Chiropractic Journal of Australia 2017; 45 (1): 38–43 ~ FULL TEXT
Thomas A. Brozovich D.C
Palmer College of Chiropractic,
1000 Brady St,
Davenport, IA 52803, USA
Objective: To discuss the chiropractic management of a patient whose unilateral color vision loss associated with macular degeneration resolved after treatment.
Clinical Features: A 66-year-old female with a history of cervical, thoracic and lumbar pain and a four-year history of macular degeneration of the left eye resulting in a loss of color vision sought chiropractic care for primarily her spinal pain. Initially she was not requesting care for her loss of color vision. She reported having multiple recent traumas (falls) injuring her cervical, thoracic and lumbar region.
Intervention and Outcome: The patient was adjusted based on location of her subluxations (intersegmental joint dysfunction). She had 17 treatments over 8 month. A thermography study was performed of the face before and after treatment and a more symmetrical thermal pattern was obtained. Her spinal pain reduced. She also unexpectedly had a return of color vision in her left eye.
Conclusion: The patient responded favorably to chiropractic care, which resulted in a decrease in spinal pain and improvement in left eye color vision.
Keywords Macular Degeneration; Color Blindness
From the FULL TEXT Article:
A patient seeking care for musculoskeletal symptoms following trauma is common in
chiropractic practice. Patients may concomitantly have other health problems identified
during the history and physical examination. The chiropractor’s treatment is typically
intended to reestablish joint function and reduce inflammation. On occasion, symptoms
and conditions other than musculoskeletal may respond to chiropractic care.
Macular degeneration has a number of causes: age, genetics, mutation, Drusen bodies,
hypertension, cholesterol, oxidative stress, race, and exposure to sunlight, vitamin D
deficiency, and smoking. Symptoms include visual distortion, blind spots, photostress,
photophobia, better night vision, peripheral vision sensitivity, and color vision loss. 
Macular degeneration also causes color vision loss and is not directly associated with
age and is not well understood.  It rarely causes total blindness.  The macula
covers about 2% of the retina, and the receptors most concentrated in the macula are
the cones, which are color receptors. The visual loss seen with macular degeneration is
better described as a loss of contrast sensitivity, with the contour of objects, shadows
and color vision being diminished.  Drusen bodies are similar to plaques and can
deprive the photoreceptors of the retina of blood and oxygen. This can explain the
progressive loss of vision; however; clinically it’s common to see Drusen bodies in
patients with normal visual acuity. Therefore, there must be another factor that accounts
for loss of vision with macular degeneration.
Thermography is a method for recording the temperature of the skin. This can be
visualized using non-contact high resolution infrared thermography. Interpretation of a
thermogram, according to the American Chiropractic College of Thermology, is based
on relative symmetry between like points on the body and based on the research by
Uematsu. [5, 6] There is normally less than .4°C difference between sides in a normal
individual. The forehead has less than 0.2°C difference between right and left side. 
The skin area is for heat transfer. The loss of heat through the skin is in the form of
infrared radiation and can be documented with thermography. The vascularity of the
skin is controlled by the autonomic nervous system. When there is a sympathetic nerve
fiber injury which is part of the autonomic nervous system due to compression as in
tumors or disc herniation, or in irritation as in local autoimmune response from trauma,
there will be asymmetry of skin temperature noted on the thermogram. 
Compression/irritation at the nerve root will appear on the thermogram in a very specific
thermal pattern noted as thermatomes, which closely resemble dermatomes.  Spinal
nerve roots do not contain postganglionic sympathetic fibers and are joined by
postganglionic sympathetic nerve fibers outside the canal. Changes in the thermal
emission are caused from irritation of corresponding sensory nerves which result in an
increase in sympathetic outflow resulting in a vasoconstriction of the supplied area. 
A study utilizing stimulation of the chest produced pupillary dilation concluded that
sympathetic activity rather than parasympathetic inhibition was responsible. 
A 66-year-old female sought care for musculoskeletal symptoms and concomitantly had
loss of color vision in her left eye. She had a history of multiple injuries. Several of her
injuries were a result of falling off horses, leading to moderate to severe sprains/strains,
grade 2, in the thoracic spine. She also suffered multiple concussions in some of her
falls. She commented that the loss of color vision of the left eye was worsening. She
also had a history of TIAs.
Examination revealed a coherent, alert, 6 ‘2”, 160-pound female. Vital signs were
normal. Review of systems revealed dry skin, headaches, corrective lenses, macular
degeneration with color blindness, TIAs, hiatal hernia, and depression. Cranial nerve
exam revealed macular degeneration and color vision loss in the left eye. Her visual
acuity was 20/25 in the right eye and 20/80 in the left eye. She also had episodes of
nausea and dizziness. The vertebral basilar artery insufficiency exam was negative.
