Visual function, traumatic brain injury, and posttraumatic stress disorder

Abstract

Abstract-Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are signature injuries of the Iraq and Afghanistan conflicts. The conditions can be comorbid and have overlapping signs and symptoms, making it difficult to diagnose and treat each. TBI is associated with numerous changes in vision function, but vision problems secondary to PTSD have not been documented. To address this shortcoming, we reviewed the medical records of 100 patients with a history of TBI, noting PTSD diagnoses, visual symptoms, vision function abnormalities, and medications with visual side effects. Forty-one patients had PTSD and 59 did not. High rates of binocular vision and oculomotor function deficits were measured in patients with a history of TBI, but no significant differences between patients with or without PTSD were evident. However, compared to patients without PTSD, patients with PTSD had more self-reported visual symptoms in all four assessments and the complaint rates were significantly higher for light sensitivity and reading problems. Together, these findings may be beneficial in understanding vision problems in patients with TBI and PTSD as comorbid conditions compared with those with TBI alone.

Sleep Disturbances in Traumatic Brain Injury: Associations With Sensory Sensitivity

“…In support of this is recent work by Goodrich et al that shows the prevalence of light sensitivity is significantly higher in Veterans with comorbid TBI and PTSD (31/38 subjects; 82%), compared to those with only TBI (13/48 subjects; 27%). 46 Additionally, previous work in a sample of 1,114 of civilians with TBI demonstrated that subjective light and noise sensitivity were significant independent predictors of PTSD symptomology. 47 The authors speculated that the presence of light and noise sensitivity perpetuated subject's awareness of their traumatic event/injury, 48 while impeding fear extinction through second-order conditioning.…”

Vision-related symptoms after acquired brain injury and the association with mental fatigue, anxiety and depression

“…The characteristics of the visual symptoms differed between those with or without anxiety/depression, particularly regarding reading difficulties, blurred vision, light sensitivity, light-dependent issues, and an increased tendency to bump into objects or persons. Goodrich et al (21) found that the TBI-PTSD group experienced more problems, especially regarding light sensitivity and reading difficulties. These symptoms are among those with the highest diversity in our study, and one may speculate that there might be an association between certain visual symptoms and anxiety/depression.…”

“…The visual system is highly integrated in the processes of cognition and emotion and it is possible that interference with the visual system may lead to increased levels of depression and anxiety (19,20). Goodrich et al described differences in visual symptoms in patients with traumatic brain injury (TBI) or both TBI and post-traumatic stress disorder (PTSD).The groups were rather similar regarding visual symptoms, although the TBI-PTSD patients reported more light sensitivity and more reading problems (21). Another treatment relating the vision and emotion is Eye Movement Desensitization and Reprocessing (EMDR), which is a method used for PTSD, in which horizontal eye movements are used as a tool for the treatment (22).…”

Visual system pathology in humans and animal models of blast injury

“…Our understanding of visual dysfunction in humans is based, in part, on post‐mortem analyses and retrospective studies involving questionnaires and review of medical records (Capo‐Aponte et al, ; Goodrich et al, ; Hellerstein, Freed, & Maples, ; Magone, Kwon, & Shin, ) (Table ). While useful in identifying the diversity of blast‐related injuries (Lew et al, ), retrospective studies can differ widely in the methodologies used to assess and classify pathologies.…”

“…Commonly reported impairments include problems with accommodation, saccades and pursuits, vergence, integrity of the visual field, and photophobia (Alvarez et al, 2012;Bulson, Jun, & Hayes, 2012;Our understanding of visual dysfunction in humans is based, in part, on post-mortem analyses and retrospective studies involving questionnaires and review of medical records (Capo-Aponte et al, 2012;Goodrich et al, 2014;Hellerstein, Freed, & Maples, 1995;Magone, Kwon, & Shin, 2014) (Table 1). While useful in identifying the diversity of blast-related injuries (Lew et al, 2009(Lew et al, , 2011, retrospective studies can differ widely in the methodologies used to assess and classify pathologies.…”