Vestibular disorders are caused by two kinds of problems with vision:
- Oscillopsia: Inability to see clearly while moving
Examples: Objects appear to jump, jiggle, blur, or move around when you drive, walk, or move your head, or, more rarely, when you sit still.
- Visual Sensitivity: Sensitivity to certain kinds of visual scenes
Examples: Dizziness increases when you look at objects that move or when you look at “busy” patterns on carpets, curtains, wallpaper, etc., or rows of similar objects in stores, or words or lines on pages. Certain kinds of lighting (fluorescent or sodium or mercury vapor) may also increase symptoms. A combination of fluorescent lighting and busy patterns (or objects that move) seems to produce the worst results.
What causes these problems?
The two different problems have two different causes:
- Oscillopsia is caused either by a loss of the vestibulo-ocular reflex or by involuntary eye movements (spontaneous or positional nystagmus). These in turn are caused by damage to the inner ear, the nerves that connect the inner ear to the brain, or the brain structures to which the inner ear is connected.
- Visual Sensitivity is also caused by damage to the inner ear or nervous system, but in a different way. When vestibular information is lacking or “weird,” the brain seeks information from the other senses, including vision, about how the body is moving and which way is up. Unfortunately, the visual system is easily tricked by patterns or moving objects into believing that the body is moving when it is not. The resulting confusion among the senses causes dizziness and nausea.
Can these problems be cured?
Yes, if the vestibular problem that causes them can be cured, or if the brain can learn to adapt to the vestibular problem. This is not always possible. In cases of severe bilateral loss of vestibular function, oscillopsia may be permanent. If the vestibular problem comes and goes, the brain cannot permanently adapt, and visual problems will be present whenever vestibular symptoms are present.
If the problems can’t be cured, does anything help?
- Exposing yourself cautiously and incrementally to provoking environments or activities can speed the adaptation process. Staying at home, lying down, perhaps in a dark room, will almost certainly prevent adaptation. Do as much as you can, as soon as you can.
- Dark glasses may help with lighting. Be careful when using dark glasses. The older you are, the more light you need to see. Never use dark glasses at twilight or at night, and be careful if you use them indoors or on overcast days.
- If you must work in an area with fluorescent lights, try lighting your desk or work area with a small incandescent light.
- Direct your attention elsewhere. Pick out something that doesn’t make you uncomfortable and try to look directly at that, concentrating on what you see. If you are walking, pick a large object a short distance away and walk directly toward it. Pay attention to touch cues; feel your body in the chair, your feet on the floor, and your hands on the table or arm rests. You may want to use a cane or a shopping cart to help you to concentrate on touch cues for balance.
- Becoming tense or stressed won’t help. Learn some relaxation or breathing exercises, and use them as often as you can, especially when symptoms are active.
- It may help to pick a few stores and use them frequently. If you can find objects on shelves by memory, you won’t have to spend time staring at rows of cans or bottles.
- Haybach, P.J. “Vision,” Chapter 5 of Meniere’s Disease: What You Need to Know. Portland, Oregon: Vestibular Disorders Association, 43-51, 1998.
- Haybach, P.J., Preventing Vestibular Problems. Vestibular Disorders Association, 1996.
- Yolton, R.L. Eyeglasses and Vestibular Disorders. Vestibular Disorders Association, 1999.
- Yolton, R.L., and Citek, K. Computer Screens and Dizziness. Vestibular Disorders Association, 1999.
- The Inner Ear and the Neurologist
- Adaption to Oscillopsia
- Bilateral Vestibulopathy
- Understanding Balance
Exercises for Oscillopsia
If you already have poor vision for other reasons not related to having a vestibular schwannoma (aka AN) removed, oscillopsia may become much worse.
Normally, vestibular function declines with age.
Many people with bilateral vestibulopathy complain of a mild confusion or “brain fog”, which is attributed to the increased attention needed to maintain balance and good vision, due to loss of vestibular input. Others call it “inability to multi-task”. It is thought that in persons with bilateral vestibular loss, the ongoing extra effort needed to keep one’s balance reduces the amount of attention that is available for other thinking tasks.1
Vestibular physical therapy exercise program
Cawthorne Cooksey Exercises: 2
In bed or sitting:
- Eye movements — at first slow, then quick.
- up and down.
- from side to side.
- focusing on finger moving from 3 feet to 1 foot away from face.
- Head movements at first slow, then quick, later with eyes closed.
- bending forward and backward.
- turning from side to side.
- Eye movements and head movements as above.
- Shoulder shrugging and circling.
- Bending forward and picking up objects from the ground.
- Eye, head and shoulder movements as before.
- Changing form sitting to standing position with eyes open and shut.
- Throwing a small ball from hand to hand (above eye level).
- Throwing a ball from hand to hand under knee.
- Changing from sitting to standing and turning around in between.
- Moving about (in class)
- Circle around center person who will throw a large ball and to whom it will be returned.
- Walk across room with eyes open and then closed.
- Walk up and down slope with eyes open and then closed.
- Walk up and down steps with eyes open and then closed.
- Any game involving stooping and stretching and aiming such as bowling and basketball.
Diligence and perseverance are required, but the earlier and more regularly the exercise regimen is carried out, the faster and more complete will be the return to normal activity. Ideally, these activities should be done with a supervised group. Individual patients should be accompanied by a friend or relative who also learns the exercises.3
2 Vertigo Rehabilitation Exercises. – Principles and practice of Cawthorne-Cooksey treatment for dizziness due to labyrinthitis and other forms of inner ear balance organ damage.
3 Balance and Vestibular Rehabilitation Therapy – American Hearing Research Foundation