Traumatic brain injury and concussions

What Is a Traumatic Brain Injury?

Traumatic brain injury (TBI) occurs when a sudden injury damages your brain. There are two types of TBI: a closed head injury that doesn’t break through the skull (yet may still cause brain damage), and a penetrating head injury, which causes the skull to break.

Approximately 47% of traumatic brain injuries are caused by falls, particularly among young children and those over 65 years of age. Other TBI injuries can result from blunt force trauma (15%), car accidents (14%), and violent physical assaults (9%).

The symptoms experienced following a TBI include headaches, confusion, dizziness, convulsions, poor concentration, memory issues, and personality changes. Because more areas of the brain are used to process vision than any other system, traumatic brain injuries can often result in vision problems.

In order to recover from a TBI, one needs to undergo rehabilitation, which can come in many forms — depending on your specific case and requirements. It may include physical, occupational, and speech therapy, as well as neurological, and psychiatric care. Neuro-optometric rehabilitation, however, is one of the most effective ways to resolve a range of traumatic brain injury vision problems.

Common Vision Problems & Symptoms Following a Brain Injury

Visual problems are often overlooked during initial treatment of a brain injury and in some cases; symptoms may not be present until sometime following the injury. If you notice any changes in your vision following a concussion or some other head trauma, don’t ignore them: Immediately contact your eye care professional. It is important to determine the cause of the vision change. Early diagnosis leads to appropriate treatment and/or referral to a specialist, such as a Neuro-Optometric Rehabilitation Optometrist.

Left untreated, visual system disorders can have serious consequences, such as the ability to organize and make sense of visual information along with poor depth perception and difficulties concerning balance and posture.

Following are some common vision problems that may occur following brain injury or other medical conditions such as a stroke:

Eye focusing – Blurred vision or ability to shift focus between objects between near and far distances may be compromised.
Eye teaming - Your eyes may not work together properly as a team even to the point of experiencing double vision.
Eye movements – You may experience difficulty with eye movements when reading or trying to follow a moving object (like a ball being thrown). Losing your place while reading is a common complaint.
Motion sensitivity – The integration between the vision and balance system can be disrupted, making it difficult to process motion properly. Symptoms can include discomfort and even dizziness when scrolling on a computer screen or phone, or when in busy environments such as grocery stores, social settings, or sporting events.

Symptoms may vary among individuals, but some typical symptoms include:

Visual Field Loss – Partial or complete vision loss can also occur after a head trauma. The area of the brain that has been affected as well as the extent of the damage will determine your field of view. This may cause such problems as bumping into objects, being struck by approaching objects, or sudden falls.
Eye Pain and Headaches – Whether it is a stabbing pain, dull ache around the eye, or even redness, burning or itching, you may experience eye discomfort following head trauma. Headaches can be long-lasting, even past one year from injury. These symptoms can make it hard for you to carry out daily activities or can cause you to have more difficulty thinking and remembering things.
Sensitivity to Light - Brain injury is often accompanied by increased light sensitivity and general inability to tolerate glare. Photophobia, or sensitivity to light, can be exacerbated by specific light sources, such as bright sunlight and fluorescent lighting. Recent studies have also suggested that LCD screens (such as from computers or smartphone devices) can be particularly bothersome after a concussion.

Unfortunately, TBI-related vision problems may often be overlooked during the initial brain injury treatment as visual disruptions may not be present until some time has passed following the accident.

Following a TBI, there is often an interruption in communication between the eyes and the brain.

Studies show that 90 percent of TBI patients suffer from visual dysfunctions such as, but not limited to, blurred vision, sensitivity to light, reading difficulty, headaches with visual tasks, reduction or loss of visual field, and difficulties with eye movements. Visual function is often overlooked in diagnosing brain injury symptoms, particularly during initial treatment of the injury. Vision problems that are left untreated can have serious consequences.

Reference: Ciuffreda KJ, Kapoor N, Rutner D, Suchoff IB, Han ME, Craig S. Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry 2007;78(4):155-61.

