‘Hope for HIE’ Not Just the Name of a Facebook Group

“Hope for HIE.”

It’s more than simply the name of a Facebook group for parents of infants with hypoxic ischemic encephalopathy (HIE). It’s what the Mind-Eye Institute in Northbrook, Ill. is giving to families of HIE children, thanks to the Institute’s evidence-based approach of stimulating the eye’s retina to help patients overcome some of the vision and developmental problems related to HIE, a serious brain injury occurring before, during or immediately after birth.

“Mounting scientific research and clinical experience have demonstrated that using an individualized mix of lenses, filters and prisms to vary the way light disperses across a patient’s retina – particularly the peripheral retina – can influence brain wiring in ways that may be useful in rehabilitation,” says Deborah Zelinsky OD, founder and executive research director of the Mind-Eye Institute.

The retina is formed by an “extension of brain tissue” and is an active part of the central nervous system, Dr. Zelinsky explains. “That’s why damage to the brain, as occurs in cases of HIE, often disrupts retinal circuitry, affecting the eye’s linkage to other sensory inputs and often hindering development of processes like thinking, spatial awareness, movement, perception of surrounding environment and selective attention to sound.”

The Mind-Eye Institute is internationally recognized as being at the forefront of research and clinical work involving the retina’s impact on brain function. Dr. Zelinsky and her team focus on neuro-optometric rehabilitation and the application of advanced methods for assessing brain function, with emphasis on the often-untested linkage between eye and ears.

Those tests – in infants and adults – involve comprehensive eye-movement assessments at conscious, subconscious and unconscious levels, evaluating control and reaction time of shifting gaze from place to place and ability to fixate, follow and focus on both moving and stationary targets. The Institute also checks vestibular and optokinetic reflexes in different directions. The vestibular reflex test measures a patient’s ability to re-orient and hold a steady gaze on a stationary object when the head and/or body moves, while the optokinetic reflex refers to reflexive eye movement when an object is moving, such as watching a freight train pass by.

HIE occurs either in the womb or during the birthing process when the infant brain is deprived of oxygen for an extended period of time due to restricted blood flow to the brain or abnormally low levels of oxygen in the bloodstream. Maternal hypotension, heart or lung complications in the developing fetus, placental abruption, or a prolapsed or injured umbilical cord are all potential causes of HIE. The condition, which reportedly occurs in as many as 2.5 births out of 1,000 in developed countries, can lead to impairments in both eyesight and hearing – sensory systems that are critical to a child’s motor and skill development.

Cortical vision impairment (vision loss because of injury to the pathways between the retina and visual cortex), tunnel vision (peripheral retina damage) and strabismus (crossing of eyes) are among common eyesight abnormalities sustained by HIE patients.

Christine Roman-Lantzy PhD has developed a CVI (cortical vision impairment) Range Assessment and written two published books on CVI. Dr. Zelinsky feels honored to be sharing the same speakers’ platform with Dr. Roman in April 2020 at a conference in San Francisco where both professionals will discuss differences between eyesight and vision – eyesight defined as simply seeing something and vision being the interpretation of it.

“Babies diagnosed with CVI are not able to interpret their environment, even though their eyes can see,” Dr. Zelinsky says. “The structures are in place, but the function has not yet been learned. Both Dr. Roman and I sincerely believe that brains can learn new skills.”

In the case of one HIE child who was first seen by Dr. Zelinsky and her team at seven months and is now four years old, retinal stimulation using colored filters has helped resolve the child’s strabismus and has enhanced retinal processing. As a result, the child’s visual attention has become more acute, the ability to locate and fix gaze on objects by sound strengthened, motor development improved, and an interest in books and reading developed. Work remains ongoing to deepen the child’s depth perception for common functions such as walking down stairs and to build learning skills like discerning letters in words and putting together puzzle pieces.

The term “retinal processing” refers to the brain’s ability (partially beneath a conscious level of awareness) to take in many external sensory signals (from eyesight, hearing, smell, taste and touch) and synthesize the information, reacting and responding, depending on many internal sensory signals.

“This mind-eye connection is unique to each person’s processing system and experiences,” says Dr. Zelinsky, who is a featured health professional among participants in Hope for HIE. “Neuro-optometric rehabilitation is able to use this concept of mind-eye testing – versus conventional eye health and eyesight testing – to prescribe therapeutic methods on a very individualized basis in order to bring sensory systems into synchronization.”

Dr. Zelinsky believes that the standard 20/20 letter recognition used in current eye evaluations needs an update to match the changes in modern society’s visual usage, since that testing was developed in 1862.

“The 20/20 testing was invented to standardize eye care when much of the nation remained unsettled, overland travel was by horseback or horse-drawn wagons, and prairies and mountains dominated individuals’ peripheral sight,” she says. “This 150-year-old testing system addresses central eyesight by having the patient consciously look at non-moving targets (usually a letter chart or, for babies, a series of stripes) in a darkened room, but ignores peripheral retinal processing, which comprises an overwhelming percentage of a person’s visual awareness. Peripheral eyesight is used for perception of moving targets, such as occurs while simply scrolling on a computer or iPad, surfing the Internet, watching movies or driving.”

Patrick Quaid, MCOptom, FCOVD, PhD has determined that “only about six percent of our visual field is dedicated to where attention is placed on central targets. The remainder — 94 percent — is used for peripheral retinal processing,” Dr. Zelinsky states. “Our outdated 20th century eye-testing methods do not typically evaluate the subconscious use of peripheral eyesight nor its linkage with central attention.”

Today’s optometrists have many advanced tools to address deficits or imbalances in both central and peripheral eyesight. “By using their knowledge to alter the way light disperses across the retina and readjust a patient’s visual balance and eye-ear connections, optometrists can positively affect patients’ external eyesight as well as their internal processing,” Dr. Zelinsky says.

“We are already 20 years into the 21st century. Let’s leave 20/20 eye acuity testing where it belongs – in the 20th century.”