New York State Medical Treatment Guidelines for Vision Injury in workers compensation patients

The guidelines provided by the New York State Workers Compensation Board offer general principles for the management of Vision Injuries. These directives aim to assist healthcare professionals in determining appropriate strategies for addressing injuries affecting vision as part of a comprehensive treatment plan.

Healthcare practitioners specializing in Vision Injuries can rely on the guidance from the Workers Compensation Board to make well-informed decisions about the most suitable approaches for managing visual impairments in their patients.

It is important to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding the management of Vision Injuries should involve collaboration between the patient and their healthcare provider.

Understanding Vision and Oculomotor Challenges in TBI

Traumatic Brain Injury (TBI) often gives rise to a spectrum of vision and oculomotor issues. Among these, oculomotor-based reading difficulties stand out as a prevalent symptom in TBI patients. Various visual symptoms accompany TBI, including eye-focusing problems, challenges in judging distances, diplopia (double vision), dizziness, vertigo, nausea induced by visual stimuli, heightened sensitivity to visual motion, photosensitivity, visual inattention, distractibility, and difficulties in assessing distances (both relative and absolute).

To address these concerns, a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), or Doctor of Optometry (OD) with specific training and experience in TBI-related visual disturbances should conduct a comprehensive vision evaluation. This evaluation employs standard examination techniques and supplementary tests to diagnose visual disorders associated with TBI. Subsequently, a treatment plan is devised, incorporating rehabilitative interventions.

Rehabilitative interventions may encompass vision therapy, specialized reading spectacles, prism spectacles, and/or tinted spectacles, tailored to address the unique visual challenges arising from TBI.

Assessing Vision in TBI Patients: Tests and Recommendations

Visual Acuity Testing

For certain patients with Traumatic Brain Injury (TBI), Visual Acuity Testing is recommended, particularly in cases of severe TBI or when there are concerns about TBI-related impacts on vision. This assessment aids in identifying deficits in visual acuity and is typically performed once. A follow-up assessment may be considered to detect improvements or resolution, especially upon referral to a specialist as clinically indicated. Visual Acuity Testing serves as a primary means to evaluate impairments in visual acuity, providing valuable insights in the evaluation of TBI patients.

Visual Evoked Potentials (VEP)

In select cases where more common testing methods are not feasible, Visual Evoked Potentials (VEP) are recommended to assess the visual system. This is particularly applicable in severe TBI cases where conventional methods like bedside testing or Snellen testing may be challenging. VEP offers the benefit of assessing the visual system and can be used as a baseline assessment. If abnormalities persist due to the injury, follow-up testing with visual evoked potentials is a reasonable approach.

Visual Field Testing

In specific cases, Visual Field Testing is recommended, particularly when there are indications of severe TBI or concerns about TBI-related impacts on visual fields, including reported deficits. This assessment aids in identifying deficits in visual fields and is typically performed once. A follow-up assessment may be considered to detect any improvement or resolution.

Visual Perception Testing

Selective use of Visual Perception Testing is recommended for severe TBI or patients with TBI and visual symptoms. This testing is generally indicated when there are concerns about significant impacts on vision. The benefit lies in identifying deficits in the interpretation of visual inputs. Similar to other assessments, Visual Perception Testing is typically performed once, with the option for a second assessment to track improvements or resolution.

Fluorescein Angiography

In specific cases, Fluorescein Angiography is recommended for the evaluation of visual impairment associated with TBI, where the visualization of retinal blood vessels is indicated. This assessment is typically performed as a one-time evaluation.

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