title: Treatment of vertical heterophoria ameliorates persistent post-concussive symptoms: A retrospective analysis utilizing a multi-faceted assessment battery.
abstract: OBJECTIVE
  To examine the effectiveness of neutralizing prismatic lenses for reduction of headache, dizziness and anxiety in patients with persistent post-concussive symptoms and vertical heterophoria (VH).
  
  
  BACKGROUND
  Approximately 5-10% of patients with traumatic brain injury (TBI) develop persistent post-concussive symptoms. Many rehabilitation/treatment modalities are tried, but are largely unsuccessful, indicating a need for more effective treatment.
  
  
  METHODS
  This retrospective study included 38 patients with persistent post-concussive symptoms, who were diagnosed by an optometric binocular vision sub-specialist with VH (a sub-set of binocular vision dysfunction [BVD] that manifests as vertical eye and image misalignment). Data was collected both before and after prism application and included validated survey instruments for headache, dizziness, anxiety and BVD symptom burden; subjective rating (0-10 scale) of headache, dizziness and anxiety severity; and a sub-analysis of the BVD survey instrument questions that pertain specifically to headache, dizziness and anxiety. Upon conclusion of treatment, subjective assessment of overall improvement of heterophoria symptoms was obtained utilizing a 10 cm visual analogue scale.
  
  
  RESULTS
  Results demonstrated marked reduction in all measures of headache, dizziness and anxiety (19.1-60.8%) and an overall subjective improvement of VH symptoms of 80.2%.
  
  
  CONCLUSIONS
  Neutralizing prismatic lenses are an effective treatment of headache, dizziness and anxiety in patients with persistent post-concussive symptoms and VH.
authors.affiliation: a St. Joseph Mercy Hospital , Ypsilanti , MI , USA.|b Vision Specialists Institute , Bloomfield Hills , MI , USA.|c University of Michigan , Ann Arbor , MI , USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Rosner
authors.affiliation: b Vision Specialists Institute , Bloomfield Hills , MI , USA.
authors.forename: Debby L
authors.initials: DL
authors.lastname: Feinberg
authors.affiliation: a St. Joseph Mercy Hospital , Ypsilanti , MI , USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Doble
authors.affiliation: d The Oakland University William Beaumont School of Medicine , Rochester , MI , USA.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Rosner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000628:therapy; D001924:Brain Concussion / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D005139:Eyeglasses; D005260:Female; D006261:Headache / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D013285:Strabismus / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D015357:Vision Disparity / Q000502:physiology; D055815:Young Adult
keywords: Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD); TBI; anxiety; binocular vision dysfunction; convergence insufficiency; dizziness; headache; post-concussive symptoms; prism lenses; reading or learning disability; vertical heterophoria