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    How to care for stroke patients

     

    I have designed and prescribed specially-designed eyeglasses over the past 20 years to help those with hemianopsia. The optical care of hemianopsia is based on using prism to expand side vision awareness. Available hemianopsia-related glasses I worked with were difficult to prescribe, difficult for the patient to use, or had optical design flaws.

    I learned what worked and what didn’t work. I designed a prism technology called SVAG (Side Vision Awareness Glasses) that can be prescribed by any trained optometrist (See Figures 1 and 2).

    Prior to developing SVAG, hemianopsia-related eyeglasses afforded only a limited circular viewing area. This limited the patients’ appreciation of the expanded field awareness or required a highly-cognitive patient who could adjust to simultaneously viewing straight ahead while noticing out-of-focus peripheral images caused by Fresnel prism.

    I developed SVAG with a high Abbe value because patients with older hemianopsia glasses complained of distracting color aberrations. SVAG also have a higher index of refraction, making them thinner and more cosmetically acceptable. There is also no prism button or Fresnel lens strip on the front of the lens. SVAG provides clear side vision with a wide viewing area when looking through the prism lens.

    Eyelid paresis

    Some stroke patients develop blepharoparesis, while others develop ptosis.

    If there is ptosis, avoid disuse of the ptotic eye by taping it open about a centimeter for five minutes a few times per day using Transpore surgical tape. Be sure to allow enough slack in the tape for blinking. Patients should instill an artificial tear every minute to prevent discomfort and drying during the interval the eye is taped open.

    If there is a blepharoparesis and the eye won’t close, be sure to use Transpore surgical tape to keep the eye closed to prevent corneal staining and discomfort.

    Related: Multiple sclerosis and optometry

    After years of watching physical therapists work use massage with stroke patients, I decided to try a similar massage technique on the eyelids. I found that some patients with stroke-related ptosis or blepharoparesis responded to an eyelid massage.

    The massage is conducted with your finger, using a brisk moderate stroking of the affected lid in a lateral and radial fan shape. An alternating warm or cool pack applied before lid massages may increase sensory stimulation to the lids, enhancing the effect. Massage for a few minutes four times per day for three weeks. Discontinue if no change in ptosis or belpharoparesis.

    Some ptosis patients have what I call diplopic pseudo-ptosis or DPP. Stroke survivors with a stroke-related esotropia or exotropia subconsciously learn to close the offending eye to avoid diplopia. Although they will appear to have ptosis, it is not ptosis. Cover the non-ptotic eye; if the patient is capable of opening the apparently ptotic eye, you have discovered a DPP.

    For blepharoparesis, I sometimes use commercially available lid weights to pull the lid down. The lid weights come in a fitting set of graded weights with an adhesive backing. These test weights are used to determine the weight of a gold lid implant used by oculoplastic surgeons. Optometrists can use the test set weights to treat blepharoparesis noninvasively until surgery is indicated.

    Specialty optometric consultation is available through colleagues associated with Neuro-Optometric Rehabilitation Association (NORA) and the College of Optometrists in Vision Development (COVD).

    References

    1. National Stroke Association. What is stroke? Available at http://www.stroke.org/understand-stroke/what-stroke. Accessed 3/22/16.

    2. National Stroke Association. Transient Ischemic Attack. 1999. Print.

    Errol Rummel, OD, FAAO, FCOVD, FNORA, FIALVS
    Dr. Rummel is in private practice in Jackson, NJ, and is director of the Neuro-Optometric Rehabilitation and Visual Perception Clinic at ...

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