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 -- GOOD VISION
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:
OPTOMETRY AND REHABILITATION
- 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
- 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
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
WHAT IS BEHAVIORAL OPTOMETRY OR DEVELOPMENTAL OPTOMETRY?
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
Not all optometrists practice behavioral or developmental optometry. To locate a behavioral or developmental optometrist in your area, go to Find a Doctor.