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CONCUSSION TRAUMATIC BRAIN INJURY & HIDDEN VISUAL PROBLEMS Reprinted with permission by the Optometric Extension Program Foundation (OEPF), a non-profit organization.
Editor: Rachel Cooper, Optometrists Network

Often visual problems resulting from Concussions and other Traumatic Brain Injury are overlooked during initial treatment of the injury. Frequently these problems are hidden and neglected, lengthening and impairing rehabilitation. Vision is the most important source of sensory information. Consisting of a sophisticated complex of subsystems, the visual process involves the flow and processing of information from the eyes and body to the brain. Because there is a close relationship between vision and the brain, Traumatic Brain Injury, including Concussions and Sports-related Head Injury can disrupt the visual process, interfering with the flow and processing of information. The result is a vision problem. Symptoms indicating a vision problem are:

  • Blurred or blurry vision
  • Sensitivity to light
  • Reading problems; decreased fluency, speed and/or comprehension
  • Reading difficulties; words appear to move or change appearance
  • Headaches with reading and other visual tasks
  • Comprehension difficulty
  • Attention and concentration difficulty
  • Memory difficulty
  • Double vision
  • Aching eyes
  • Loss of visual field


Good visual skills are necessary for efficient information processing. When processing visual information is difficult, one may "try harder," straining without even knowing it because the effort is subconscious. If the visual system is inefficient, every task can seem difficult, using more energy than required. Visual skills affected by Traumatic Brain Injury include:

Eye Tracking:
the ability of the eye to move smoothly across a printed page or while following a moving object.
quickly and accurately locating and inspecting a series of stationary objects, such as words while reading.
Focus Change (Accommodation):
looking quickly from far to near and back without blur.
Depth perception:
judging relative distances of objects - how far or near they are.
Peripheral vision:
monitoring and interpreting what is happening in the surrounding field of vision
Binocularity (Two Eye Vision) and Eye Teaming:
using both eyes together as a team - smoothly, equally and accurately.
Maintaining attention:
keeping focused on a particular activity while interference, such as noise or motion, is present.
accurately picturing images in the "mind's eye," eye retaining and storing them for future recall.
Near vision acuity:
clearly, seeing, inspecting, identifying and understanding objects viewed within arm's length.
Distance acuity:
clearly seeing, inspecting, identifying and understanding objects viewed at a distance.
Vision perception:
understanding what is seen.

Very few in the health care professions, including head trauma rehabilitation centers, are adequately aware of visual problems resulting from Traumatic Brain Injury and the visual-perception consequences. Unfortunately, this creates a gap in rehabilitative services, resulting in incomplete treatment and frustration for the patient, family and treatment team.

The vision care professional can play an important role in the rehabilitation effort. Through vision therapy and the proper use of lenses, a behavioral or developmental optometrist specifically trained to work with Traumatic Brain Injury patients can help improve the flow and processing of information between the eyes and the brain.

Vision therapy can be a very practical and effective. After evaluation, examination and consultation, the optometrist determines how a person processes information after an injury and where that person's strengths and weaknesses lie. The optometrist then prescribes a treatment regimen incorporating lenses, prisms, low vision aides and specific activities designed to improve control of a person's visual system and increase vision efficiency. This in turn can help support many other activities in daily living.


Behavioral or developmental optometry is based upon the core principle that vision is a learned process and can be developed or enhanced at any age. Optometrists practicing this method have continued their education beyond the basic Doctor of Optometry (O.D.) degree. This continuing education emphasizes the use of lenses, prisms, and vision therapy to enhance a patient's visual capabilities, reduce visual stress, prevent and rehabilitate vision problems. As a member of the rehabilitative team, behavioral optometrists have extensive experience treating the vision problems stemming from Traumatic Brain Injury.

Not all optometrists practice behavioral or developmental optometry. To locate a behavioral or developmental optometrist in your area, go to Find a Doctor.

Helping Parents and Patients since 1996


To learn more, read the following articles:

Traumatic Brain Injury & Hidden Visual Problems

Brain Injury Success Stories

Conditions Treated by Neuro-Optometric Rehabilitation

Frequently Asked Questions: Eye Muscle Surgery

Loss of Visual Field Due to Brain Injury

Visual Problems Associated with Neurological Events

What is Vision Therapy?

Visual training teaches the brain to see again after stroke

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