Today’s guest blogger is Dr. Charles Shidlofsky. Dr. Shidlofsky is a 1988 graduate of Southern College of Optometry in Memphis, TN. His practice is located in Plano, Texas and is devoted to treating those with visual processing problems. Included in this group are patients with add/adhd, dyslexia, autism, traumatic brain injury etc. He currently is an adjunct professor of optometry for: Southern College of Optometry, Western University College of Optometry, University of Houston College of Optometry and UIW-Rosenberg College of Optometry. In addition, he currently hosts a Developmental Vision/Vision Rehabilitation Residency at his office.
Sometimes the day in the life of a Neuro-Developmental Optometrist can provide surprises………..
A 16 year old contact lens patient come to my office for an annual wellness vision examination and to update his contact lenses prescription. As I began the examination I noticed several changes since his last exam. He was no longer correctable to 20/20 but only 20/40 (BIG CHANGE!). In addition, I noticed his pursuit tracking was slow, so I proceeded to do a King-Devick test. His test scores on each card averaged 25 seconds (average for his age is 14 seconds). I began to question him and he reported that during the previous week, he had been struck in the head with a baseball during a high school game and has been having headaches since then. At that point, I did a flicker visual field (Heidelberg Engineering) which is very sensitive to magno (peripheral) visual function. His visual field was severely impacted.
Based on these results, I became suspicious that this young man had sustained a concussion. I discussed this possibility with the patient and his mother. After further questioning, he told me that he left school the previous Friday after talking with the athletic trainer. With the patient’s and the parent’s permission, I contacted the athletic trainer at his high school (this is Texas—every high school has an athletic trainer). I learned that she ran an Impact Test on the previous Friday and that is the reason he was sent home. There seemed to be a miscommunication between the athletic trainer and the school nurse who released the student., because the parents were told he was being sent home for headaches (not necessarily a concussion). We requested that the athletic trainer re-evaluate that patient later in the week and report her findings.
I did receive a call later in the week saying that his Impact scores had improved significantly. I followed up with the patient early the following week and found that his King-Devick score had improved to an average of 12 seconds and the visual field was much improved (although not yet within normal limits).
At this point, after discussion with the athletic trainer, he has been cleared to return to the classroom but only for class work (no test taking allowed). We also have allowed him to resume light exercise as long as he is monitored for symptoms. I will continue to monitor his progress and communicate with the athletic trainer, school nurse, and his family.
What could have happened if this young man didn’t happen to come in to update his contact lens prescription? Would he have returned to the baseball field? Happily, his vision (and therefore his brain) seems to be recovering quickly. How many student athletes are struggling with post-concussion syndrome? We need to find them and help them. Be sure to come to the COVD/OEP/NORA Symposium on increasing optometry’s role in concussion management at COVD’s Annual Meeting on April 15th. I will present you with an update!