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Managing vision conditions associated with brain injury

Concussion, head injury and stroke can cause significant difficulties for an individual’s vision. Optometrists trained to work with brain injury can play an important role in rehabilitation.

Richard Shanks specialises in the diagnosis and management of vision conditions associated with acquired brain injury including rehabilitation treatment using vision therapy.

Acquired brain injury is an all-encompassing term for damage to the brain. Concussion, head injury and stroke can cause significant difficulties for an individual’s vision, in turn compromising their ability to use their vision to read, drive, walk and work, particularly in visually “noisy” situations. Vision problems and symptoms are a common difficulty associated with acquired brain injury but are not easily addressed by those who do not have specialised understanding of vision’s role in activities of daily living.

Optometric management may include lenses, prisms or tints and vision therapy. Optometrists trained to work with acquired brain injury can play an important role in rehabilitation and are an important member of the multi-disciplinary team involved in rehabilitation.

Effects of brain injury

The brain is the most important part of the visual process. Head injury and concussion can result in degradation of visual information processing.

The nervous system that controls how the eyes work and focus together, transmitting visual information to the brain, involves the most complex systems of the brain. Vision enables us to be aware of our surroundings and to know where we are in our world, to allow us to walk through our environment, direct hand and other actions to write and hold things, and to help us stay balanced.

When the effects of brain injury result in the visual system not to work efficiently, it can significantly interfere with a person’s quality of life. Symptoms can prevent a person from returning to work, limit ability to read or use a computer, and limit the progress of other rehabilitative services involving near visual tasks.

Acquired brain injury can result from a blow to the head, stroke or neurological dysfunction. It can result in impairment of cognitive abilities, interfere with sensory processing and/or sensory-motor function. There can also be loss of physical function or emotional symptoms.

Common diagnoses include:

  • traumatic brain injury
  • mild closed head injury
  • post-concussive syndrome
  • cervical trauma syndrome
  • stroke
  • cerebral palsy
  • multiple sclerosis
  • cerebral vascular accident

Acquired brain injury that may cause visual problems can occur as a result of the following:

  • stroke
  • sporting head injuries and concussion
  • motor vehicle and bicycle accidents
  • assault
  • whiplash
  • falls

Often visual problems resulting from acquired brain injury are overlooked as life-threatening conditions are dealt with during initial treatment of the injury. As the person recovers, adaptations to their vision limitations can cause a longer or impaired rehabilitation.

Common symptoms indicating a vision problem may include:

  • blurred vision
  • double vision
  • difficulty with reading and/or reading comprehension
  • reduced ability to concentrate on sustained tasks such as reading
  • headaches and fatigue, particularly with visual tasks or bright light
  • dizziness, attention and concentration difficulties and brain fog
  • sore or aching eyes
  • sensitivity to light
  • mood changes or memory issues

Signs of eye problems can include:

  • an eye turn (strabismus)
  • closing or covering one eye
  • turning or tilting head
  • difficulty walking straight or bumping into objects
  • balance and co-ordination problems
  • poor depth judgement
  • poor eye-hand co-ordination
  • poor awareness of surroundings

Visual dysfunctions can be amenable to neuro-optometric rehabilitation.

Optometric evaluation may include assessment of eye power and focusing ability, assessment of binocular vision function, visual field (peripheral vision) assessment, assessment of effects of vision on balance, posture, movement and eye-hand co-ordination, visual information processing and comprehensive eye health assessment.

Optometric management with glasses may include task specific spectacles, incorporation of prisms or tints to reduce light sensitivity.

Vision therapy aims to improve focusing, eye movements, eye teaming and eye-hand co-ordination.

Optometric management may also include counselling and education with the patient, family and caregivers about the visual problems, goals and prognosis and management options.

The optometrist can work together with other medical professionals such as the occupational therapist, neurologist, general medical practitioner and other rehabilitative specialists and provide referrals when required.