Post Concussion / TBI vision assessment

Individuals of all ages who have experienced some sort of neurological insult or injury and who are experiencing visual symptoms can benefit from a

A Post-Concussion / Traumatic Brain Injury vision assessment evaluates many functions of the visual system, including:

How the eyes work together
Whether the eyes are working hard to focus and aim together
Eye scanning and tracking ability
How the person processes their environment and moves through it
The integration between vision and other systems such as balance, auditory, and the body’s sense of position in space
Complex visual perceptual ability (how a person organizes and interprets the information that is seen and gives it meaning and visual memory (the ability to remember something seen in the past)
Information provided during a standard eye exam such as visual acuity, refraction, eye health evaluation, and peripheral vision testing are looked at as well.

Following the examination,Dr. Neufeld will work with the patient to develop a treatment plan that is specially designed to improve or eliminate a patient’s specific symptoms and difficulties. Treatment may include specialized glasses to help with visual processing, and/or a Vision Rehabilitation (Vision Therapy) program that incorporates both in-office and out-of-office procedures for the remediation and management of your visual problems with the goal to improve activities of daily visual living and performance.

Children who have suffered a concussion

Though the symptoms of TBI in children resemble those experienced by adults, the functional impact can be very different. Because the brain of a child is in development, a brain injury can result in cognitive impairments. Though not always apparent following the injury, it may manifest itself as the child gets older. Your child may face physical, cognitive, and emotional challenges which can result in struggles for children, their families, schools, and communities.

Even a mild TBI, such as a mild concussion, can interfere with the healthy functioning of the brain’s visual pathways, causing a disruption in the way the brain and eyes communicate and a host of visual dysfunctions. One does not have to lose consciousness or "see stars" to have had a concussion. Concussions from sports such as hockey, volleyball, basketball and football are quite common although many are undiagnosed and the child and may return to play much sooner than he/she should. Multiple concussions within shorter periods of time can cause longer lasting effects.

In fact, studies show that 90% of TBI patients experience some form of vision disruption, which may result in long-term, life-altering consequences, such as blurred vision, visual field loss, reading problems, among others. They may also cause the person to be identified as dyslexic or having attention deficit disorder (ADD), and may present as spatial dysfunctions affecting posture and balance.

Therefore, once the child is stabilized following a brain injury, the patient should receive physical therapy, occupational therapy, speech therapy, optometric and neuropsychological testing. Rehabilitation will teach the child how to compensate for impaired or lost functions and will provide strategies on ways to optimize the use of these abilities as they return.

How Does a Concussion / TBI Affect Vision?

Since more areas of the brain are used to process vision than any other system, traumatic brain injuries often cause visual problems. Such injuries can disrupt the communication between the brain and the visual system and interfere with the processing of visual information, leading to blurred vision, reading difficulties, sensitivity to light, and double vision, among other symptoms.

Visual problems tend to be overlooked during the initial treatment of brain injury, especially with mild TBIs such as a concussion or whiplash.

Furthermore, a regular eye exam often fails to reveal the extent to which the visual process has been affected since the vision complications that develop are not related to visual acuity (20/20), but rather to eye teaming, focusing, and tracking.

If you are experiencing post-concussion visual symptoms, there is always the risk that they will worsen over time. Some patients notice visual problems only while experiencing an additional stressor such as illness, family or work stress, or when there is a disruption to normal routines.

What Treatment Can a Neuro-Optometrist Provide?

If you’ve sustained a TBI or a concussion, Dr. Neufeld offers Neuro-Optometric Vision Rehabilitation, an individualized treatment regimen to rehabilitate the connection between the brain and the eyes and the visual system. This therapy can minimize or even eliminate TBI-related visual symptoms weeks, months, or even years after the injury.

Schedule Your Evaluation

Call Calgary Vision Therapy to schedule your Post-Concussion / TBI evaluation.