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TBIs and Your Vision

How Traumatic Brain Injury Impacts Eyesight

It was one of those freak accidents that you hear about. John, a local professional from Richmond, was in a big box store when a steel display sign hanging from the ceiling suddenly broke and came crashing down on his head.

The impact left John lying on the floor, unconscious. He was taken to a local hospital and diagnosed with a concussion after experiencing short-term memory loss, speech issues, nausea, and dizziness with any head movement. 

Traumatic brain injuries – more commonly referred to as TBIs – are described as direct impacts to the head, causing a physiological disruption of the brain function. As a result, the visual system can be affected. 

In John’s case, more than a week after the accident, he had major vision problems that would not go away. He couldn’t drive and couldn’t tolerate riding in a car either. 

We often think about vision as simply what we see; however, vision also includes how the brain makes sense of what we see. A traumatic brain injury can affect vision by damaging parts of the brain involved in visual processing and perception. 

Some common vision complaints after a traumatic brain injury are blurred vision, difficulty reading, double vision, eyestrain, motion and light sensitivity, perceptual deficits, and grainy or wavy vision.

These symptoms may be a result of problems with eye movements, eye teaming issues, weakness or imbalance in the muscles that move the eyes, or other eye muscle problems. These visual anomalies adversely affect the patient’s quality of life and can interfere with activities of daily living, school, and work. 

Freak accidents like John’s that result in TBIs are not uncommon. Out of my patient base treated for TBI, about 20 percent of patients experienced an uncommon or rare accident. The other 80 percent were involved in car accidents.

In terms of treatment options for patients who have experienced vision challenges related to TBI, rehabilitation therapy is an innovative approach. Unique in the region, this therapy offers head trauma patients an option that has traditionally been otherwise unavailable. 

Through specialized neuro-optometric rehabilitation therapy, patients engage in weekly therapeutic treatments and are often able to return to school and work. 

It is a tailored program where a foundation is established to make sure a patient’s vision is corrected and both eyes are seeing equally. Then, we move on to basic eye muscle exercises and other therapy techniques. 

In most cases, patients will start to notice some vision restoration and success in four to six weeks. Other, more serious cases, such as John’s, can take years for complete recovery. 

According to the most recent data available from the Centers for Disease Control and Prevention, in 2013, approximately 2.8 million people came to the emergency department due to a traumatic brain injury. If you or someone you know experiences a concussion or some other type of TBI, don’t hesitate to seek treatment. The sooner the rehabilitation process begins, the sooner you return to everyday life. 

Suzanne Kim, OD, is board-certified by the National Board of Examiners in optometry and serves as the director of the MEDARVA Low Vision Center, where she is committed to providing low vision care to people with visual challenges. Dr. Kim enjoys hiking, yoga, cooking, and traveling the world in her free time.

MEDARVA Delivers ‘Wonderful Experience’ to Out-of- State Patient

Three months ago, Shaun Lilley was living a life of agony. She was always in pain, could barely sleep, dealt with constant swelling and her bad knee had already led to two painful falls. She tried cortisone shots and had multiple MRIs, but nothing seemed to help.

Shaun needed a knee replacement to bring her life back to normal, but after calling her insurance provider, she was told she would be responsible for at least half of the procedure’s sky-high costs. She was running in circles, unable to get an answer as to how much the procedure would set her back.

Unable to foot a bill that could reach as high as six digits, Shaun searched for a more affordable option, but there was no one near her home town of Lake Row, on New York’s Long Island, that provided a low-cost knee replacement.

She was crushed, thinking she would never be able to live a life without pain. That is, until a friend put her in touch with our president and CEO, Bruce P. Kupper, and Chairman Peter Pastore.

After speaking with Shaun, Bruce knew just who to call – Dr. Vivek Sharma of Colonial Orthopaedics – an orthopedic surgeon specializing in knee replacements and part of our network here at MEDARVA.

