This isn’t a political statement. Nor is it a tribute to the band, Foreigner.
It is a statement regarding awareness of one of the more common sequelae of Acquired Brain Injury: double vision. Here is a very famous individual, on a very public stage, thrust deeper into the public eye because of her binocular vision problems after closed head injury.
The vertical lines that you’ll notice on Secretary of State Clinton’s left lens indicates that the lens is a Fresnel Prism, a type of membrane lens that is cut out and applied to the inside surface of a spectacle lens. The more vertical lines you see, the higher the power of the prism, so the prism Hillary is wearing is pretty powerful. Her double vision must therefore be of a significant amount without her prism in place.
The New York Daily News was among the first media outlets to comment on the observation. Coverage of the story however has been impoverished by the meager discussion about Hillary’s concussion, without a single source that I’ve seen speculating on what caused the double vision, what her treatment has been, and what the outlook for resolution is. But perhaps you’re thinking along different lines, possibly something like Hillary’s now famous line at the Benghazi hearing where the now famous Fresnel photos were taken: “Is her double vision due to a brain bleed, or due to the concussion she experienced when she passed out and hit her head in December? What difference, at this point, does it make? It is our job to figure out what happened and do everything we can to prevent it from ever happening again.”
There’s been alot of attention drawn to concussions related to sports injuries, and efforts at prevention, but comparatively little attention has been paid to the visual sequelae of passive episodes such as Secretary Clinton experienced. While I respect anyone’s right to privacy about their own health issues, this is a golden opportunity for Hillary to both open up about what she is experiencing, as well as broadening awareness of vision rehabilitation for ABI. OEPF recently published an excellent and timely overview of these issues in a book authored by Padula, Munitz, and Magrun. The most likely explanation for Hillary’s use of the Fresnel prism in her glasses is double vision due to strabismus. However, she could have elected to wear her contact lenses together with a more attractive pair of glasses incorporating prism. Our colleague Dr. Padula coined the term Post Trauma Vision Syndrome, which includes not only binocular vision problems, but a tendency to stare, as well as light sensitivity. Hillary wore contact lenses prior to this episode, and her reduced blink rate no doubt makes her more comfortable in glasses. She can be seen in several of the images fiddling with her frames, adjusting them one suspects to obtain best focus, or to lessen her double vision. In some of the other images she appears to be cupping or shielding her frames at the edge, possibly to reduce glare or disturbance from the periphery of her vision.
So Hillary, if you or one of your team is reading this, please contact a rehabilitative optometrist who has experience with helping patients improve visual function after acquired brain injury. Much like concussions in sports, this has been an area in which the visual problems experienced by patients are often overlooked. Through sketchy media reports it sounds like your visual challenges will linger without active optometric guidance and therapy. Of course, you may already be working with such an individual and if so, we’ll look forward to seeing your progress!