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Homonymous Hemianopia: Rehabilitation with Scanning and Expansion Prism Therapy

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Homonymous Hemianopia: Rehabilitation with Scanning and Expansion Prism Therapy Kasey Suckow, OD Resident: Ocular Disease / Low Vision Rehab Hines & Jesse Brown VA ... – PowerPoint PPT presentation

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Title: Homonymous Hemianopia: Rehabilitation with Scanning and Expansion Prism Therapy


1
Homonymous HemianopiaRehabilitation with
Scanning and Expansion Prism Therapy
  • Kasey Suckow, OD
  • Resident Ocular Disease / Low Vision Rehab
  • Hines Jesse Brown VA ChicagoAAO Meeting
  • Tampa 2007

2
Homonymous hemianopia
  • Common etiologies
  • Stroke (most common1)
  • 8.1 over 652
  • 20-30 with VF defects3
  • Traumatic Brain Injury
  • Signature injury
  • Lesions along visual pathway

1. Zhang, Xiaojun MD, et al. J Neuro-Ophtho
September 2006 180-183. 2. Neyer, et al.
Prevalence of Stroke 2005. JAMA. July 2007
279281. 3. Rossi PW, et al Neurology
1990401597-9
3
Therapy
  • Therapy goals
  • Increased Awareness
  • Increased Visual Field
  • Therapy Options
  • Scanning Therapy
  • Prism Therapy
  • Yoked prism
  • Expansion prism

4
Scanning Therapy
  • Never go where your eyes have not gone
  • Critical for orientation and mobility
  • Pt safety

5
Basic Movements
  • Head Posture
  • Turn towards side of defect
  • Field shift
  • Eye movements
  • Constant scanning
  • Systematic movements
  • Walking

6
Scanning and Turns
  • Turning into defect
  • Stopping in place
  • 90 degree turn
  • Scan into defect
  • Looking up and down

7
Complex environments
  • Combining all individual skills.
  • Coordinated, intentional movements
  • Encourage pt to take their time

8
Expansion Prism Therapy 4. Peli, Eli MSc, OD,
FAAO. Optometry and Vision Science. Sept 2000
453-464.
  • Increased field of view
  • Peripheral prism
  • 8 x 22mm segments
  • 40 Diopter fresnel
  • Monocular fit
  • Superior and inferior
  • Peripheral diplopia
  • Clear single central vision

9
Field Expansion 4. Peli, Eli MSc, OD, FAAO.
Optometry and Vision Science. Sept 2000 453-464.
10
Expansion Prism Therapy 4. Peli, Eli MSc, OD,
FAAO. Optometry and Vision Science. Sept 2000
453-464.
  • Monocular fit (on side of VF defect)
  • Upper segment first
  • Demonstrate increased field
  • Training
  • Cleaning and care
  • 2 wk adjustment
  • Lower segment
  • 2 wk adjustment
  • Prism ground into lens

11
Pt Education A.R. Bowers, et al. IVOS September
200647 E-Abstract 3489
  • Viewing through carrier lens
  • Increasing peripheral awareness

12
Increased awareness
13
Prism Adaptation A.R. Bowers, et al. IVOS
September 200647 E-Abstract 3489
  • Image jump
  • 10-15 degrees
  • Adaptation
  • 75 acceptance rate

14
Case 1
  • 67 WM with hx of recent stroke
  • HH confirmed with HVF
  • VA 20/25 OD, 20/20 OS
  • No head turn/abnormal posture
  • Functional complaints
  • Bumping into people/objects on his left
  • Difficulty avoiding objects on left
  • Problems shaving left side of face
  • With actual act of shaving
  • Difficulty cooking

15
Therapy and Response
  • Scanning therapy following previously listed
    steps shows increased performance and subjective
    improvement.
  • Expansion Prism Therapy also has positive
    subjective results with both upper and lower
    prism.
  • Pt notes increased awareness and avoidance of
    objects on left side.

16
Case 2
  • 74 WM with history of head trauma (gunshot wound
    50 yrs prior)
  • HH confirmed with HVF
  • VA 20/40 OD, 20/32 OS
  • Left head turn
  • Significant fall history
  • Functional complaints
  • Pt did not have any complaints, but interested in
    prism therapy for increased left awareness.

17
Therapy and Response
  • Scanning therapy shows pt is proficient and has
    developed good compensating skills.
  • Pt notes improved awareness of field, but not
    enough improvement to warrant permanent lenses,
    and preferred habitual Rx alone.

18
Differences between Pts
  • Case 1
  • Relatively recent loss
  • No head turn
  • Poor scanning strategies
  • Several Functional complaints
  • Case 2
  • Long term loss
  • Left head turn
  • Good scanning strategies
  • Few functional complaints

19
Conclusions
  • Benefits of Scanning and Prism Therapy
  • Safety
  • Street crossing
  • Fall prevention
  • Orientation and Mobility
  • Increased Confidence
  • Each pt unique
  • Consider patient goals and motivation
  • Successful rehabilitation involves therapy with
    or without prism.

20
Acknowledgements
  • Steve Rinne, MA Low vision research therapist
  • Amy Wurf, MA Low vision therapist
  • Joan Stelmack, OD MPH
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