Shoulder depressor, Kemp’s test. Schepelmann’s test, and bilateral leg raising and
lowering tests all produced mid-thoracic pain. The Soto-Hall test produced mild cervical
tenderness. Chiropractic exam using static and motion palpation, instrumentation and
leg checks revealed subluxations at C2, C6, T1, T6, and L5. The remainder of the
examination was negative.
She was referred to a neurologist. A visual evoked-response test revealed dysfunction
in her left optic nerve. Brain MRI revealed microangiopathic ischemic vascular disease
(accounting for her TIA’s). A fluorescein angiogram revealed abnormalities in her left
eye. Several months into treatment, a repeat fluorescein angiogram was performed and
it was noted that her left eye had shown improvement in its vascularity and visual acuity.
Management and Outcomes
She had 17 treatments over 8 months. Treatment consisted of chiropractic manipulation
to the cervical, thoracic and lumbar region based on location of subluxations
(intersegmental joint dysfunction). We adjusted the subluxations located at C2, C6, T1,
T6, and L5. During the first few adjustments she experienced seeing a brilliant flash of
green light in her left eye during a thoracic adjustment. Following the adjustment, she
noticed that her color vision returned to normal. She indicated that she could see color
through her left eye as well as her right eye.
Two facial thermograms were performed according to the protocol of the American
Board of Clinical Thermology.  Five standard views were taken, consisting of frontal
view, right side view, left side view, right oblique view, left oblique view, focusing
particular attention to the temperature in the supraorbital region.  Following
equilibration, the first thermography examination was performed prior to any adjustment
procedures. She was then adjusted. Following a second equilibration, the second
thermography examination was performed. Table 1 shows the results of the
Ten standard photographs were taken of the patient’s face during the thermography
procedure to monitor for any possible ptosis, cormiosis, or enophthalmos. No
abnormalities were noted on the photographs throughout the entire procedure,
indicating no signs of Horner’s syndrome.
The patient’s history, physical exam findings confirmed macular degeneration of the left
eye. These findings were confirmed with a visual evoked-response test, internal
ophthalmoscopic exam, and a fluorescein angiogram and explained why she had been
experiencing left eye visual deficits.
This case raises questions related to the underlying etiology of her macular
degeneration. There are multiple causes for macular degeneration. The question arises,
why, with chiropractic treatment and the removal of subluxations (intersegmental joint
dysfunction), was there a change in her left eye symptomatology and what was the
mechanism? The mechanism of the disease caused from Drusen bodies is primarily a
hypoxia response of the retina and macular region. 
It is possible that there was a decrease in blood flow to the retina with this patient. To
determine if this was a possibility, a thermographic study of the face could be performed
and would reveal the measurement of skin temperature and provide information about
alterations in local flow. [6, 8] The primary arteries involved would be the supraorbital
and supratrochlear arteries, which arise from the internal carotid artery via the
ophthalmic artery supplying the frontal region of the face.  These arteries supplying
the frontal area of the face are the terminal ends of the internal carotid artery. Just
proximal to the supraorbital artery is the ophthalmic artery supplying blood to the retina.
Therefore, monitoring the blood supply on the frontal region of the face would confirm if
there was a deficit of blood supply to the ophthalmic artery and reveal a decrease in
blood supply to the retina and indicate a state of hypoxia to the retina. [9, 12]
Macular degeneration of the left eye with deficits of thermal emission noted in the
supraorbital region would give indication of decreased blood supply through the
ophthalmic artery to the retina. The result would be a decrease in macular function and
a loss of color vision. [1, 2, 6, 8, 9]
Following treatment, increased vascular flow noted on
the thermogram would indicate that subluxation could cause the hypoxia to the retina.
The decreased blood flow arises from different mechanisms than in peripheral nerve
injuries. Spinal nerve roots do not contain postganglionic sympathetic fibers in the spinal
canal and IVF region. The spinal nerve is joined by postganglionic sympathetic nerves
outside the canal some distance from the compression/irritation at the IVF region
secondary to subluxation. This compression/irritation causes an increase of the sensory
nerves, (nociceptive pain C fibers) signal. The sensory nerve synapses in the cord and
stimulates the preganglionic sympathetic nerve.
The preganglionic sympathetic nerve
travels to the sympathetic ganglion and synapses with the postganglionic sympathetic
nerve. The postganglionic sympathetic nerve then exits the sympathetic ganglion and
radiates into the periphery and innervates the peripheral vascularity causing
vasoconstriction.  This neural activity will result in a temperature change noticeable
on a thermogram and will show a cold area in the area of the nerve root distribution. 
Thermogram studies revealed an increase in frontal temperature indicating a
favorable response to chiropractic manipulative therapy and the removal of the
subluxations. This occurs by reducing irritation to the sensory nerve and decreasing the
postganglionic outflow. This re-established normal blood supply to the retina, allowing
proper function of the cones of the macula region and improving the patient’s color
vision. Further investigation is warranted.
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