After consulting with Shaun, Dr. Sharma set her up for an outpatient custom knee replacement – a more in-depth procedure that leads to less pain and a faster recovery. They had a CT scan done on Shaun’s right knee and designed a left knee in its mirrored image. Six weeks later, she would be ready to go.

Shaun had all of her preliminary work done back home in Long Island and set an appointment to have the surgery done on December 6. She made arrangements to stay with a family friend in nearby Urbanna, Virginia and she could hardly wait to put the pain behind her.

That Wednesday, Dr. Sharma installed Shaun’s new custom knee. Following the procedure, she stayed at Stony Point Surgery Center for a couple of hours before moving to The Laurels of Bon Air for rehabilitation, where she spent the following night before going to Urbanna to continue her physical therapy with Amedisys Home Health in Saluda, Virginia. After finishing her final session, Shaun was able to return to New York.

Now, just over a month later, Shaun is back home living pain-free. Her range of motion has increased more than 50 percent since the procedure and her quality of life has increased tenfold.

The procedure, which she paid for entirely out-of-pocket, cost Shaun less than a third of the national average rate for a total knee replacement, even with the tailor-made custom knee. On top of the affordable rate, she said the quality of care she received from everyone at MEDARVA blew her out of the water.

Her experience was so positive that her boyfriend, who is looking into a total knee replacement himself, is thinking of having the procedure done at MEDARVA, despite having an insurance policy that would pay to have the operation done in New York.

Shaun said her original insurance problems turned out to be a blessing in disguise, and it was all thanks to MEDARVA.

“It’s unbelievable. The whole process has just been a really wonderful experience for me,” she said. “I got better care than I would have up here (in New York). In my experience, if I have to have the other knee done, I know where to go.”

These are the kinds of things we love to hear at MEDARVA. Want to know more about how we can help you? Visit our website at or give us a call at (804) 775-4500.

Dealing with Spring Allergies

The Curse of Spring

Eddie Edwards, Marketing Director
Eddie Edwards is Marketing and PR director for MEDARVA Healthcare

Hay fever, or allergic rhinitis, can make those beautiful Spring days pretty miserable. Here are some of the symptoms:

  • Runny nose
  • Nasal and/or ear congestion
  • Sneezing
  • Red, itchy, watery eyes
  • Sore, scratchy throat
  • Post-nasal drainage
  • Itchy sinuses or ear canals
  • Cough
  • Asthma-like symptoms (wheezing, etc.)

Avoid that yellow dust!

Even though it’s difficult, try to avoid pollen, the main trigger for Spring hay fever symptoms. Here are some tips:

  • Monitor the pollen counts every day so you know what to expect and how to prepare
  • Try to stay indoors on dry, windy, days
  • Plan outdoor activites in the afternoon or evening
  • Have someone help with gardening and other outdoor chores
  • Always wear a mask when working outside
  • Take antihistamines on high pollen-count days
  • Keep windows closed, use HEPA filters, and air conditioning
  • Wash your bedding in hot water every week

Why do I have allergies now?

If you developed allergy symptoms as an adult, you’re not alone. Adult-onset seasonal allergies are common. Typically, these reactions occur when something in your environment has changed. An allergic reaction occurs when your body identifies something as being harmful and then produces antibodies to try to fight that substance. Those antibodies then attach themselves to cells in the body and release a chemical called histamine. Histamine creates inflammation which causes your allergic symptoms.

Many people experience these reactions after a move to a new state where different allergens may be present. When our bodies are exposed to new potential allergens, there is a higher likelihood of having a reaction. If you’re new to Virginia you may be enjoying the different seasons but struggling with allergies this spring.

Allergies can also affect us differently each year. One cause of this is a longer than average winter. If cold temperatures cause a delay in pollination of trees, they pollinate at the same time as many other plants and flowers – increasing the amount of pollen at one time.


Treatment options include prescription and over the counter antihistamines and steroid nasal sprays, and prescription steroid inhalers. In some cases, a deviated septum — the bone and cartilage which separate one side from the other — can make allergy symptoms worse.  A simple surgical procedure can straighten the septum, stop the blockage, and help relieve symptoms.



