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Traumatic Brain Injury (TBI) and Reading (or EKG for the EYE)


Reading is perhaps THE single most important visual/perceptual skill we need to function in everyday life. Yet, we seem to accept as a given, that all people can read, some a little a slower, some faster.

What happens when normal reading is disrupted? We all know that some children have reading disorders and can struggle both in school and for the rest of their lives with this problem. But we tend to forget those individuals who were once reading well until something happened to them.

We know that strokes can often damage the vision and perceptual centers in the brain, forcing patients to endure months or years of rehabilitation therapy in an attempt to relearn old skills.

Sadly, many victims of TBI face the same challenges and are too-often ignored. Those who experience head trauma or significant whiplash often have their brain centers scrambled, sometimes they spontaneously improve, but sometimes they don’t.

We as physicians need to begin to quantitatively measure the actual process of reading. As a typical reader goes across a string of words on a line, the eyes smoothly follow (this is called smooth pursuit). At the end of a line, the eyes instantly move back to the beginning of the next line (this is called saccades, or rapid movements of the eye between fixation points).

Head trauma can disrupt these eye movements, and a well-trained ophthalmologist (eye physician) can measure these abnormalities. When individuals visit other doctors or attorneys after a head injury or severe whiplash, they often have a variety of complaints. But what tends to linger and impair their lives in the long term is reading difficulty. If a head injury patient is asked what most disturbs them besides pain, it is their inability to return to daily activities that involve reading. They are often embarrassed to admit and are rarely asked about reading, but it’s a critical question.

Unlike most eye doctors and other medical specialists, I run a practice that carefully evaluates eye movement disorders, and can objectively account for a patient’s subjective complaints of difficulty reading a book, or reading from a computer screen.

The EKG for the Eyes is Here

I objectively evaluate pursuit (slow eye movements) and saccades (rapid eye movement) and make full use of newer technology that tracks eye movement. I use the King-Devick test, one such eye tracking technology. Precision eye movement can now be measured in an office setting. I do this test on my head injury patients every day and it only takes a few minutes. Recent research in ophthalmology demonstrates that these patients have quantifiable abnormalities in saccadic eye movement. The eyes of head injury patients tend to overshoot and undershoot their target, and these eyes have delays in moving off a target. These errors in movements form eye movement tracings, much like the ones we have all seen on EKG’s for the heart.

We need to stop ignoring these patients. Even if effective therapy lags behind, these patients deserve to be told they are not just imagining their problems. This reassurance alone is therapeutic. Most eye doctors ignore these patients or sell them expensive glasses. Wouldn’t it be nice to have an experienced eye care specialist working at the frontier of eye movement disorders and using state-of-the-art testing?

If a patient had chest pain wouldn’t you expect a cardiologist to immediately order an EKG?

Patients with head injuries deserve the same consideration.

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