Madison Area Lyme Support Group

By William V. Padula, OD SFNAP FAAO FNORA

Tick-borne infections can affect your vision in many ways. There may be blurring, double vision, light sensitivity, visual distortion, difficulty with balance, dizziness, and problems focusing, to name several.

Vision is more than just the image that we see. 70% of all the sensory nerves in the entire body come from the eyes. In fact, the eyes don’t actually see. Rather, they are sophisticated ‘cameras’ through which the brain does the seeing.

The brain has two primary means for organizing visual information. One process (the focal process) is the conscious or attentional process. This part of our vision provides information about detail so that we can see to identify objects. We link our thinking or cognitive process to this portion of vision.

However, there is a second process called the spatial or ambient process. It sets up the ability to use the focal process. The spatial visual process matches information with the balance centers and sends information to the cortex to organize how we see space before we actually see the detail.

The focal process isolates on details. Using the analogy of the forest and the trees, the focal process sees the ‘trees’ and the spatial visual process sees the world as the ‘forest.’ Together the spatial process gives orientation and organization to stabilize the visual process first with proprioception (information from the muscles and joints) establishing a grounding or stability with gravity to engage the spatial visual process first before looking at the detail.

The spatial visual process grounds the visual process and cortex so that the focal process can disassociate to look at a detail without losing orientation to our position sense. When the spatial process becomes unstable, the visual world becomes detail oriented (suddenly the visual world sees only the ’trees’) and this becomes over-whelming, similar to driving in a snowstorm at night with your high beam headlights on.

Maintaining the balance

There is a balance between the two visual processes that must be maintained. This balance provides efficiency, accuracy and the ability to adapt to change in our visual as well as sensorimotor world. (Sensorimotor refers to how we use our senses to interact with our surroundings.)

Lyme-related diseases often produce inflammation, which can disrupt the balance between the two visual processes. Because vision is connected neurologically to respiration and cardio function through the autonomic nervous system, any changes with the visual process will affect the autonomic system.

The imbalance in the visual process produces stress and affects the cardio-rhythms and respiration. A tick-borne infection that becomes neurological will not only directly affect the brain processing associated with visual processing, but may also affect the soft tissue and joints, cardio-respiratory systems, the vestibular system, etc. In turn the neurological imbalance affects both the visual process in the brain directly as well as the indirect relationships with other motor and sensory systems.

Research

One way of evaluating how the eyes and brain work together is called a visual evoked potential (VEP) test. It measures the electrical signal that the brain’s visual cortex generates in response to visual stimulation. Research shows that abnormal results on this test strongly indicate tick-borne disease.

My colleagues and I have also found another potential eye-related biomarker for tick-borne infections—a hazy white ring surrounding the optic nerve. This is called peri-papillary ischemia, and it is highly associated with tick-borne infections. We believe it arises from biofilms that clog the narrow capillary vessels around the optic nerve, blocking blood flow.

In my practice, I have found that changes in the VEP brain waves can be brought back to normal through use of special lenses and various therapeutic techniques. This therapy helps the brain reset how it processes information and resolves many of the patient’s visual challenges. This indicates that VEP abnormalities don’t have to be permanent.

Balance and Movement

The balance difficulties associated with tick-borne disease often come from a mismatch of information between the spatial visual process and other balance centers. This produces a condition know as Visual Midline Shift Syndrome (VMSS).

When there is a mismatch of visual spatial information and information from muscles, joints and the vestibular, the visual midline can become shifted. When this occurs, persons will drift when walking or feel as if they are not as stable. For example, people with this visual spatial imbalance often feel that they are too close to one side of the road when driving. Or they may feel like they are being pulled to one side when walking.

VMSS can be improved by the use of special glasses called “yoked prisms.” These realign the visual midline and re-center the center of mass. Balance can in many cases be improved very quickly when these prisms are prescribed properly.

A Part of the Solution: Rehabilitation of Vision

The following checklist provides a self-assessment for potential symptoms associated with visual processing that may be affected by tick-borne disease.

• Difficulty converging the eyes to maintain alignment for reading ____
• Difficulty maintaining focus of the eyes for near vision activities ____
• Losing place when reading  ____
• Blurry vision that changes  ____
• Dizziness ____
• Difficulty with attention and concentration ____
• Loss of comprehension when reading  ____
• Difficulty with visual memory  ____
• Avoids looking at objects close to the face  ____
• Difficulty with balance when walking  ____
• Drifting when walking ____
• Experiences feeling of being overwhelmed when in busy, crowded environmen____
• Bumps into objects ____
• Light and glare sensitive ____

If you are experiencing any of these symptoms, you need a careful assessment of your neuro-visual process. There are some neuro-optometrists who specialize in working with persons with tick-borne infections.

The treatment approach will differ from a standard vision exam. It will include brain wave testing (VEP) and a careful assessment of the neuro-visual-postural organization through instruments to assess weight shift during walking and shift in visual midline/center of mass (COM).

This testing should be accomplished in conjunction with the physician treating the tick-borne infection and not in place of it. Services from psychologists for counseling and/or neuropsychological testing may also be important. Persons with tick-borne infections will need an inter-professional approach for treatment. When the visual process becomes compromised, the problem often continues even after the tick-borne infection has been treated and resolved.

Dr. William Padula is the founder of the Padula Institute of Vision Rehabilitation, in Guilford, Connecticut. More information at his website: padulainstitute.com

________________

**Comment**

Advances like this are always encouraging; however, it’s important to remember that oftentimes proper treatment will ameliorate symptoms entirely or will at least improve them vastly.  That said, we need all the tools in our toolbox we can get!

For more:

• https://madisonarealymesupportgroup.com/2021/08/10/how-lyme-disease-can-affect-your-vision/
• https://madisonarealymesupportgroup.com/2022/04/04/rehabilitating-your-lyme-impaired-vision/
• https://madisonarealymesupportgroup.com/2021/04/05/lyme-disease-can-impact-your-visions-contrast-sensitivity/
• https://madisonarealymesupportgroup.com/2019/06/29/atypical-papillitis-an-isolated-manifestation-of-lyme-disease-which-isnt-isolated/
• https://madisonarealymesupportgroup.com/2018/09/29/lyme-patients-check-your-vision/
• https://madisonarealymesupportgroup.com/2020/04/15/rare-case-of-optic-neuropathy-caused-by-lyme-disease/
• https://madisonarealymesupportgroup.com/2015/09/16/bizarre-symptoms-msids/
• https://madisonarealymesupportgroup.com/2017/07/21/growing-list-of-eye-problems-in-lyme-disease/  The authors described patients with tick-transmitted diseases presenting with the following ophthalmologic findings:
  • Follicular conjunctivitis
  • Periorbital edema and mild photophobia
  • Bell’s palsy, cranial nerve palsies and Horner syndrome
  • Argyll Robertson pupil
  • Keratitis
  • Optic neuritis, papilledema, papillitis and neuroretinitis
  • Myositis of extraocular muscles and dacryoadenitis
  • Episcleritis, anterior and posterior scleritis
  • Anterior, intermediate, posterior and panuveitis
  • Retinal vasculitis, cotton wool spots and choroiditis
  • Retinitis, macular edema and endophthalmitis

And again, these things are not rare.  They are rarely reported.  Big Diff!