Protecting Sight of Premature Life

Dr. Matthew Doerr
Dr. Matthew Doerr

A period of time in the Stiles family’s life that was supposed to be filled with joy transformed into one of fear and uncertainty when their baby, Andy, was born at 27 weeks and immediately confined to the Neonatal Intensive Care Unit. While a team of physicians worked day and night to stabilize him, innumerable thoughts flew through his parent’s minds: Was he going to survive? Would he have brain damage? Had his lungs developed properly?  In that overwhelming moment, it did not occur to the new parents, amongst all the possibilities, that their baby may not be able to see.

An infant’s eyes are not fully developed until they are almost full-term. When they enter the world prematurely, especially prior to 30 weeks of gestation, they are at much higher risk for abnormal eye development and blindness if they are not followed closely by an ophthalmologist.

“I just remember seeing him hooked up to all these tubes and alarms,” Jan Stiles said of when their baby, Andy, was in the NICU during his first few months of life. “He was so small and helpless and I couldn’t do anything to help him. His care was in the hands of his doctors and nurses.”

Among the team of doctors tending to Andy was pediatric ophthalmologist, Dr. Matthew Doerr. Dr. Doerr was responsible for performing the weekly eye exams Andy needed to ensure that his eyes developed properly, and if necessary, to perform the medical or surgical interventions that might have been necessary to give little Andy his best chance at normal vision.

“I understood their distress. Parents, who haven’t slept in weeks, and are faced with the complicated and difficult situation of an extremely premature baby just want to hear us say that everything will be fine,” said Dr. Doerr, who has now joined Dr. Edwin Wortham V at VPOS (Virginia Pediatric Ophthalmology Specialists) in Richmond. “As a father myself, I understand a family’s need to hear that.”

“Early intervention in the visual development of a child is critical and sometimes easy to overlook. As anyone who works with children knows, they often won’t complain of a problem, so you have to know what to look for and the right questions to ask,” Dr. Doerr explained. Early intervention and prevention of complications can be the difference between normal vision and profound vision loss.

Part of Dr. Doerr’s specialty is being keenly aware of his young patients and adept at recognizing small nuances and signs in their behavior that when addressed early, can make a huge difference down the road. His own three children have helped him better communicate with his patients and their families. Two of his own children have vision problems, which has helped him relate to what some of his patients and their parents deal with every day.

In his practice, Dr. Doerr sees a wide variety of pediatric eye issues ranging from glasses prescriptions, to routine and complicated ocular misalignment, to even surgical and medical management of congenital cataracts and glaucoma. VPOS, under the expertise of Dr. Edwin Wortham, has been helping children and adults with eye problems since 1992. The practice is located across the street from the Stony Point Surgery Center, where the majority of their procedures take place.

Patients like Andy, and many other premature infants like him, are the types of cases that Dr. Doerr finds most rewarding. “Making a difference in a newborn’s life has a profound impact on everyone involved and I’m thankful for the opportunity,” he said. “I enjoy following these children as they grow and doing everything I can to ensure that they continue to see the world clearly.”

Raising Awareness of Cancers That Strike Below The Belt

Melinda Conklin is the founder of Hitting Cancer Below the Belt, a Richmond nonprofit dedicated to below the belt cancer prevention, education and awareness.

Each year, Hitting Cancer Below the Belt hosts its signature event, the Boxer Brief 5k, to raise funds that support local efforts for colon cancer early detection and prevention, as well as GI health research.

Colon cancer is the second most common cancer in the United States, and is the second leading cause of cancer death in the US. The disease is not gender specific and affects men and women equally.

Melinda is no stranger to colon cancer, unfortunately. Her husband, Rich Conklin, passed away after being diagnosed with colon cancer in 2011, at the age of 43. There is a 95 percent survival rate if you can catch colon cancer early enough, which inspired Melinda to focus on spreading colon cancer awareness in her community. Melinda formed Hitting Cancer Below The Belt to educate others about colon cancer, spread awareness and to share information about the importance of early detection and prevention.

