UNIVERSITA’ DEGLI STUDI DI MILANO-BICCOCCA

Facoltà di Scienze dei Materiali
Corso di Laurea in Ottica e Optometria

HOCHSCHULE AALEN- TECHNIK UND WIRTSCHAFT
B.Sc. Augenoptik/Augenoptik und Hörakustik
Studienschwerpunkt Augenoptik

Tesi di Laurea di Sara PELOSO
Matr. N: 794473

Relatori: Prof. Antonio PAPAGNI
Prof. Dr. Anna NAGL

Correlatori: Dott. Chiara BRAGA
Optometrista Marco GRASSI

Anno Accademico 2017 / 2018

CASE ANALYSIS AND DISCUSSION 

The cases seen and treated for this work present an apparently different anamnesis and set of symptoms, since the  reported discomforts are actually different depending on the subject, age and use of the visual system. However,  common backgrounds are the continuous compensation made by the system to support the inability to integrate central  and peripheral information. 

This is because, when the visual system is not supported by adequate skills in carrying out daily tasks, there are  repercussions in the performance of the individual, who is forced to make payments to support the act of vision. These  fees relate to the general system and affect posture. 

The subjects analyzed were 4 males and 6 females, of which 8 with emmetropia and 2 with a refractive error. The  median age is 19.9 years, with a minimum age of 8 and a maximum of 53. 

For each case, one of the three types of Device (A, B, C – all with power lower than 0.25 Δ) was selected, depending on  the responses found in the initial evaluation. Device A was applied to 2 subjects, Device B to 3 and Device C to 5. The cases analyzed are presented below and for each of them it is reported: 

– What emerged during the initial evaluation: 

  • initial symptoms 
  • the results obtained from visual tests 
  • what was detected about the interference of the visual system on the mandibular joint, on the walk and the  dynamic relation with the space (including head rotation test and vertical diameter of mandibular opening test) immediate response of the system with the device appropriately selected and suited for the subject (variation  

of the response in the head rotation test and vertical diameter of mandibular opening test) – Changes after one month of use of the visuo-perceptual reprogramming device 

  • variation of the discomforts 
  • improvements obtained to visual tests compared to the first evaluation 
  • system response after a month of use of the device (variation of the response in the head rotation test and  vertical diameter of mandibular opening test) 

– Changes after three months of use of the visuo-perceptual reprogramming device 

  • improvements obtained to visual tests compared to the first evaluation 
  • system response after three months of use of the device  

– Stability after six months of use of the visuo-perceptual reprogramming device 

  • variation of the discomforts 
  • improvements obtained to visual tests compared to the first evaluation 
  • system response after six months of use of the device  

– Graphs of the variation of discomfort, the rotation of the head and the vertical diameter.

CONCLUSIONS 

The relationship between the visual system, the stomatognathic system and posture is explained by their  communication along the trigeminal pathway and by the integration of information coming from the different systems  at the collicular level. 

In fact, the visual system is the sensory system that supplies our brain with most of the information regarding the  external world (about 80%). Based on the information received from the visual system, the brain processes an answer  by programming movement and therefore the relation with the surrounding space. 

The visual dysfunctions must be considered under a larger aspect. Incorrect processing and integration of information  from different systems causes perceptual changes that can lead to an altered spatial relation. In two-dimensional space  it causes a reading with loss of the sign, difficulty in maintaining the graphic trait within the guidelines of the sheet, in coloring inside the spaces. In three-dimensional space it involves an incorrect calculation of distance/depth and  instability/dizziness in walking. The compensation implemented to support the lack of functional visual abilities is of a  muscular type and over time tends to be structured in common tension disturbances including headache, stiffness at  the base of the neck, non-relaxed night rest, bruxism, and an increase in visual defects. 

The SiXDEVICE was applied to the ten subjects analyzed, to harmonize and balance the visual information and to make  the system’s response to the surrounding reality more coherent.  Overall, they could benefit greatly from using the device. 

Considering each category of discomfort, we note that: 

– Fatigue during reading occurs at the first evaluation “Often” in 8 cases and in two cases “Sometimes”. It is  maintained “Often” at the first check in 1 case (case of DSA), decreases to “Sometimes” in six cases, it remains  “Something” in 1 case and is canceled in two cases. At the third check, it is reduced to “Sometimes” in one case  (case of DSA) and is completely canceled in all other cases. 

