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Neuro-Optometric Evaluation​

  • ​Every patient is different.  A neuro-optometric examination evaluates the aspects of vision from the eye to the brain that can be affected by damage to the central and peripheral nervous system.  This exam is not limited to patients with concussion or traumatic brain injury, and can be necessary for patients with visual complaints due to other neurological disease including Parkinson's disease, cranial neuropathy, multiple sclerosis, myasthenia gravis, stroke, posterior cortical atrophy, cortical visual impairment, and more.

  • The diagnostic tests may include and/or evaluate

    • How well you see

      • Visual acuity (clarity) - Many patients have reduced or missing pieces of their vision after a head injury and/or stroke while others have 20/20 visual acuity but still feel that their vision is "off" or blurry.  Some common visual acuity complaints we see in our practice include intermittent blur/fluctuating vision, blurry vision with head movement, blurry vision with eye movement, difficulty with blur after a prolonged amount of time or with specific visual tasks, halo of peripheral blur around objects, or blur due to oscillopsia (image movement due to nystagmus).  A neuro-optometric evaluation takes a thorough evaluation to find the functional cause of your complaint so the doctor can discuss prognosis and management options.

      • Contrast sensitivity - contrast sensitivity is the ability to see subtle shades of gray.  Many patients with visual field loss or ocular health disease like glaucoma and/or cataracts have difficulties with contrast sensitivity, making it difficult for them to read low contrast objects like the newspaper, or trip on low contrast concrete stairs.  Contrast sensitivity diagnostic testing and tint assessment can substantially improve a patient's visual quality of life.

      • Peripheral vision/Visual field loss- the pattern and amount of visual field lost is determined by the location and extent of damage that occurs to the brain.  Understanding how much vision is lost and how to compensate for this loss is crucial to returning to your visual life.

      • Light sensitivity/pupil reaction - Many patients who have suffered from a brain injury complain of light sensitivity.  Light sensitivity can be debilitating as it can impede on one's ability to interact in social conditions, go outside, and go to stores that have certain triggering lighting.  Light sensitivity can be caused by numerous things including the eyes, the brain, the ears, and even the neck! By thoroughly evaluating the cause of the light sensitivity, the doctor can help you remediate it and/or adapt to it with tinted lenses to allow you to pursue living in such a brightly lit world!

      • Refractive prescription - Having single, clear, and comfortable vision is our primary goal.  We are happy to refract you if we think it is necessary to improve your vision.  The majority of our patients have already seen their primary care optometrist and/or ophthalmologist who have performed an excellent refraction for you already - but the refraction was not the cause of the visual complaint.  Thus, you got new glasses and contacts but your visual complaints remain.  In these cases we are happy to co-manage your prescription with your primary care eye doctor(s) to get you the right prescription for you.  Often times it is the lens modality - progressive, bifocal, contact lenses - that can be the cause of many patient complaints and we can discuss these options with you to make you as visually comfortable as possible, so you can make the right lens choice when you return to your primary care eye doctor.

    • How healthy the eyes are

      • We are happy to perform your ocular health exam for you during your appointment.  We are also comfortable with co-managing your ocular health care with your preferred primary eye care doctor​ (optometrist or ophthalmologist) - please call our office for further details

    • How well your eyes work together as a team

      • Eye alignment (strabismus) - in order to have single vision with both eyes open, the eyes need to both be pointed in the same direction.  Some people have an eye misalignment, known as strabismus, that causes them double vision when it gets out alignment.  For more information about our strabismus evaluations, please click here

      • Eye movements (comprehensive sensorimotor/oculomotor examination)  - it takes every single lobe of your brain to make the eyes move. Additionally, making an eye movement to the left is a different part of the brain than making an eye movement to the right, which is different from up and down, and different if the eyes move slowly or quickly!  These eye movements are screened using a variety of methods including prism dissociation methods, timed eye tracking tests, and our RightEye eye tracker.​​

    • How the eyes move while your head is moving and/or stationary (vestibular-oculomotor screening evaluation)

      • Vestibular-Ocular Reflex (VOR) - the VOR is the fastest reflex in your body.  It allows your brain to get a stable visual image while your head and/or body is moving.  We screen your vestibular-oculomotor system to see if the oculomotor component is not stabilizing, and causing headache, dizziness, nausea, and/or blur when your head or body is in motion.  Often times patients with VOR dysfunction get hyper sensitivity to sound and vision, making them over-stimulated, anxious, and disoriented in visually crowded areas like grocery stores.  By evaluating if it is the eyes or the ears causing the problem, we can help provide desensitization therapy and/or co-manage your case with a vestibular physical therapist in your area.

    • Treatment options may include prism glasses, tinted lenses, and/or vision therapy