This year’s Boxer Brief 5k will be held on Saturday, June 6 at 8 a.m. at Stony Point Fashion Park. This fun, annual event raises much-needed funds to support local efforts for early detection and prevention in the Richmond community. MEDARVA Healthcare is proud to sponsor the Boxer Brief 5K and we hope you will join us for this year’s event. You can learn more and register online here.

Online registration for the Boxer Brief 5k ends on Wednesday, June 3, 2015. If you’d like to register in person, you can pick up a registration packet at Lucky Foot Midlothian on Thursday, June 4 from 3 to 7 p.m. or at Lucky Foot Willow Lawn on Friday, June 5 from 3 to 6 p.m.

We’re gearing up for this year’s race and can’t wait to see you there!

The Art of Facial Restoration and Aesthetics Around the Eye

With summer in full swing and the sunrays at its strongest, we are constantly reminded of the importance of protecting our eyes. Not only is it important to protect your physical eye, but you don’t want to neglect the area around your eye as well.

Many factors can damage your eyes. From excessive sun exposure to trauma and disease, our eyes are vulnerable and when damaged can be extremely difficult to mend.

Dr. Jeffrey Zuravleff

At Stony Point Surgery Center, we are proud to have Dr. Jeffery Zuravleff in our network, Dr. Zuravleff strictly focuses on the needs of individuals for cosmetic, corrective and reconstructive surgery of the eye.

A Delicate Approach

As a specialist in oculoplastic and reconstructive surgery, Dr. Zuravleff treats both functional and aesthetic problems of the upper face and eye region. Facial disfigurement and scarring from trauma, facial paralysis, tearing, thyroid eye disease and excision and reconstruction of cancerous lesions are among the many medical problems treated by Dr. Zuravleff. He is accustomed to working around the eye and face and understands the delicate anatomy and function of the eyelids and their surrounding structures.

How Is His Work Different From Ophthalmology?

Oculoplastic surgeons, like Dr. Zuravleff are ophthalmologists or “eye surgeons” who are board certified and have completed several years of additional, highly specialized fellowship training following their ophthalmology residency. Oculoplastic surgeons understand how eyelid surgery can affect the comfort of the eye and the clarity of vision.

Oculoplastic surgery manages and repairs problems primarily related to the tissues or structures surrounding the eye, rather than the eyeball itself. These structures include the eyelids, the tear ducts, and the orbit “bony socket surrounding the eye”.

What Can He Do For You?

Dr. Zuravleff can address abnormal eyelid position and contour, reconstruction of the lids following skin cancer removal, burns, or trauma. In addition he performs facial rejuvenation cosmetic procedures such as eyelid lifts, eyebrow lifts, cheek lifts, as well as non-surgical procedures like injectable fillers, and Botox.

If you are interested in learning more about how Dr. Zuravleff can help you please contact him at 804-934-9344 or visit his website at:


Dr. Zuravleff received his Doctorate of Medicine from the University of Pittsburgh’s School of Medicine and Master of Science from the University of Pittsburgh’s School of Public Health. He received residency training in ophthalmology and a fellowship in oculoplastics at Duke University Medical Center.

He has lectured locally, nationally and internationally and practiced as an oculoplastic and orbital surgeon since 1990, managing the care of over ten thousand patients with functional and aesthetic issues of the face.

With his wife, Lynn, Dr. Zuravleff has spent the past eight years restoring the home and grounds of Grasberger’s Spoon Factory on their 160-acre farm/estate.  Dr. Zuravleff is also an amateur potter and enjoys outdoor sportsman activities.

Perception is Everything: A Kids-Eye look at the 5 Senses

Did you ever wonder why your 7-year-old trips over his shoes, without picking them up? Or why your teenager doesn’t hear you when you ask him to make his bed? Or why your toddler spits out the carrots she loved just yesterday?

