PDS patient presenting visual symptoms, pain and fatigue

Birth:

Delivery with forceps

From early age:

Clumsiness and falls resulting in serious injuries

Difficulty going up and down stairs

Diplopia and triplopia during ball games

Dislike of stripes and highly contrasting colours

Aged 6-7:

Anxiety when asked to read due to:

Headaches and retroocular pain

Text moving/swirling around

Words like spiders walking around or doing a complex dance routine

Aged 7:

Diagnosed with both Meares Irlen Syndrome and Convergence Insufficiency (CI)

Coloured lenses improve reading speed by 70%

Slight improvement of CI with visual therapy

Reported increased attention span

But *Persistent headaches and abdominal pain*

From age 8-9:

Misses 30-40% school

Aged 10:

Emergency appendectomy after 6 weeks of abdominal pain

But *appendix found to be healthy*

Following the appendectomy, experienced long lasting severe migraines both ocular and abdominal

Possible triggers identified include coloured text, computer screens, videos on large screens

Aged 12:

Severe visual stress and ocular migraines lasting several weeks with aura and visual loss

Acute abdominal migraines

Medical tests all negative:

MRI scan; abdominal; psychological

Paediatric team suggested ocular and abdominal migraines could be a consequence of visual stress disorder

Prescribed medication:

Zolmitriptan (migraine) and Ondansetron (nausea) for acute episodes

Pizotifen for migraine prevention

By July 2019, 7 months of regular abdominal nausea, and fatigue and *1 day of school in 2 months*

At the time of consultation with professor Orlando Alves da Silva (July 2019):

Presented with a pallid complexion, slumped standing posture with cervical rectification and abdominal protrusion

Limitation of head rotation to the left, and head extension shorter to the left side

Hand eye-test error of localisation of 90mm

Positive test for SDP mixed pure with left predominance

Prescription

Active prisms RE: 2Δ (125º) LE: 3Δ (55º)

Refraction added to Active Prisms RE: Sph -0.25; Cyl -1.00 (90º) LE: Cyl -0.75 (75º)

Postural reprogramming and proprioceptive insoles

Wearing the test glasses:

Symmetrical head extension and head rotation, achieving rotation of 90º to the left and to the right

Localisation error corrected

Gains colour in her cheeks

Immediately reports feeling much better with less nausea

Before wearing the Active Prisms:

Her environment would ‘wobble’ and move around

A tree might seem like it was standing up and doing a jig

Walls would bend, curve and move

Words on a page would look like they were doing a complex dance routine

Eyes are hot coals burning in the head (would put cold water on the eyes but it didn’t help)

Objects as ‘blobs’ lacking in clear detail

Objects merge into one and other

Impossible to get to know her surroundings well

Impossible to find her way around her locality (school, the local town) with any confidence

Constant stomach pain that lasted weeks. It felt like there were little people in the tummy scratching at the inside with their fingernails or punching the stomach from the inside

Nausea, it felt as though the tummy was eating itself constantly churning around and twisting in on itself

After wearing the Active Prisms for a few hours:

patient is able to distinguish both forms and detail

e.g. patient describes seeing cars clearly, including the number plates and noticing cars have different logos (Mercedes, Peugeot); flowers, trees with a sense of wonder

Patient is continuing to “feel great”:

Her sight feels better than it ever has

Enjoys seeing everything around her

Tummy feels better than it ever has

No ill feeling in her gut at all

Says that it is way better than her ‘normal’

Doesn’t remember feeling this good (at the time of posting, 16 July 2019)