Brain Injury: Seeing a Different View

In a split second, Martha Davoli’s view of the world shifted, figuratively and literally. It happened on March 1, 2012, seconds after she parked her car, got out and took just a few steps. “I didn’t realize there was ice under about an inch of snow,” she described to me in a quiet voice. “My feet flew out from under me and I fell and the back of my head hit the pavement, the ice, really hard.”

She lay on the ground for a minute, then pulled herself up and walked a short distance. “All of a sudden,” she describes, “I had a huge headache and felt a little dizzy and nauseous.”

In the emergency room Martha learned that she had a concussion — a mild traumatic brain injury. She went home and remembers spending lots of time on the couch because of constant fatigue, constant headaches and constant nausea. Six weeks later she returned to her job as Director of Creative Services at Maine Medical Center but only for a few hours every day. The headaches and fatigue dragged her down.

Medication eventually tamed the headaches, but sometime in July or August, other brain injury symptoms emerged. “I had extreme sensitivity to light, sound, and seeing things move,” she says. “If I was driving, it would feel like oncoming traffic was coming right at me and objects would distract me from the road ahead.”

Last September, her doctor said she couldn’t drive anymore. She still works reduced hours and takes a taxi to get there. On a recent Monday morning, her husband Peter drove her to the office of Dr. Colin Robinson, a Windham optometrist who specializes in a relatively new field called neuro-optometry. I was invited to the appointment to learn more about how Martha’s concussion had apparently affected some important connections between her brain (neuro) and her eyes (optometry).

She sat in a chair staring straight ahead as Dr. Robinson slowly moved a metal baton with a ball on the end of it from side to side in front of her eyes. He then moved it from the top of her head to her chin. Each time she had to tell him when the ball lined up with her nose. And each time it was actually in front of her left eye when she thought she was seeing it in front of her nose.

According to Dr. Robinson, information that comes into our eyes is organized through two separate systems. One is related to our main vision or what we see in front of us, and the other to our peripheral vision, or what we see around us — out of the corner of our eyes, you might say. Peripheral vision helps us orient ourselves in space and also contributes to balance, movement, coordination and posture. Dr. Robinson explained that if the two visual systems aren’t communicating because of a stroke, a traumatic brain injury, or a condition like multiple sclerosis, objects may seem as if they’re moving when they really aren’t. “The secondary, peripheral center doesn’t get information to the main vision center fast enough,” he said, “so it’s like a slow motion effect. It can create all kinds of balance and depth perception problems. It can also cause headaches and make people feel disoriented — a huge list of symptoms.”

Here’s a short list of what Martha has had to deal with since her accident, in addition to the incidents while driving her car:

1. Three of us were in the room with her during the eye exam. Our different voices, gesticulating hands and bobbing heads made her start to feel nauseous.

2. If she’s cooking and someone starts talking while the television is on in the other room and the dog trots in looking for supper, her head and ears will begin to hurt and she’ll feel nauseous and dizzy.

3. Reaching up into a cabinet, turning from the counter to the fridge, bending down — as anyone would while working in the kitchen — can make her feel as if she’s falling.

The problems that Martha experiences, from dizziness and nausea to not seeing things accurately, are fairly common in people who have had a stroke or suffered a traumatic brain injury. Remember when former Secretary of State Hillary Clinton testified before the Senate Foreign Relations Committee the end of January? She was wearing special glasses to correct double vision, which was the result of a concussion she got when she took a bad fall several weeks before. Other people may lose some of their field of vision or, like Martha, have a visual/balance disorder.

So, what can Dr. Robinson do to help Martha? He’s prescribing special prism glasses that will help correct her distorted vision so that once again, she’ll be able to see things as they really are. “It may take a while to adjust to the prisms,” he told her, “but there is usually a pretty big change in balance and coordination.”

Therapists at New England Rehabilitation Hospital of Portland frequently refer stroke and brain injury patients with vision problems to Dr. Robinson, one of only a handful of doctors who specialize in neuro-optometry. “Patients may have distorted vision that disrupts their balance and causes them to lean toward one side because they just can’t find the center,” explained director of therapy Sharon Hartl. “Dr. Robinson has shown some pretty dramatic results of somebody walking down the hallway in his office, totally leaning to one side; they put the glasses on and they can walk down the middle of the hallway without bumping into anything.”

Sandra Bergeron, an occupational therapist at the hospital says many people who’ve had a stroke or a brain injury may not realize the connection between balance problems and vision. “Any visual disturbance is not something to take lightheartedly,” she cautioned, “because it’s something happening in your brain, and you need to have it checked out as soon as possible.”

Signs and symptoms of visual disturbances related to brain injury or stroke

• Double vision
• Blurred vision
• Difficulty seeing things straight ahead
• Partial loss of visual field (you can only see half the clock, for instance)
• Bumping into things
• Loss of balance or depth perception
• Losing your place when you read
• What you read doesn’t make sense, possibly because your eyes aren’t scanning all the way to the left of the page
• Nausea or dizziness
• Light sensitivity

Wearing a pair of prism glasses — a seemingly simple solution, with the potential to help Martha get her life back and be able to do many things she used to take for granted. Other therapies that she is doing will add even more improvements. By summer maybe she’ll be driving again, eyes on the road straight ahead. She and her husband are hopeful, for the first time in a long time.

This blog post was first published in May, 2013.