Deficit of visual quality occurs at the first evaluation “Often” in 2 cases, “Sometimes” in seven cases and  “Never” in one case. At the first check is maintained “Sometimes” in six cases, it reduces to “Sometimes “in one  and “Never “in two cases. After six months, it is canceled in all ten cases. 

Binocular coordination is presented at the first evaluation “Often” in 7 cases, “Sometimes” in 2 cases and  “Never” in 1 case. At the first check is maintained “Sometimes” in 1 case, it reduces to “Sometimes” in 3 and  “Never” in 4 cases. After six months, it is canceled in all ten cases. 

Visual attention is presented “Often” in 6 cases and “Sometimes” in 4 cases at the first evaluation. At the first  check it is maintained “Sometimes” in 1 case, it is reduced to “Sometimes” in 5 and “Never” in 3 cases. After  six months, “Sometimes” remains in 2 cases and reduces to “Never” in the other 5.

 Spatial relation occurs “Often” in 7 cases and “Sometimes” in 3 cases, at the first evaluation. At the first check  it is maintained “Sometimes” in 2 cases, it is reduced to “Sometimes” in 6 and “Never” in 2 cases. After six  months, it is reduced to “Never” in all cases.

Uncertain walking occurs at the first evaluation “Often” in 8 cases and “Sometimes” in 2 cases. At the first  check it is maintained “Sometimes” in 2 cases, it is reduced to “Sometimes” in 5 and “Never” in 3 cases. After  six months, it is reduced to “Never” in all cases.

Connection of peripheral information occurs at the first evaluation “Often” in 4 cases and “Sometimes” in 6  cases. At the first check it is maintained “Sometimes” in 1 case, it is reduced to “Sometimes” in 4 and “Never”  in 5 cases. At the third check is reduced to “Never” in all cases. 

Dynamic visual stimuli occurs at the first evaluation “Often” in 4 cases, “Sometimes” in 8 cases and “Never” in  1 case. At the first check it is maintained “Sometimes” in 1 case, it is reduced to “Sometimes” in 2 and “Never”  in 6 cases. After six months it is reduced to “Never” in all cases. 

Headache is presented “Often” in 6 cases, “Sometimes” in 4 cases at the first evaluation. At the first check it is  maintained “Sometimes” in 2 cases, it is reduced to “Sometimes” in 2 and “Never” in 6 cases. At the third check  it is canceled in the remaining 3 cases and keeps “Sometimes” only in one. 

Tension phenomena occurs at the first evaluation “Often” in 9 cases, “Sometimes” in 1 case. At the first  check it is reduced to “Sometimes” in 7 and “Never” in 3 cases. After six months, it is annulled in the  remaining 4 cases and is maintained “Sometimes” in 3. 

TMJ response occurs at the first evaluation “Often” in 5 cases, “Sometimes” in 4 cases, “Never” in 1 case. At  the first check it is maintained “Sometimes” in 2 cases, it is reduced to “Sometimes” in 5 cases and “Never” in  2 cases. At the third check, it is “Never” in the remaining 5 cases and is maintained “Sometimes” in 2

As can be seen from the above graphs the discomfort concerning the visual quality is the least present, while the most  reported are the tension phenomena. This underlines the importance of the peripheral fibers and their balanced  stimulation with the central ones, underlining how the visual quality is in fact one of the many abilities of the visual  system. You can in fact have excellent visual quality and then reach the classics 10/10 and even more, without having  good visual skills that go to support the general system. In fact, they, in their entirety and together with the balance  between central and peripheral visual information, make that the vision does not interfere with the other systems. 

Considering now the inconveniences in general it is possible to observe what is shown below:   

Graph 1 shows the incidence of discomforts, considering all cases, in how many a discomfort was presented at the first  evaluation, in how many it remained present at the first check and in how many after six months.

It can be noted that: 

– Fatigue during reading occurs at the first evaluation in 10 cases, at the first check it remains in 8 and at the  third check in one case. 

