Vision Therapy for ECT Injury (Electroconvulsive therapy)

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Vision problems after ECT

hands holding a pair of glasses in front of a blurry green background. Trees can be seen clearly through the glasses lenses.

Before vision therapy, I never really made the connection between how my vision was impacted by ECT.

I thought I really only had problems with memory and concentration… never imagining either had to do with visual pathways.

I knew that during and after my ECT I lost the capacity to read/process more than a line of text at a time but I assumed it was because I couldn’t remember what I’d just read on one line to know which line to read next.

My psychiatrist said it was just memory loss that would go away. It didn’t. Turns out it was much more.

My Vision After ECT

I found a pre-vision therapy video and cannot get over the difference in my eye function evident in the “thumbnail.”

This video was recorded in April 2020. I think I started vision therapy in… August 2020?

So I’ve now been in vision therapy for more than a year.

In the old (pre-vision therapy) photo, My eyes are both turned outward, with one looking up and to right and the other is going down to the left.

If you watch the video, the only time my eyes really come together is when I’m concentrating super hard on the camera in front of me.

I never realized part of the reason it took so much energy to concentrate was because my eyes were struggling to line up, causing concentration and fatigue problems.

I don’t think I ever fully understood how much energy is required to do just the basics.

I mean I knew I was exhausted and couldn’t explain entirely why, but now I understand part of the reason is because my eyes/vision processing was struggling so hard to get on board that most of the time, they’d just go offline without me realizing it.

Vision Impacts Quality of Life

People really only talk about memory problems after ECT, I honestly thought for the longest time that memory loss was my biggest problem. I wish now it were.

I didn’t know just how bad my vision problems were or how much they subtly impacted my quality of life… largely because they always tested one eye at a time… and though my old optometrist swore I had the right prescription… my glasses never seemed to be the perfect prescription. FOR 10+ YEARS!!

Vision is More than Sight

I didn’t understand the many problems it caused are all tied to vision pathways:

  • concentration
  • working memory
  • visual memory
  • hand-eye coordination
  • depth perception
  • proprioception (understanding where my body is in space)
  • balance
  • headaches
  • reading compression
  • remembering what I read
  • visually processing movement
  • problem solving

The video thumbnail shows how wonky my eyes were roughly 20 months ago… before twice-weekly vision therapy.

I’ve been in vision rehabilitation for a bit more than a year now and though my progress has felt snail-paced, I can look at the thumbnail of this video and recognize how far I’ve come.

I can also see improvements in each of the areas I mentioned above.

Finding a NORA Vision Therapist

If you want to find a neuro Optometric Rehabilitation professional to get a comprehensive brain injury assessment and rehabilitation, you can find one through their international registry

A NORA provider may be the only one presently prepared to objectively measure brain function after ECT and create a rehabilitation intervention specifically for ECT’s unique “global dysfunction” researchers write about.

They can bill insurance for vision therapy using occupational and physical therapy codes because that’s essentially what they’re doing, but via addressing vision pathways.

Vision Disturbance is a Known Risk of Electroconvulsive Therapy

Thymatron’s 2019 user manual lists “vision disturbance” as a serious adverse event:

ECT Device Manufacturer Admits Brain Damage as a Risk of Electroconvulsive Therapy

Other serious adverse events have occurred, including adverse reaction to anesthetic agents / neuromuscular blocking agents; adverse skin reactions (e.g., skin burns); cardiac complications, including arrhythmia, ischemia/infarction (i.e., heart attack), acute hypertension, hypotension, and stroke; cognition and memory impairment; brain damage; dental/oral trauma; general motor dysfunction; physical trauma (i.e., if inadequate supportive drug treatment is provided to mitigate unconscious violent movements during convulsions); hypomanic or manic symptoms (e.g., treatment-emergent mania, postictal delirium or excitement); neurological symptoms (e.g., paresthesia, dyskinesias); tardive seizures; prolonged seizures; non-convulsive status epilepticus; pulmonary complications (e.g., aspiration/inhalation of foreign material, pneumonia, hypoxia, respiratory obstruction such as laryngospasm, pulmonary embolism, prolonged apnea); visual disturbance; auditory complications; onset/exacerbation of psychiatric symptoms; partial relief of depressive anergia enabling suicidal behavior; homicidality; substance abuse; coma; falls; and device malfunction (creating potential risks such as excessive dose administration)

regulatory update, 2018

Hope for ECT recipients With Visual PRoblems

My behavioral optometrist is in the process of writing a paper for publication about ECT’s impact on vision.

He’s working to define what “visual disturbance” means so that we can help others access the rehabilitation necessary to improve their quality of life after ECT.

Additional Resources

Other resources on visual processing

Sarah P. Hancock

Sarah Price Hancock, MS, CRC, lived for nearly two decades misdiagnosed with severe "treatment resistant" mental illness. She was given 116 bilateral ECT treatments and now lives with Delayed Electrical Injury's Myoneuroal Disorder. Sarah holds a Master’s in Rehabilitation Counseling and taught for four years in San Diego State University’s Rehabilitation Counseling program. She is the Co-Founder and Trustee of the Ionic Injury Foundation. She also hosts The Emotional Self-Reliance Podcast and guest lectures on psychiatric recovery.