Overview

A traumatic brain injury (TBI) or acquired brain injury (ABI) often affects a person’s vision. An estimated 60-70% of individuals diagnosed with a concussion may result in one or more vision dysfunctions. Symptoms experienced by a TBI or ABI patient often vary in timing, complexity, severity, and situationally. Some symptoms may include:

  • Blurry vision at distance, near, or both
  • Poor eye movements and poor tracking
  • Eye pain and headaches
  • Dizziness or balance problems
  • Sensitivity to light
  • Discomfort looking at computer or digital screens
  • Sensitivity or hyper-awareness to busy visual environments
  • Binocular vision problems
    • Double vision
    • Convergence insufficiency: inability to move both eyes inward to concentrate on a specific spot or the discomfort in doing so
    • Depth perception: lack of judgement in visual space
  • Peripheral vision problems
    • Loss of side vision entirely or lack the attention of peripheral awareness

These vision symptoms or dysfunctions can impact performance in school, work productivity, play in sports, and other everyday activities that many of us do daily.

At Wallerich Eye Care, we have a traumatic brain injury residency trained optometrist, Dr. Michael Wallerich, who provides highly specialized vision and eye health assessments for patients with a history of traumatic brain injuries (TBI) or acquired brain injuries (ABI).

Take a listen to Dr. Shirley Blanc, an optometrist specializing in neuro-optometry, who offers insights on how the brain and vision interact with one another.


What are some common conditions assessed or diagnosed during an evaluation?

  • Eye movement disorders – interaction or the movement of both eyes synchronously
  • Eye teaming disorders
    • Cranial nerve palsy – inability or loss of function of one or more of a total of six eye muscles controlling the movement of our eyes
    • Decompensating phorias – misalignment of the two eyes with poor positioning with subsequent vision symptoms
    • Convergence problems – inability to move eyes inward synchronously and without vision symptoms
    • Divergence problems – inability to move eyes outward to relax eyes while open
    • Gaze palsies or deficits – inability to look a particular direction with one or both eyes
  • Eye focusing problems
    • Accommodative insufficiency – inability to focus on a particular object at a particular distance based upon age appropriate normative values
    • Accommodative excess – inability of eyes to relax the focusing system causing blurry vision at distance and near
    • Accommodative spasm – excess or overfocusing of one or both eyes causing significant discomfort pain and poor vision
  • Photosensitivity
  • Visual field deficits
  • Cerebral disorders of vision based upon hemispheres of the brain
  • Visual illusions or hallucinations
  • Perceptual colors changes
  • Spatial perceptional changes
  • Vestibular dysfunctions (affecting balance)

Treatments and management options

  • Treating the vision deficit or dysfunction through one or more of the following treatment options:
    • Lenses
    • Prisms
    • Filters
    • Occlusion
    • Compensatory strategies
    • Low-vision devices
    • Optometric vision therapy
    • Visual processing therapy
    • Cognitive rehabilitation
  • Treatment of the ocular disease or injury diagnosed in the assessment/evaluation
  • Educate and counsel the patient, family and caregivers to help understand the vision problems while also relaying tools and prognosis of the vision problems
  • Consult and relay information within the inter-disciplinary care of healthcare providers, rehabilitative professionals to advocate for the patient

Commonly Asked Questions

What is neuro-optometry?

An eye care professional who specializes in the diagnosis, treatment and rehabilitation of a neurological condition(s) adversely affecting the visual system.

What is neuro-optometric vision rehabilitation?

It is the individualized treatment regimen for a patient with visual deficits/dysfunctions as a direct result of physical disabilities, traumatic brain injuries, and other neurological insults.

What components are often part of a neuro-optometric evaluation (some or all may take place)?

  • Comprehensive eye exam and vision exam
  • Extended sensorimotor evaluation
  • Visual perceptual and cognitive evaluation
  • Higher cerebral function assessment of visual information processing
  • Low-vision evaluation
  • Specialized testing
    • Electrodiagnostic vision testing (Visual evoked potential)
    • Visual field testing
  • Baseline TBI testing
  • Visual-Vestibular and balance testing

What are some examples of a traumatic brain injury versus an acquired brain injury?

  • Traumatic brain injury
    • Concussion
    • Sports injury
    • Assault
    • Falls
    • Motor vehicle accidents
  • Acquired brain injury
    • Stroke
    • Near drowning (anoxic brain injury)
    • Aneurysm
    • Tumor
    • Infectious disease affecting the brain or parts of the brain

Does a routine eye examination rule out vision or eye deficits secondary to a traumatic brain injury?

A routine eye examination often does not elicit or diagnose many of the eye or vision dysfunctions due to a traumatic brain injury. It is important to discuss with your eye doctor the specifics of your concern or past brain injury to comprehensively assess your eye and vision health.

Where can I find additional information on traumatic brain injuries?

Who are some of the healthcare professionals and/or collaborators working within the multi-disciplinary team for concussion patients?