Carl Garbus, O.D., FAAO
After a head injury, stroke or brain tumor visual pathways in the brain can be disturbed. Disruption of nerve fibers in the brainstem can adversely affect the balance system and orientation systems. Walking in unfamiliar environments or crowded areas, like malls, can be overwhelming. The purpose of the binasal occlusion is to help with spatial orientation. Many patients have benefited from this treatment. A common response is that the individual feels more stable and secure when ambulating. Binasal occlusion helps to direct the patient to use their ambient (peripheral) system to a greater extent.
Binasal occlusion is worn for several weeks or months. As other therapies are introduced and spatial orientation improves, the need for the occlusion becomes less important. However, at the outset this treatment is important and should be utilized several hours each day and in many cases the majority of the time. The actual wearing schedule will be determined by your doctor. It may be necessary to wear the binasal prescription for reading, as well as, for distance.
The importance of binasal occlusion is that it helps the patient to feel more grounded when walking. Often patients will comment that the floor is no longer moving and they feel better. In some cases binasal occlusion will be combined with base in prism or yoked prisms to improve balance.
The application of binasal occlusion can take several forms. Frosted scotch tape is used in most cases, but nail polish or colored filters are effective as well. The procedure is to angle the tapes so that when the tape does not interfere with convergence or when the patient looks down.
To find out if the patient is a good candidate for the binasal RX have the patient walk with and without the occlusion. Look for more steady gait and balance. Look at the patient’s footing to see if it changes with them on. Do they appear to have a smoother gait? Does the patient notice any changes? Do not rely heavily on this last one because many times they do not know the differences even though you can see it.
Binasals are a very good tool for vision rehabilitation. It is usually prescribed for 2 weeks up to 6 months depending of the patient’s condition. The use of binasal occlusion can be useful during occupational and physical therapy programs, but it has to be prescribed the eye doctor.
If you have any questions, please be sure to contact Carl Garbus, O.D. You can post your questions in the comments and I would be glad to get back to you.
Join the Neuro Optometric Rehabilitation Association and join us at the NORA Conference in Memphis, TN from April 19-22, 2012.
– Carl Carbus, O.D