So I really never understood why whiplash or neck pain would have anything to do with vision. I’m an ophthalmologist, and the main focus of my career for 30 years has been eye disease and eye surgery.
I got interested in the effect of Traumatic Brain Injury (TBI) and vision after reading articles on athletes and returning military personnel who experienced concussions. Obviously, the NFL reports on TBI on relatively young retired players got society interested in TBI. I will be honest- before looking at the research literature, I would send my head injury patients with visual complaints home, “Your eyes are normal, here’s some glasses, good luck.”
Well, now I’ve seen hundreds of such patients referred to me from a variety of sources. And I must admit I was just ignorant. These patients have findings and need help. I also discovered what specialty saw these patients- Chiropractic Physicians. I once believed that these patients had to experience a traumatic brain injury to have eye findings (and many have a mild TBI), but once again I was wrong.
I kept on reading and discovered what was also reported in the literature- patients with whiplash and neck pain without TBI have visual complaints. I went to conferences and asked the “experts.” The response- “these people are faking visual problems and just want to file lawsuits for secondary gain.”
But there is no secondary gain, even if some of these patients are exaggerating, because almost all eye doctors will say they are normal, 20/20 vision.
So what is the truth? The research literature is quite clear- the neck and the eyes are connected. The cervico-ocular (COR) reflex, the vestibulo-ocular reflex (VOR), and the optokinetic reflex (OKR) are necessary to maintain a stable image on the retina. Neck pain and whiplash disturb this finely-tuned system. There is abundant evidence in the published literature but I will keep my message straightforward- if you disturb the normal movement of the neck, you disturb key visual reflexes. These abnormalities can be assessed and measured. Now, this is a big deal: 50% of whiplash patients will report vision problems (if asked). And it’s not just whiplash, staring at a computer screen for 8 hours a day can cause neck pain. Just the staring can cause visual symptoms (we all know this to be true). But neck pain is also common, and this doesn’t go away when one walks away from the terminal.
Also, there are interesting reports on how cervical injuries can effect cerebral blood flow and cerebral spinal fluid flow (CSF). These may represent independent mechanisms of interaction between the neck, brain, and eyes.
All doctors want what is best for their patients. I am certainly not the only eye doctor interested in appropriate referrals from chiropractic physicians. But I believe I make a strong case for a unmet medical need. In my office these patients are taken seriously. It’s taken me 30 years to figure it out, but I think I have something important to say.
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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.
