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What do you recommend as the next path of treatment for vision deficits from acquired brain injury?

I suffered an acute attack of Wernicke's Encephalopathy–which is a type of brain injury–in February 2015 and was admitted following a seizure. As a result, I lost peripheral vision bilaterally, as well as 40% of my field of vision. After an evaluation by a neuro-ophthalmologist, it was determined that my brain is no longer processing the information that my eyes are sending.  I also developed horizontal nystagmus, which gets worse in low light. I have tried vision therapy and colored light therapy without any improvement.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Medical Professional

Answer transcribed from Brightway's Interview with Dr. Bryce Appelbaum

Sounds like this individual is really struggling. I think the first thing I would suggest is looking into vision therapy and whether different types of vision therapy are available. Vision therapy looks different depending on where you go and who you work with, so I would definitely want to make sure that person saw somebody board certified in vision therapy by the college of optometrist and vision development. I think light therapy, which is syntonic, usually can be effective. Vision therapy can be effective but if it's not effective, there's usually a reason why. There may have been a guarded prognosis at the beginning and if that's the case, I hope the doctor was upfront and honest and willing to volunteer their intellectual honesty and best effort in helping. However, if it's a functional problem, then absolutely vision therapy should work but it may be we need to address other things first in order to maximize the benefits of the treatment. 


Two-thirds of the nerves or input that enter the brain come from the eyes. So if there's a brain injury, the disruption to the visual skills and abilities specifically for visual processing are usually impacted. I think it sounds like this individual needs to be addressing the three components of vision, which are sensory input, motor output, and then perceptually what your brain does with that information your eyes send it. I think you mentioned that it's the brain no longer processing what the eyes are sending it. Well, if the wiring is in place and the networks are in place but we're bypassing them, then I think more of a visual information processing or perceptual emphasis for vision therapy would probably be indicated. Going back to the treatment that was done, it may be nice to get a second opinion or even an alternate opinion with somebody who can look at that individual with a new set of eyes. Oftentimes, we hit roadblocks or we start to plateau with treatment and then the key is figuring out what the next step is so that hopefully more doors open in the future.