Treatment of severe glaucomatous visual field deficit by chiropractic spinal manipulative therapy: a prospective case study and discussion.
OBJECTIVE
To discuss the case of a patient with severely reduced visual fields arising from terminal glaucomatous retinal damage and the treatment of this condition by spinal manipulation.


METHODS
A 25-year-old uniocular female patient with congenital glaucoma sought chiropractic treatment for spinal pain, headache, and classic migraine. Advanced optic disk cupping was present, and loss of vision was near complete. A 3-degree island of central vision and a small area of peripheral light sensitivity had remained relatively stable for 3 years after a trabeculectomy procedure that had resulted in intraocular hypotony.


RESULTS
It was considered possible that chiropractic spinal manipulative therapy may have a positive outcome in visual performance. Before commencing chiropractic spinal manipulative therapy, an ophthalmologic examination was performed, and visual performance was monitored through a course of treatment. Immediately after the first treatment, significant visual field improvement was recorded in the remaining eye. Maximal improvement of vision was achieved after 1 week (4 treatment sessions). Total monocular visual field had increased from approximately 2% to approximately 20% of normal. Corrected central acuity had improved from 6/12 to 6/9. Independent reexamination by the patient's regular ophthalmic surgeon confirmed the results.


CONCLUSIONS
Recovery of vision in this patient was an unexpected and remarkable outcome, raising the question of whether chiropractic spinal manipulative therapy may be of value in the management of glaucomatous visual field loss. More intensive research is required.
Wingfield
B R
BR
benwingfield@excite.com
Gorman
R F
RF
D000328:Adult; D001416:Back Pain / Q000150:complications / Q000534:rehabilitation*; D005260:Female; D005901:Glaucoma / Q000150:complications* / Q000175:diagnosis; D006099:Granuloma / Q000150:complications / Q000601:surgery; D006801:Humans; D007499:Iris Diseases / Q000150:complications / Q000601:surgery; D020393:Manipulation, Spinal / Q000379:methods*; D019547:Neck Pain / Q000150:complications / Q000534:rehabilitation; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000534:rehabilitation*; D015349:Vision, Monocular; D014792:Visual Acuity; D014794:Visual Fields