Today’s guest blogger is Marsha K Sorenson O.D.  Dr. Sorenson is a graduate of the Illinois College of Optometry and completed her residency in vision therapy and rehabilitation at SUNY College of Optometry. She is currently a staff optometrist at the Chicago Public Schools vision clinic, where she supervises optometry students and provides vision therapy services.  Dr. Sorenson also practices at Chicago Dizziness and Hearing clinic, where she provides vision therapy services for patients with vestibular disorders and brain injury.

Seeing Double? You’re never too old to develop clear, comfortable binocular vision!

I recently had the pleasure of working with TK, an 87 year old man with double vision. TK had an intermittent esotropia, or an eye that turned inward sometimes. TK had been prescribed prism in his glasses, but the amount of prism needed to eliminate the double vision had slowly increased over a period of a few years. TK said his double vision was worse when driving, and he frequently had to turn his head while driving to make the double vision go away.   The possibility of vision therapy to strengthen eye teaming was discussed with TK, and he was interested in giving it a try.

“Am I too old for vision therapy?” TK asked. I explained to him that recent research has shown that significant neuroplasticity is present in the brain of adults, and there is no age at which neurons are incapable of making new connections. I explained that while I am unable to predict exactly how much progress or how quickly progress would occur, the prognosis for reducing double vision was good. I told him about another adult patient who’d had double vision from an inward eye turn, and had great results with vision therapy.

In adults, new onset double vision is typically caused by head trauma, or decompensation-a gradual loss of eye teaming ability over time. Decompensated strabismus may occur as fusion ability breaks down, or as accommodation (eye focusing ability) decreases. Sometimes people can adapt to the prism corrections in their glasses, and require more prism to make images single. Head trauma can disrupt the control the brain has over eye movements, leading to a disruption of binocularity. Double vision is a symptom many patients can have a after a head injury.

Several research groups have recently proved that neuroplasticity is alive and well in the adult brain. For a long time, scientists believed that the visual system had a critical period of development that stopped around age 8, and that new changes could not be formed after that time. Neuroplasticity in the adult brain begins as functional plasticity, which then leads to structural plasticity. Functional plasticity occurs at a neurotransmitter level, within the synapses of neurons. These alterations in neurotransmitter function enhance the activity within synapses, which leads to changes in the strength of axons and dendrites, and formation of new synapses. This new research gives evidence that strabismus and amblyopia can be treated at any age, and treatment should be attempted in symptomatic adults.

TK underwent 24 sessions of vision therapy to improve his intermittent esotropia. He looked at 3D pictures, learned to use his peripheral vision, and wore red and green glasses to get feedback about whether both eyes were working. After 10 sessions, TK started to notice he did not have as much double vision when driving. After 18 sessions, TK tried to watch TV without his prism glasses on, and reported he could make the TV single after 10 minutes! At the conclusion of therapy, TK reported his double vision had been eliminated. If vision therapy can work for an 87 year old, it can work for you! Visit an optometrist specializing in vision therapy if you are experiencing double vision!