
3. He sleeps less and takes very less food.
So my family is worried about him and his vision. We consulted Doctors in Bangladesh but they couldn't tell us how far my boy can see or what is the problem regarding his vision?
Can you please give us some idea about the vision of my boy and what are the possibilities of vision recovery from this conditions? what are the treatments available for this problem? Will my boy be able to read and write?

Answer: As you may know, the occipital lobe of the brain (where your son has his injury) is responsible for visual perception (making sense out of visual images), visual processing, & reading (specifically the aspects of perception and recognition of printed words).The occipital lobe of the brain is making sense out of the images that the eyes are sending to it for processing, so it is possible that your son's eyes and vision are normal, but that the brain is not able to interpret or make sense of the images it is receiving from the eyes.

In the United States, we have vision specialists called Neurodevelopmental optometrists that can assess vision issues following a brain injury. These professionals are able to prescribe exercises or in some case, special lenses that can assist with getting the eyes and the brain to communicate effectively. I am not sure if these professionals are available in Bangladesh, but here is the website where you can find more information on vision and brain injury: https://nora.cc/index.php There is an area where you an "find a provider" and you may be able to reach out to specialists who could provide you more detailed information on vision and brain injury.

The infant brain is able to compensate for injuries much more easily than the adult brain can. I am glad that your son was diagnosed with his vision issues early on so that his brain can "rewire" to find another pathway to process visual information since his visual pathway seems to have been damaged.  

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Question: My son had a cardiac arrest due to heartfibrillation of unknown origin while he was jogging. He was reanimated for 25 minutes. After more than two months in a vegetative state he woke up has has been progressing since then.

He has a spastic tetra paresis, mainly the arms and hands are affected, he has little function in both hands. He has a pronounced dysarthria and the worst damage for himself is an extensive visual impairment. He is able to see colours and simple geometric shapes but no faces or objects. He is fully orientated, his short-term and long-term memory are excellent.

Due to these impairments he is unable to do anything by himself, except of walking independently in familiar environment.

The MRI scan shows bilateral lesions in the caudate nucleus and putamen, also a small necrosis in the visual cortex, though this might also be an artifact the radiologists said.

My son is still young, his life had just begun, he had just startend medical school. He would do everything to get a healthier life back, to be able to use his hands or even get part of his vision back.

I am very aware that present research is still far away from regular clinical therapies but there might be preclinical or even clinical studies in regenerative medicine.

Answer: In terms of your son's visual impairment, have you had him evaluated by a neuro-optometrist? As you may be aware, this type of rehabilitation professional is looking specifically at the connection between the eyes and the brain. This the website that can help you identify a professional in your area. https://nora.cc/ They may be able to provide you with exercises to assist with the connection between the brain and the eyes or to determine if there are other therapies that can assist in restoring your son's vision.

In terms of regenerative medicine, this is a fascinating area of research. There are some stem cell trials that are ongoing but often times, the requirements to participate in these studies are very strict. Currently, I am only aware of stem cells trials for traumatic brain injury and stroke, but not for anoxia due to cardiac arrest. 

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Question: My father Frank Sanzo was diagnosed in July 2014 with cataracts, when we finally went through the process of seeing 3 doctors who all had different opinions. Lastly, the day that he was scheduled for cataract surgery the doctor told him you don't have cataracts, get an MRI ASAP. So we did and what they found was a lesion in the occipital lobe of the brain. We took him to his oncologist who had previously treated him for CLL over a year ago. My father at the time was a project manager for the Trump Organization. He was working in Miami at the Doral and said he felt as if he had sand in his eyes. Hence coming home to see a eye doctor that prescribed him glasses, which didn't help. Then the second doctor said it was cataracts and set up the surgery with a specialist. Finally after, several months of no progress and now back to his oncologist who was baffled as to what it could be. They thought it was press. Anyway he stayed at Westchester Medical and they ran many tests with no results. So, the Trump family offered to get down into the city to get a brain biopsy. The next day he was transferred and the results were devastating. They stated he had Progressive Multifocal Leukoencephalopathy and there is no cure. So the sand in the eyes months prior were the start of the lesions. We took him all over the country and saw doctors that gave him e weeks to 3 to 5 months to live. Finally we went to Dr. Berger and he told my father you have nothing to lose so he prescribed Mefloquine and Martazapine. Now we were traveling to the University of Penn monthly and Dr, Berger put us in touch with Dr. Avi Nath at the NIH. Well we are in a clinical study and he is still alive 3 years later. Are there any advancements in helping my father with his vision. He can see lines, polls and is able to get around. The unfortunate part is that he can not define or focus or see color.

Answer: Have you ever heard of a neuro-developmental optometrist? This is a type of rehabilitation professional that studies the connection between the eyes and the brain. Since your father has lesions in the occipital lobe (the area of the brain responsible for processing visual information), this type of doctor would know the advances that have been in visual processing. These types of doctors can also "prescribe" vision exercises to strengthen the connection between the eyes and the brain. Not sure if any of this will help, but it will not hurt to try. There is an organization called (NORA--Neuro-Optometric Rehabilitation Association) https://nora.cc/ which can help you find a provider in your area. 

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Question: Could you please inform me of what it means to have cortical blindness? My son suffered a TBI in a car accident 14 years ago at the age of 12. I was told at that time he had cortical blindess due to scarring on his eye.

Answer: Cortical blindness is a form of vision loss that is caused by damage to an area of the brain that is responsible for processing visual information. Cortical blindness can be the result of a traumatic brain injury or stroke. Since your son suffered a traumatic brain injury, most likely his cortical blindness is due to damage sustained to the visual cortex of the brain (area in the back of the brain called the occipital lobe that is responsible for processing visual information). Many times the eyes are okay, it is the connection between the eyes and the brain that is damaged. There are secondary visual pathways and often times with cortical blindness a person can still "see" visual stimuli. This is called blindsight.

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Question: My 11 week old son was born with congenital toxoplasmosis. He has microcephaly and a recent ct head shows fluid where the majority of his occipital lobe should be.

The ophthalmologist said that his eye structure is good and no damage to optic nerve.

His eyes move together and when I go to his gaze he can smile when I smile. Unfortunately he can not follow toys and does not stare at my face like other babies do.

I was wondering if the part of occipital lobe which process visual movement is damaged is it possible that other parts of the brain can take over? Does he have the potential to see moving objects despite the damage to the part of the brain which does this? Have you known of that happening in others with similar brain injury?

Answer: The brain is amazing and can often "rewire itself" if parts of the brain are damaged. If the occipital lobe (which is the area of the brain that processes visual information) is damaged, other areas of the brain may be able to take over these functions. The key is that the brain responds to input, so just because your son doesn't appear to be tracking movement, don't stop giving him that visual input. You may want to consider consulting with a neuro-developmental optometrist who specializes in the connection between the eyes and the brain. The website: https://nora.cc/ can help you to locate a provider in your area. 

** More information about TBI related vision problems >>

   


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