Despite the evidence of your own eyes and ears, there’s probably nothing wrong with your child’s senses. The sensory faculties of touch, sight, taste, smell, and hearing, allow us to perceive the environment are fine. It’s just that different stages of growth and development allow the child to use them in ways none of us would imagine – or at least not since we were kids ourselves.

1. Touch

The delicate, soft skin of an infant is loaded with sensory nerves, programmed to respond to touch. Think about how a baby just knows how to find the nipple when the side of his face is gently stroked, and how tiny babies respond to that inaugural bath, when for the first time they are wet and cooler than usual.

For a newborn these encounters with touch aren’t just comforting, they can help him thrive. A report out of the Touch Research Institute from the University of Miami School of Medicine revealed that premature babies, who were much less cuddled and touched than their full-term counterparts, weren’t gaining weight at comparable rates. When infant massage and therapeutic touch programs were introduced, these little ones gained more weight and improved their development.

2. Sight 

Anyone who had poor vision as a young child can remember the first time he donned those prescription glasses. Who knew that tree bark had actually had texture!

Vision problems are commonly noticed when a child starts school, but there are a number of things that can be done to evaluate vision beforehand. Natario Couser, MD, is the medical director of Where Healthy Eyes and Ears Lead to Success (WHEELS), an initiative from Prevent Blindness Mid-Atlantic and MEDARVA Healthcare that conducts pre-school screening to help identify children at risk. He says ophthalmologists, clinics, and programs like WHEELS are a valuable tool in diagnosing and treating problems before they can affect learning.

The sense of sight is critical to learning success. “Approximately 80% of the information children process during the school day is from visual stimuli,” says Dr. Couser,. “If a child has problems seeing clearly, learning can be affected. Fortunately, most problems can be easily treated with noninvasive techniques and eyeglasses.”

3. Taste

It’s amazing how your toddler will love squash one day and spit it out the next right?!

The sense of taste is more complex than you would think. It’s closely aligned with the sense of smell, says otolaryngologist Evan Reiter, MD, with VCU Health System’s department of otolaryngology. The taste buds, specialized nerve endings on the tongue, can distinguish several kinds of flavors, notably sweet, salty, bitter, and sour.

All taste buds are not alike. There is research indicating that tweens may be more sensitive to sweet flavors than younger or older children. Also, the overall sensitivity of the taste buds seems to increase and refine by the teenage years.

An unexpected link between taste preference and society was described in a Stanford University study. When kids were given unidentified foods, they preferred the flavors of a highly advertised food chain to similar foods from other sources. Food preference is an important area of scientific study, especially with the new emphasis on combating childhood obesity.

4. Smell

It is estimated that humans have about five million smell receptors, and that the peak sensitivity is at around eight years of age. It will gradually drop off with age, with women generally maintaining the sense of smell better than men.

We use the smells to help taste our food, and we form emotional links and memories from the smells. “We’ve all had the experience of recalling an event when a particular odor wafts by,” says Richard Costanzo, PhD, professor of physiology and biophysics at VCU’s School of Medicine and a pioneer in the study of smell and taste disorders.

“It may be a special perfume, chocolate chip cookies in the oven, or the smell of a gas leak. These are powerful emotional triggers that generate feelings and, in the case of a warning odor, prompt action. In that way, the sense of smell can truly be a life-saver.”

5. Hearing

Are you deaf? Am I talking to myself? These are common questions exasperated parents ask teenagers, says Travis Shaw, MD, ear, nose, throat, and sinus specialist. “Rest assured – this selective hearing loss is not a permanent condition and will go away without treatment, if not without a lot of parental frustration!”

Like the other senses, the sense of hearing has a great impact on learning and development. We learn to associate sounds with emotions. Soft music is relaxing; very loud sounds can sometimes be painful – and may actually damage the fragile receptor cells in the ear.

It is clear that the senses are truly our window into the world. Throughout our children’s lives, the information gathered using these faculties will help them mature into balanced and productive members of society. Science and medicine have developed insights, technology, and procedures that help us keep these windows wide open from the very beginning.