VT to Treat Concussion-related Vision Problems

VT to Treat Concussion-related Vision Problems
By Linda Conlin, Pro to Pro Managing Editor

Convergence insufficiency is a common condition following a concussion. Convergence insufficiency is a vision disorder in which the eyes can’t turn inward together when looking at close-up objects, like tablets and smartphones. The condition is caused by a lack of communication between the nerves and the muscles that control eye movements. Symptoms include headaches, blurred vision and double vision. Previously, recovery from concussion-related convergence insufficiency was by waiting for the condition to resolve on its own, but it was rarely achieved. Now, the American Optometric Association reported a study that found office-based vergence/accommodative therapy with movement (OBVAM) yields stronger results. (https://www.aoa.org/news/clinical-eye-care/diseases-and-conditions/vision-therapy-yields-faster-recovery-from-concussion-related-eye-condition)

OBVAM is a specialized, active vision rehabilitation therapy designed to treat convergence insufficiency and focusing problems that occur after a concussion. Therapy sessions are guided by a trained therapist in a clinical setting. It targets the eyes' ability to turn inward (convergence) and focus at near (accommodation). Unlike traditional vision therapy, OBVAM incorporates head and body movement while performing visual tasks to better mimic real-life activity and improve sensorimotor integration. The therapy consists of 12 to 16 one-hour in-office sessions, typically twice a week, combined with home-based exercises.

The CONCUSS randomized clinical trial compared the effectiveness of OBVAM with delayed therapy for concussion-related convergence insufficiency. The 106 study participants ranged in age from 11 to 25 and had persistent post-concussive symptoms from four to 24 weeks after their injury. Study participants were randomized into two groups: those who would receive immediate OBVAM twice weekly for six weeks and those whose OBVAM would be delayed for six weeks after enrollment. After six weeks, 79% of the participants in the immediate group had improved concussion-related convergence insufficiency symptoms, compared with just 13% of the delayed group.

In the study’s second phase, the delayed group received twice-weekly OBVAM for eight weeks, while the immediate group received an additional two weeks of twice-weekly OBVAM. Participants were reassessed after each group received 16 OBVAM sessions. At that time, 81% were classified as a success, and 95% were classified as improved. There was no statistically significant difference between the immediate and delayed groups’ findings, indicating that OBVAM will benefit a patient similarly whether implemented immediately or after a six-week delay.
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The Centers for Disease Control (CDC) notes that about 7 out of 10 emergency department visits for sports- and recreation-related TBIs (traumatic brain injuries) and concussions are among children ages 17 and under. Contact sports, including football, basketball, and soccer, are associated with 45% of all emergency department visits for sports- and recreation-related TBIs and concussions among children ages 17 and under. In addition, bicycling and playground activities also are associated with high numbers of emergency department visits for TBIs and concussions among children. When those injuries result in convergence insufficiency, school, work and sports are affected. This study provides evidence that concussion-related vision problems can be effectively treated with office-based vision therapy, and early intervention leads to a quicker return to activities.