TBI Awareness: The Importance of Working With a Neuro-Optometrist

Traumatic Brain Injury (TBI) is a term used within the medical community to describe an injury to the brain which is not hereditary, congenital or degenerative. Traumatic Brain Injury can be result from a blow to the head, whiplash, seizure disorders, tumors, stroke, toxic exposure, or infectious diseases to name a few. The incidence of prevalence of brain injury outnumbers breast cancer, spinal cord injury, multiple sclerosis and HIV/AIDs combined.

Because Traumatic Brain Injury (TBI) is not hereditary, congenital or degenerative – anyone can experience a TBI at sometime in their life. The statistics are staggering. It is estimated that each year 1.7 million people in the United States sustain a Traumatic Brain Injury. Of these, about 75% are concussions or other forms of Mild Traumatic Brain Injury (MTBI). Most commonly, children ages 0 to 4, adolescents 15 to 19 years of age, and adults 65+ are more likely to sustain an Traumatic Brain Injury. Some reports reveal that 30% of all Traumatic Brain Injury sustained by children occur while participating in sports and recreational activities.

Because approximately 75% of Traumatic Brain Injury cases are concussions, we are going to focus our discussion on concussions. A concussion is a mild form of Traumatic Brain Injury (mTBI) which is caused by a bump, blow or jolt to the head or body that jars, shakes or moves the brain in the skull. It is important that a concussion be properly diagnosed and treated so the brain has the opportunity to recover, and to prevent symptoms from worsening.

A concussion can change the way the brain normally functions. Following the injury, symptoms can occur immediately, within a few hours, or several days or even weeks later. Symptoms can include:

• Amnesia

• Balance or vestibular problems

• Blurred vision

• Confusion

• Concentration or memory problems

• Double vision

• Headache

• Sensitivity to light

• Slowed reaction time

Many of the symptoms associated with a concussion are related to the visual system. It is easy to understand why. Almost half of the cranial nerves affect eyesight, 4 directly and 2 indirectly. Many brain abnormalities cause vision problems. That's why it is important to seek the care of a Residency Trained Neuro-Optometrist following a Traumatic Brain Injury. Residency Trained Neuro-Optometrists complete a formal year-long training program dedicated to diagnosing and treating patients with vision problems caused by Traumatic Brain Injury. Idaho currently has one Residency Trained Neuro-Optometrist, Ryan C. Johnson OD FAAO in Boise, Idaho.

Residency Trained Neuro-Optometrists, such as Dr. Ryan C. Johnson, diagnose and treat vision problems following a Traumatic Brain Injury (TBI). These visual deficits include:

• Accommodation (eye focusing)

• Binocular vision (eye teaming)

• Ocular motility (eye tracking)

• Ocular posture

• Visual-vestibular interaction

• Visual field loss

• Visual information processing (working memory/processing speed)

Let's take a look at how these visual deficits might affect an individual following a Traumatic Brain Injury (TBI).

Symptom Deficit

• Blurred vision Accommodation/Binocular vision/Vergence

• Difficulty reading Ocular motility/Binocular vision/Vergence

• Difficulty with visually stimulating environments Vergence/Visual-vestibular interaction

• Dizziness Vergence/Visual-vestibular interaction

• Double vision Ocular posture/Vergence

• Eyestrain/fatigue Accommmodation/Vergence

• Missing, or blank, areas of vision Visual field deficits

• Reduced depth perception Ocular posture/Vergence

• Slow reading speed Visual perceptual processing/
  Binocular vision

It requires the specialized training of a Residency Trained Neuro-Optometrist such as Dr. Ryan C. Johnson who, with an in-depth understanding of neurological pathways, can properly diagnose and treat:

• The three types of Accommodative Dysfunction: accommodative insufficiency, accommodative infacility and accommodative excess.

• Ocular Motility (eye tracking): pursuits / saccades (originating in the pons portion of the brain stem, located above the medulla oblongata and below the midbrain).

• Fixation: originating in the parietal lobe and prefontal cortex (for attention)

• The two types of vergence: convergence and divergence. Convergence is turning the eyes inward when looking near. Divergence is turning the eyes outward when looking in the distance.

• Visual-information processing: 70% of sensory input to the brain is vision related. Vision information is processed (directly or indirectly) in every lobe of the brain. Visual-information processing affects visual memory, visual discrimination, visual spatial relations, figure ground, and visual closure.

• Visual-vestibular interaction: vision integrates with balance through the Vestibular Ocular Reflex (VOR). The Vestibular Ocular Reflex maintains stable, bifoveal retinal images during head and body movement. A few of the symptoms resulting from Visual-Vestibular Dysfunction include:

  • Closing or covering one eye

  • Difficulty tracking

  • Diplopia (double vision)Disequilibrium

  • Dizziness / nausea

  • Eyestrain / fatigue

  • Loss of place when reading

  • Motion sickness

  • Oscillopsia

  • Sensitivity to visual motion

  • Skipping lines or words when reading

  • Slow reading rate

  • Vertigo

A Residency Trained Neuro-Optometrist, such as Dr. Ryan C. Johnson, can accurately diagnose vision problems caused by a Traumatic Brain Injury (TBI) and prescribe an individualized treatment plan. Prescribed treatment can include:

• Separate distance and reading glasses. It is not uncommon for patients suffering from a Traumatic Brain Injury to need very different prescriptions for upclose, reading tasks versus far away, distance activities.

• Prescription lenses that include precise prism correction.

• A prescribed vision rehabilitation program of vision therapy. Vision therapy is most effective when prescribed and overseen by a Residency Trained Neuro-Optometrist.

If you, or someone you know, has suffered a Traumatic Brain Injury (TBI) we encourage you to seek the care of a Residency Trained Neuro-Optometrist. Traumatic Brain Injury results in life-changing symptoms and deficits. It is important to remember that proper diagnosis is the first step to recovery. A Residency Trained Neuro-Optometrist, such as Dr. Ryan C. Johnson, is uniquely qualified to both properly diagnose and prescribe an effective, individualized treatment plan. We're here to help, and just a phone call away.