Interview with Dr. Shah

 Dr. Shah:

I’m Dr. Shah. I am a neurodevelopmental optometrist and I specialize in vision, cognition, and performance. And because we do neurodevelopmental optometry, we also work with a lot of concussion patients.

Sean:

Dr. Shah, can you talk a little bit about what inspired you to get into this field in the first place? Did you have your own experience with concussions? What made you start this?

Dr. Shah:

So what made me start neurodevelopmental optometry was actually my own eye issues. I have one eye that when I was born, a lazy eye, totally non-functional, and over time I really wanted to improve it, but I was told that it wasn’t possible, that the wiring was set. And so I went on this journey of education, learning, and then I actually figured out how to change my brain wiring to allow both eyes to work together. And then from there I started the practice to help other people.

Neurodevelopmental optometry is a fancy way of just saying how to make the brain and the eye function better. And we have many concussion patients on a weekly basis now because any concussion, like you know, the brain-eye gets disrupted. The brain gets disrupted. The vision can get disrupted. A lot of the first symptoms that concussion patients mention are light sensitivity, blurry vision. Their vision feels off, and these are all issues because the brain that controls the pathway for the eyes got disrupted.

These are probably the most fulfilling patients I have for myself because we take them from not being able to work to going back to living normal lives. And it’s just so hard to go from where maybe you are performing at this level and then suddenly one event takes you down to a level you’ve never experienced, and you don’t feel like yourself. These concussion patients we work with just don’t feel like themselves. They feel like there’s somebody else, that something is wrong with them, but they can’t pinpoint it, they can’t figure it out. And so I have the pleasure of helping them through this tough process with other specialists that are working with them as well to create a game plan to get them from this point back to how they were, or in a lot of cases even better than where they were before.

Sean:

I appreciate you breaking that down for me. The neurodevelopmental optometrist is essentially trying to make the brain and eye function better and go hand in hand with one another. I use these—I don’t know what your opinion is—given your role, but I use these blue light glasses a lot now because sometimes I’ll still get headaches, and for some reason they stem on the left. They start from the left side of my eye, and it just goes up into my head. I’ve been using these blue light glasses. So maybe can you give a couple of tips that you usually give concussion patients or exercises that you have them do as you help them recover?

Dr. Shah:

Absolutely. So light therapy would actually help you a lot. There are two types of light therapies that are prominent right now that most people have heard of. The first light therapy is photobiomodulation, which works on the actual cells in the mitochondria, and the other is syntonic light therapy, which I find very effective for concussion patients because it actually goes to the autonomic nervous system.

A lot of my concussion patients are stuck in fight-or-flight mode. You get hit and jarred, the brain gets a coup-contrecoup motion, you get beat up a little bit, and it messes up the pathway connection to the eyes along with the rest of the body, which is why you can have twitching of different parts of the body and a lack of coordination for a while. But the light, when you look through it, stimulates the nervous system, and you can modify where you want it to go with the light depending on which filter you use, and that’s something called syntonic light therapy.

For you specifically, if you’re still having sensitivity from time to time and still having issues with that pathway, syntonic light therapy would be very useful for you to get you back to status quo or even better than status quo. So that’s something to consider for any concussion patient: use light effectively to help your brain get to a better autonomic nervous system.

If you’re still having light sensitivity and you notice that putting the blue light blockers helps, that means that the LED light is still stimulating you and your brain sensitivity is still running high. We’ve been doing that for a while now, and our concussion patients love it because we get a lot of concussion patients who travel three or four hours to come here.

There are not a lot of providers who specialize in this small field. There’s a handful in all of California who are really trained in everything that comes to vision, cognition, performance, and light therapy. A concussion patient unfortunately doesn’t have a lot of options. They’ll see a primary care physician, and the primary care physician is busy. They are not familiar with everything in the realm of a concussion. Sometimes if you go to one of the bigger concussion centers, then you’ll hear about it and get the referral placed. But if you’re going to a normal primary care physician, they may not be aware of all the options available and may not even be sure what to look for.

The same thing applies with a normal optometrist or normal eye doctor. They may not be aware that there are all these amazing options available for recovery and rehab.

Many of my patients will have a concussion and think they’ve recovered until they talk to somebody who is more like me or talk to somebody who’s had a concussion and is still struggling. Then they realize maybe I’m not fully recovered, maybe I’m still having some issues.

