Approximately half of whiplash victims have problems with vision. These are not necessarily patients with head injury or Traumatic Brain Injury (TBI)- these are patients who experience what is termed in medicine “whiplash associated disorder” (WAD).
As you know I am an ophthalmologist, so I read the most prestigious peer-reviewed academic journal: Ophthalmology, The Journal of the American Academy of Ophthalmology. I just read the June issue and I found an article discussing the relationship between whiplash and Convergence Insufficiency. I have discussed in a previous blog the importance of Convergence (the capacity for both eyes to focus on an up-close target) and TBI.
This new article investigates patients who just experience whiplash with no neurological problems, no TBI. And among these patients seen at an Orthopedic Emergency Room, just over 45% had symptoms of Convergence Insufficiency. This is an impressive number for an orthopedic emergency room and suggests that all whiplash victims, many of whom only see a chiropractor, should at least be examined by an eye care professional. I would suggest to the general audience of this blog that currently less than 2% of these accident victims are seen by an eye care professional shortly after whiplash injuries even if they have visual complaints. One purpose of my blog is to change that percentage- I plan to reach out to Chiropractic physicians in making this happen.
The article goes on to say that only 7% of these patients have demonstrated Convergence Insufficiency by detailed eye examination. But the objective and subjective criteria for making this diagnosis is difficult. How do you tell a patient having difficulty reading after whiplash that it’s just his/her imagination? Well you can’t, you can be optimistic about recovery but some of these patients continue to have poor reading function and experience significant economic and personal disruptions in life.
As prudent doctors we all all worry about secondary gain- are these patients just faking it to get money from insurance companies? Secondary gain is discussed in this article. We don’t examine human beings in a perfect world, but much the same thing was said about football players and returning veterans from the Middle East. They were told to “tough it out” for years. And the experts have been proven wrong- these human beings had real damage.
Whiplash alone can damage vision?
I have generally believed that head injury was the mechanism causing blurred vision and difficulty reading. Apparently, neck injury alone (whiplash) can effect reading- the cause remains unclear. But the upper spine and the brain stem are located in the adjacent anatomic space. Thus, there are many theories of how this connection may be important from a vision and neurologic standpoint.
This will be the subject of future blogs. The take-away message today is simple: Whiplash = eye exam.
Steven H. Rauchman, M.D. is an eye physician and surgeon who has been in private practice for 30 years. He has served as a Traumatic Brain Injury (TBI) medical/legal expert for the last 6 years specializing in the area of personal injury and related traumatic brain injuries.