NORA

NEURO-OPTOMETRIC REHABILITATION ASSOCIATION, INTL

PO Box 14934 Irvine, Santa Ana CA 92623-4934

Phone: 1-866 2C-BETTR (866-222-3887)
Web site: WWW.NORA.CC email: noraoptometric@yahoo.com

CLINICAL PEARLS

Diplopia Affecting Balance

Author Unknown
NORA Newsletter 7(1) Summer 1997


A common visual problem following a TBI or CVA is diplopia. In most cases the person is
either not treated or full time patching is applied. In either case, the ramifications are quite
negative on overall rehabilitation in PT, OT and speech therapy.

By neglecting to treat diplopia, the person is left with the confusion of two overlapping
visual worlds. Full patching will stop the diplopia but will also shift the concept of visual
midline, causing direct interference with balance and posture.

Following a neuro-optometric rehabilitation evaluation, treatment options should include
correction, utilizing prism of the lowest value necessary for fusion. However, this should be
prescribed only after a through evaluation of visual midline in conjunction with physical and
occupational therapists present in order to study balance and posture. Once the midline
assessment is complete, the compensating prism should be applied in order to position the
base of the prism in the direction necessary to simultaneously shift the midline in the desired
direction.

For example, if the person has a right exotropia and the midline is shifted to the left
(causing a leaning to the left), then position the prism base-in before the left eye. In this way
the binocularity will be reinforced through the ambient visual process by centering the
concept of visual midline.