Let me give you an example. We have a teen—he’s 14—and he plays football. He had a concussion and hallmark concussion symptoms: light sensitivity, a little vertigo, very sensitive to loud sounds, blurry vision, double vision, and a very hard time reading on the phone. Just hallmark concussion signs. We start working with him, we see improvement, and mom is there. Mom was curious. She’s like, “Hey, I had like three concussions when I was his age and I was just wondering, are there long-term side effects?” Then we start talking and I ask her a few questions and have her do a couple of tests.

These tests were very simple. We didn’t even put her behind an eye tracking system or any of our fancy stuff. We did a simple test where we had her look at my two thumbs and we moved them around and did some vestibular work and some eye tracking work. I wanted to see how she felt, and she felt very uncomfortable. She felt like it took a lot of effort. She felt dizzy. I asked her, “How long can you read without losing your spot?” She said, “Well, I always have lost my spot.” I was like, “For how long?” She said, “I don’t know. I thought it was normal.” I asked, “Were you losing your spot before your concussions?” She said she couldn’t remember.

Then she started thinking back. She said she thought she had always lost her spot after her concussions. So we put her behind the eye tracking system and detected that she has ocular motor dysfunction, meaning the eye tracking is inaccurate because post-concussion it never got fixed. It was good enough to live life and get her by because the light sensitivity wasn’t as bad, but she couldn’t read longer than a few minutes without losing her spot. When she read, she needed breaks every ten minutes. She thought that was normal because it had been that way for many years now.

Things like that happen a lot. Cases like yours, cases like hers—we see a lot in the exam room. Even when I’m talking to patients’ family members about concussions, they sometimes say, “Wait a minute, that happens to me. I still have that.”

Sean:

When you told her story, I think, no, it doesn’t happen anymore. ButI think when I was still playing, even after I was medically allowed to play and cleared to play, I would sometimes lose track of—not necessarily reading from a book—but reading slides in class. That was difficult for me. And if I concentrated for too long of a time period, I would get those throbbing headaches again. Thankfully I’m managing it well. I think, I am not in a state of denial but I think looking at other therapies like the light therapy could help.

Could you give one piece of advice that you have for a person, or maybe a couple of pieces of advice, for someone who is on the concussion recovery path?

Dr. Shah:

My advice would be to, and this is a tough one because there’s so much to say, is you have to be your own advocate. If you’re an athlete who is battling concussions, try not to prioritize the present. Prioritize your future. This applies to non-athletes too. It’s not just getting back to work or the field. It’s getting back to your optimized self.

Once you change your mindset on that, then you can find the correct people to help you. If you’re thinking your main goal is “I just need to get back on the field,” you will be in that denial state. You will ignore certain things because your brain already set the goal as my goal is here. If your goal is just to return, it doesn’t matter if you’re fully optimized or present. You just want to get to that goal. But if you have the right mindset of, “I need to protect my future self,” then you’ll take the time required to heal.

Not every concussion heals right away. It takes time.

The main thing I want to say, besides the mindset shift, I want people to know that with concussion recovery there is a lot of new research that is different from how people used to manage concussions. Big concussion centers know that, people like you know that, but smaller practices, primary care physicians, and hospitals may not be aware that concussion protocols are different now.

For example, there is not a lot of people know that you need to start vision training within about a week or two of having a concussion if you want to get back to your optimized state. The longer you wait to do vision training, the harder it is to get your muscles back in sync. Before, it was thought you only needed vision therapy if you had issues, but a lot of new research is coming to show if we can start working on things earlier, it’s better for that concussion patient to get back in sync.

Same thing with exercise. Before, they would say you need to be in a dark room and sit and see nothing. The seeing nothing part is probably okay—you shouldn’t be scrolling on your phone—but blood flow is actually a good thing. Light exercise, light bicycling, movement—it’s actually a good thing. You shouldn’t be completely stationary in a dark room doing nothing. You want light brain activity and  let the brain be stimulated by blood flow.

I could go on and on, but for those listening, if you want one or two takeaways:
One is definitely to be your own advocate. You gotta be your own advocate. Get the right mindset. Mindset is first, and then second is to make sure you are following concussion recovery that is gonna get you optimized as soon as possible.