Deficit of visual quality, is presented at the first evaluation in 9 cases, at the first check it remains in 7 and at  the third check is zero in all cases. 

– Binocular coordination is presented at the first evaluation in 9 cases, at the first check it remains in 5 and at  the third check is null in all cases. 

– Visual attention occurs at the first evaluation in 10 cases, at the first check it remains in 7 and at the third  check it remains in only 2 cases. 

– Spatial relation is presented at the first evaluation in 10 cases, at the first check it remains in 9 and at the third  check it is zero in all cases. 

– Uncertain walking occurs at the first evaluation in 10 cases, at the first check it remains in 7 and at the third  check it is zero in all cases. 

– Connection of peripheral information occurs at the first evaluation in 10 cases, at the first check it remains in  5 and at the third check it is zero in all cases. 

– Dynamic visual stimuli occurs at the first evaluation in 9 cases, at the first control it remains in 3 and at the  third control it is null in all cases. 

– Headache occurs at the first evaluation in 10 cases, at the first check it remains in 4 and at the third check it  remains in only one case. 

– Tension phenomena occurs at the first evaluation in 10 cases, at the first control it remains in 7 and the third  control it remains only in two cases. 

– TMJ response occurs at the first evaluation in 9 cases, at the first control it remains in 7 and at the third control  it remains in two cases. 

Analysis of the variation of the freedom of head rotation and of the mandibular opening: 

It is possible to notice that for each rotation measurement the error is ± 2.5 °, since the sensitivity of the instrument  used is 2.5 °. This means that the sum, i.e. the segment on the circumference that represents the rotation has an error  of ± 5 °. This error unfortunately is dragged when we compare the difference between the final rotation and the initial  one becoming ± 10 °. It would therefore be interesting as possible future development, to analyze the variation of  rotation induced by the device with a more sensitive instrument. 

Comparing now the improvements of the rotation and of the vertical diameter considering only the various increases  we note: an immediate average increase of the head rotation, when the device is inserted, of 14.75 °, at the first check  increases with respect to the initial of 22.75 ° and in the end after six months the average head rotation has improved  by 30°. The same is for the vertical diameter which presents a average increase of 3.50 mm immediately, 5.00 mm after  one month and of 6.70 mm after six months. (see table 1) 

Is it also shown the minimum and the maximal variation (see table 2).

 

Here are presented the graphic of the median values the variation of mandibular opening and that of the head

Considerations and conclusions: 

First, I would like to underline the uniqueness of the effects obtained by using the SiXDEVICE for the ten analyzed cases.  Positive results are obtained at visual, and especially at the postural level, of greater general well-being. 

The variation of the prescription in cases 4 and 5 during the course is significant. This shows how a system in perceptual  closure, presents the request for a stronger correction that, if prescribed, tends to structure the tension condition. It  has been demonstrated with these two cases that when balancing the visual information, it is possible to eliminate the  refractive component given by the system compensation, as well as reducing all the related discomforts, and correcting  with glasses the real ametropia. 

Another important consideration is the considerable improvement occurred in case 1 and 7. Case 1 shows initiall y poor  reading and writing skills, as shown in the picture on page 44 and case 7 is DSA certified (with a specific learning  disability). However, for both it has been possible to notice an improvement in the reading and writing capacity. This  makes us reflect on how important the visual system is in these simple tasks and how, by harmonizing and balancing  visual information, general benefits can be achieved. The reflection therefore arises: how many children with disability  are characterized as deficiencies in reading/understanding/attention without first having made a thorough optometric  evaluation (and therefore not the only assessment of clear vision that as we have seen these two cases have since the  beginning). 

This evaluation of the visual system differs from the traditional examination for the detailed evaluation of the visual  processes and the interactions they have with other systems. The SiXDEVICE represents the instrument through which  the harmony of visual information is obtained to find a global equilibrium free of adaptations. 

Finally, I want to also underline the importance of a multidisciplinary collaboration and the joined work between  professionals (optometrists, physiotherapists, osteopaths, psychologists, speech therapists…) offering to the user a 360°  service. Through the sensorial opening that the device allows to obtain, the other professionals, acting according to  their protocol, can obtain an immediate release.