Focus on Brain Injury Patients in Optometry

Last week, we wrote about how eye-tracking technology can help diagnose brain injury patients. That got us curious, and we found a 2013 report to Congress that estimated the number of people experiencing traumatic brain injuries every year at 1.7 million. These injuries, in addition to incidents of stroke, tumors, aneurysms and other medical problems, mean that you are likely to encounter patients with brain injuries in your optometric or ophthalmological practice.

Sometimes these patients will tell you about their brain injury, but in other cases the patients might not think the injuries are important to mention or might not be aware that their vision problems are a result of a brain trauma. We did a quick survey of the literature and came up with some signs you can look for to diagnose head injury-related vision problems.

Symptoms of Brain Injury-related Vision Problems

In addition to myopia and hyperopia, look for problems with inability to quickly and accurately locate objects, problems getting the eye to move smoothly while following a moving object, and problems with binocularity, visualization ability or vision perception.

You can also look for the following symptoms: trouble reading, light sensitivity, blurred or double vision, aching eyes and headaches, memory difficulty, or loss of visual field.

According to the American Optometric Association, you should look for signs of these symptoms even if the patient isn’t complaining about them. For example, if a patient has been bumping into things, he or she might be having trouble with attention on visual tasks. If the patient is closing or covering one eye, they might be experiencing blurriness. If they are turning their head when trying to see more clearly, it might be a case of double vision. As another example, poor posture might be a sign of dizziness.

If you see these problems, you have some decisions to make. First, note that changing a prescription right away is not usually the best solution. These problems can resolve themselves in as little as three months. In the least severe scenarios, simply educating patients about the problem might be enough. Advise them to keep an eye on symptoms. On the other end of the spectrum, you might see problems such as pupils of different sizes that point to a need for immediate treatment. In such cases, send the patient for emergency medical help.

Vision Therapy as a Solution

In other situations, you should refer the patient to a behavioral optometrist for vision therapy, or coordinate your efforts with the patients existing rehabilitation team. Vision therapy using a series of lenses, prisms and low vision aids can help rehabilitate those with TBI-related vision problems. These tools include partial occlusion on glasses, fesnel prisms, binasal occlusion to reduce amount of incoming information, and more.

You can read studies about optometry and acquired brain injury here. We would also like to hear from you, the people on the front lines of optometry: Have you seen brain injury patients in your practice, and how have you treated them? Were the symptoms easy to diagnose? If you have experience, what do you recommend for other optometric professionals when it comes to dealing with acquired brain injury? If you haven’t encountered this, what questions do you have? Let us know in the comments below and we’ll follow up with another blog post.