Traumatic Brain Injury

In the case of a traumatic brain injury, the most difficult symptoms to deal with usually involve double vision, peripheral vision loss and balance disorders.

The fastest growing segment of the population benefiting from neuro-vision rehabilitative therapy are patients who have experienced a traumatic brain injury. Insults to the brain can occur in many different ways. Common causes include car accidents (closed head injury, whiplash), concussions (mild to severe), stroke, and aneurysm. Due to the extensive visual pathways located within the brain, any type of adverse neurological event, whether mild or severe, will likely have an impact on the visual system. Brain injury can result in an altered state of consciousness and may lead to impairment of cognitive abilities, sensory processing, or physical function.

Vision problems are often overlooked during the initial stages of treatment for traumatic brain injuries. Oftentimes the problems are initially hidden, which further delays treatment. Many brain injury patients are left with double vision, binocular vision difficulties, and severe accommodative (focusing) problems. This can lead to an inability to read, drive a car, or return to work.

Initially, physicians and therapists often choose to patch one eye in order to eliminate adverse symptoms. This strategy not only delays proper treatment, but also decreases a person’s peripheral vision, which further hinders their mobility, often while they are already experiencing mobility challenges. The sooner vision care is sought following a brain injury, the greater the degree of recovery is possible.

Visual Symptoms Associated with Brain Injury

• Blurred vision
• Light sensitivity
• Reading difficulties — words appear to move on the page
• Comprehension difficulty
• Attention and concentration difficulty
• Memory challenges
• Double vision
• Eye pain and discomfort
• Headaches associated with visual tasks
• Loss of peripheral vision
• Vision/balance disorders

Peripheral vision loss, or visual field loss, refers to a portion of our visual world which has been removed — essentially a large blind spot. The position and magnitude of this blind spot places the person at increased risk of further injury and harm from bumping into objects as well as being struck by undetected approaching objects.

Various treatments are available to help people deal with visual field loss. Treatment may involve scanning and tracking exercises in the area of loss as well as the use of prisms and special glasses to help with orientation and mobility concerns. Remediation requires effort, time, and patience from everyone involved with the situation.

Double vision is a serious and intolerable condition that can be caused by strabismus (misalignment of the eyes), ophthalmoplegia (paralysis of a specific eye muscle limiting eye movements), gaze palsy (inability to gaze into certain directions), and decompensated binocular skills in patients with brain injury, stroke, and other neurologically compromising conditions. Prisms, lenses, and/or vision therapy can often help the patient achieve fusion (alignment of the eyes) and alleviate double vision.

Visual Balance Disorders

Visual balance disorders can be caused by a Visual Midline Shift Syndrome (VMSS), eye movement disorders, nystagmus (involuntary oscillation of the eyes), and disruptions of central and peripheral visual processing. Treatment will depend on the visual diagnosis and etiology. Lenses, prisms, and visual rehabilitation activities are used in the remediation of these disorders.