Case of the week 1-17-2009

I always seem to have a multitude of interesting cases from week to week, but one in particular this week seemed to stand out. Perhaps the reason it stood out is because it involved someone who I have known for a while who plays a I sport that I really do enjoy, both as a player and spectator.

This particular patient has been playing ice hockey most of his life. I got to know his father in one of the leagues he and I played in about 10 years ago. Shortly thereafter the whole family came to see me as patients mostly for routine care. The son and the patient in this case went from High School hockey to Juniors up in Canada and then last year played Juniors right here in the Dallas area. He played well enough to earn a college scholarship to play hockey this year. Unfortunately, over the last year he has sustained numerous concussions and was deemed unable to play. He then enrolled at University of Oklahoma and was playing club hockey there when he got a few more concussions.

When he came in for his routine annual exam this week, he was telling me about his hockey misfortune over the last year. I asked him if he has noticed anything different in his memory skills and visual skills since the concussions. He said, in fact, he has noticed many differences. He is far more sensitive to light, he was deemed mildly dyslexic at school this year (which has never been a problem for him) and he had trouble focusing from the board to his work. He also held his books and near point work closer to his eyes. This certainly raised the red flag in my mind.

During my testing, I noticed reduced focuing ability, abnormal convergence skills and some tracking difficulties. All these finding had previously been normal when tested. I brought him back in and did some electo-diagnostic tests looking at the whole sensory system: from visual; to vestibular; to proprioceptive and their ability to integrate. We also did a neuro-cognitive test for memory skills. What we saw on the results was quite astonishing for an athlete. Most skills were significantly reduced from normal.

I prescribed therapeutic lenses and occlusion therapy for this patient and I will report on his results when he comes back in. I am optimistic though, that we will make a significant impact on his skills. I feel that his diagnosis of mild dyslexia is probably a mis-diagnosis but instead he was suffering from Post-Trauma Vision Syndrome. For more information on Post-trauma Vision Syndrome you can refer to the Neuro-Optometric Rehabilitation Assn. website: www.nora.cc .

Hope everyone had a great week.
Charles Shidlofsky, O.D.