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RESEARCH LIBRARY - DOCUMENT [71]

Category: Case Studies
Date 3-aug-1999
Case Title Treatment of Severe Glaucomatous Visual Field Deficit by Chiropractic Spinal Manipulative Therapy
Author Benjamin R. Wingfield, BAppSc(Chiro), R. Frank Gorman, MBBS. DO, FRACO
Main Condition/ Disease  Visual Disturbance
Source Journal of Manipulative and Physiological Therapeutics; Volume 23, No6, 428-34; (Jul/Aug 2000)
Abstract This paper is a single case of a patient with reduced visual field and retinal damage due to congenital glaucoma. The patient apparently sought chiropractic treatment for “spinal pain, headache and migraine.” Ophthalmologic exams following chiropractic intervention revealed improved visual field from 2% to 20% of normal. Recovery of vision was an unexpected and remarkable outcome.
Summary This is case study of a female patient who had damage to the optic disk due to the effects of glaucoma. The patient had her left eye removed at age 3 and glaucoma progression resulted in marked loss of vision in her remaining eye such that at age 16 she was “declared legally blind”. The patient apparently sought chiropractic care because of “long-term back pain, neck pain, headache, and frequent classic migraine.” I find in my research that in many cases people seek out chiropractic care for those conditions for which chiropractic treatment is pigeon-holed e.g. back pain. They are amazed to discover that when they are treated other symptoms and deficits seem to improve. This frequently occurs when upper cervical spine dysfunction is addressed. For 2 years prior to her chiropractic treatment “her right visual field remained constant as a 3-degree central island.” She reported cervical and thoracic pain, which led to headaches and migraines. Previous chiropractic intervention to the lumbar and thoracic spine had not resulted in any visual field change. Confirmation of the patient’s visual field deficit was confirmed by ophthalmic examination. “Total area of vision …. was assessed as 2% of a normal field.” She indicated that her perception of vision was “shadows only.” Her posture was noted as “good” but she had some loss of cervical curve and complained of soreness in right sided flexion of the c-spine. Subluxations were detected in various segments in the cervical, thoracic and lumbo-sacral spine. Chiropractic manipulation using diversified technique was applied (low amplitude, high velocity) with “joint cavitation sound.” Immediately after the first chiropractic treatment the patient reported that she “can now see a hand, not just a shadow”. Ophthalmic examination revealed visual field increase from 2% to 11%. Following the 2nd chiropractic session the filed increased further. Many months after her treatment he visual field has increased to 20% and been maintained. Her headaches, migraines, neck and back pain responded well with migraines ceasing completely. In the discussion session of the paper there is a familiar theme, that is, “cervical pathology may irritate the sympathetic nerve fibres (vertebral nerve), which accompany the vertebral arteries which may lead to constriction of the vertebral-basilar arterial system.” The paper mentions Bogbuk et al in a study stimulating the cervical sympathetics resulting “in pronounced decrease in carotid artery flow (30% of control group)” and further said stimulation has been shown to “reduce blood supply to the retina in human subjects.” The authors reference also Otte et al who found visual disturbance following cervical trauma “with vision and cerebral perfusion returning to normal after cervical massage.” This reduced blow flow has been verified in previous studies listed on my site, which utilise Doppler sonography to measure vertebral and carotid arterial flow in patients experiencing tinnitus. The flow was found to be reduced on the side that the tinnitus was being experienced. The exact mechanism causing visual disturbances may not be known, however, in my readings and conclusions reached in most of the research the cervical sympathetic nerve fibres and vascular structures flowing through the cervical spine seem to be implicated in the majority of human dysfunction. Upper cervical chiropractic intervention seems to be the therapy of success when dealing with cervical dysfunction. It stands to reason then that a well constructed scientific study focussing on the above hypothesis may well provide the answers we seek. The treatment was a good outcome for this patient, but one has to wonder if she could have achieved normal eyesight and not lost her left eye had she had the benefit of chiropractic evaluation and treatment very early on in her life.
References  
Keywords glaucoma; visual field deficit;migraine;chiropractic manipulation;ophthamology; cervical spine
 

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