What are common post-concussion vision symptoms?

  • Intermittent blurry vision 

  • Blurry vision with head movement

  • Double vision

  • Reading difficulties - words that move on the page, skipping words while reading, losing place while reading, inattention while reading, unable to retain information while reading, etc

  • Eye-tracking problems

  • Vision-derived dizziness, nausea, and/or headaches provoked by visual tasks like reading, scrolling on the computer, traveling in the car, watching television, reading, visual motion

  • Light sensitivity (photophobia/photosensitivity)

  • Anxiety in visually crowded areas like grocery stores or hallways

  • Eye pain/eyestrain with visual tasks

  • Fatigue/inattention with cognitive tasks

  • Atypical flashes of light or visual hallucinations (ex: visual snow or static in vision, sparkles in vision)

How common are post-concussion vision symptoms?

  •  About 80% of patients who suffer an acute concussion or mild traumatic brain injury will suffer from some type of oculomotor or vision dysfunction. 

  • Of those 80%, many will self-resolve over time, usually within 3-4 weeks of injury. 

  • It used to be thought, that with time/"rest" these vision complaints would eventually self-resolve over the course of months to years. 

  • However, recent (within the  last 5-10 years) scientific studies have shown that after 4 weeks post-injury, these visual dysfunctions are unlikely to self-resolve and about 20-30% of patients will continue to suffer with oculomotor dysfunction that will require active concussion vision rehabilitation for recovery. 

  • Additionally and optimistically, many studies show that active vision rehabilitation not only fixes the oculomotor/vision dysfunction but can actually expedite the recovery of of post-concussion symptoms.

How can a brain injury or neurological disease impact vision if the eyes are healthy?

  • Well... it's complicated

  • The ability to "see" and interact with the world around you goes beyond proper spectacle correction and eye health as it requires precise coordination of the eyes, the brain and the body.   

  • For example, in order to "see" a soccer ball move in front of you - your eyes need to perfectly focus  

that image of the ball to the back of the eye (retina), transmit that signal to the visual cortex (occipital lobe) at the back of the brain - and then the brain has to interpret WHAT that visual information is (temporal lobe), WHERE it is relative to you (parietal lobe), and then decide HOW it wants to react to that visual information (frontal lobe).

  • Since the eyes lead hand/body movements, if you decide you want to kick the soccer ball, you then need to move your eyes/head (brainstem/vestibular system) to where you want the ball to go, and engage the proper muscles of your body (brainstem, cerebellum, parietal lobe).

  • The ability to interact with what we see requires every lobe of the brain and all aspects must be working in coordination and with precision in order to see the world without headaches/dizziness/nausea/confusion. When a patient develops a neurological disease or injury, there are many places along the pathway where our ability to "see" can be altered - even though the eyeballs themselves are healthy

What are the most common post-concussion vision findings?

  •  The most common post-concussion vision problems are due to oculomotor (eye movement) dysfunction.  The brain controls seven major eye movements that can be impacted post-concussion.  These include but are not limited to:

    • Fixation - the ability to look at a target and keep it visually stable

    • Saccades - the ability to move the eyes quickly from one target to another  

    • Pursuits - the ability to slowly track an object moving in front of you

    • Accommodation - the ability for each eye to focus clearly on an object in front of you at different distances

    • Convergence - the ability to cross your eyes from distance to a near approaching target

    • Divergence - the ability to uncross your eyes from near to a distance target moving away 

    • Vestibular-ocular reflex - the ability for the eyes and head to work together to quickly move and track a moving object

  • Impairments in the aforementioned eye movements contribute to the visual and many cognitive symptoms post-concussion

How does post-concussion vision rehabilitation work?

  • With targeted evaluation and active management, concussion is a treatable injury!

  • Active rehabilitation like oculomotor vision therapy is a better treatment option for patients than prescribed rest alone, and expedites symptom recovery

  • Post-concussion vision therapy targets the problematic eye movements in a systematic pattern to both strengthen the eye movements and desensitize the brain's symptomatic response to the eye movement

  • For more information on vision therapy and neuro-optometric rehabilitation - click here.

References

  • Anzalone AJ, Blueitt D, Case T, McGuffin T, Pollard K, Garrison JC, Jones MT, Pavur R, Turner S, Oliver JM. A positive Vestibular/Ocular Motor Screening (VOMS) is associated with increased recovery time after sports-related concussion in youth and adolescent athletes. AJSM 2017;45(2)474-479

  • 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.

  • Collins M, Kontos A, Okonkwo D. et al. Statements of Agreement from the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015. Neurosurgery. Dec 2016;79(6):912-929.

  • Ellis MJ, Cordingley D, Vis S, Reimer K, Leiter J, Russell K. Vestibulo-ocular dysfunction in pediatric sports-related concussion. J Neurosurg Pediatr 2015:16:248-255

  • Goodrich GL, Flyg HM, Kirby J, Chang CY, Martinsen GL. Mechanisms of TBI and Visual Consequences in Military and Veteran Populations. Optom Vis Sci 2013: 90:105-12

  • Laukkanen H, Scheiman M, Hayes JR. Brain injury vision symptom survey (BIVSS) questionnaire. Optom Vis Sci. 2016;94(1):43-50.

  • Master CL, Scheiman M, Gallaway M, et al. Vision diagnoses are common after concussion in adolescents. Clin Pediatr (Phila). 2016;55(3):260-267.

  • Pearce KL, Sufrinko A, Lau BC, et al. Near point of convergence after a sport-related concussion: measurement reliability and relationship to neurocognitive impairment and symptoms. Amer J Sports Med. 2015.  

  • Storey EP, Master SR, Lockyer JE, et al. Near point of convergence after concussion in children. Optom Vis Sci. 94(1):96-100

For more patient-friendly information on brain injury and vision - there are excellent resources for you on the NORA website - click here

Have more questions? Feel free to email us at info@virginianeurooptometry.com 
 

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