Treatment of vestibular disorders with weak asymmetric base-in prisms: An hypothesis with a focus on Ménière's disease

• Published in: Journal of vestibular research Vol. 27; no. 5-6; pp. 251 - 263
• Main Authors: Bos, Jelte E, Lubeck, Astrid J A, Vente, P Eric M
• Format: Journal Article
• Language: English
• Published: Netherlands IOS Press 2018
• Subjects: Adult; Eyeglasses; Female; Humans; Male; Meniere Disease - diagnosis; Meniere Disease - physiopathology; Meniere Disease - therapy; Middle Aged; Reflex, Vestibulo-Ocular - physiology; Rotation; Vestibular Diseases - diagnosis; Vestibular Diseases - physiopathology; Vestibular Diseases - therapy; Vestibule, Labyrinth - physiology; Visual Fields - physiology; treatment; after-image; prisms; oculogyral illusion; star-walk; Ménière’s disease; efference; re-afference
• ISSN: 0957-4271; 1878-6464
• DOI: 10.3233/VES-170630

Regular treatments of Ménière's disease (MD) vary largely, and no single satisfactory treatment exists. A complementary treatment popular among Dutch and Belgian patients involves eyeglasses with weak asymmetric base-in prisms, with a perceived high success rate. An explanatory mechanism is, however, lacking. To speculate on a working mechanism explaining an effectiveness of weak asymmetric base-in prims in MD, based on available knowledge. After describing the way these prisms are prescribed using a walking test and its effect reported on, we give an explanation of its underlying mechanism, based on the literature. The presumed effect can be explained by considering the typical star-like walking pattern in MD, induced by a drifting after-image comparable to the oculogyral illusion. Weak asymmetric base-in prisms can furthermore eliminate the conflict between a net vestibular angular velocity bias in the efferent signal controlling the VOR, and a net re-afferent ocular signal. The positive findings with these glasses reported on, the fact that the treatment itself is simple, low-cost, and socially acceptable, and the fact that an explanation is at hand, speak in favour of elaborating further on this treatment.