Saturday, March 3, 2018

Vision rehabilitation after concussion and other brain injuries


We were looking back at our research archive on the optometric treatment of concussion patients. A few important studies from a few years back deserve mention. One study noted that people with traumatic brain injury often have a constellation of eye movement (sometimes called oculomotor) deficits. The study noted that over 90% of patients with mild traumatic brain injury (sometimes abbreviated TBI and sometimes called acquired brain injury) were found to have one or more oculomotor dysfunctions.

The vision rehabilitation therapy that we provide in our vision therapy clinic, sometimes called oculomotor rehabilitation or oculomotor training, is effective in providing significant improvement in eye motor disorders that result from traumatic brain injuries ranging from concussions, severe head injuries and strokes.

Disorders of convergence and divergence

A study entitled "Effect of oculomotor rehabilitation on vergence responsivity in mild 
traumatic brain injury", published in 2013 in the Journal of Rehabilitation Research & Development examined a group of patients before and after they received oculomotor training and placebo therapy to determine whether there was improvement in their convergence and divergence ability. Convergence refers to the way the eyes move inward or converge when doing near work. Divergence refers to the ability of the eyes to move outward or diverge when focusing on objects that are moving away from the body.

The researchers found that convergence and divergence abilities improved significantly following oculomotor training, as did depth perception and visual attention. No improvement resulted from placebo therapy, suggesting that the the rehabilitation therapy was effective and that no improvement is expected in the absence of therapy.

The authors concluded that there was "overall improvement in nearly all of the critical, abnormal measures of vergence was observed both objectively and clinically. Improved vergence motor control was attributed to residual neural visual system plasticity and oculomotor learning effects in these individuals."

Disorders of accommodation


A 2014 study entitled "Effect of oculomotor rehabilitation on accommodative responsivity in mild traumatic brain injury" and also published in the Journal of Rehabilitation Research & Development looked at the effect of vision therapy rehabilitation for a group of oculomotor dysfunctions known as "accommodation". Accommodation refers to the ability of the eyes, through a complex neurological process, to change optical power to maintain a clear image or focus on an object as its distance from the eyes varies.

The researchers looked at 12 patients with mild traumatic brain injury who had vision related symptoms and gave them a program of rehabilitative oculomotor training (lasting six weeks with two three hour sessions per week) as well as placebo therapy. The researchers found that the rehabilitation program produced significant improvement in the patients' accommodation abilities. No improvement was found following placebo therapy. The authors conclude that "[t]hese results provide evidence for a significant positive effect of the accommodatively based OMT on accommodative responsivity. Such improvement is suggestive of oculomotor learning, demonstrating considerable residual brain-visual system plasticity in the adult compromised brain."

The statistic in the graphic that accompanies this post comes from a 2008 study by Ciuffreda et al. published in the journal Optometry which found that  90% of patients with traumatic brain injury who were treated with vision therapy had significant improvement in their eye movement disorders.

Thursday, March 1, 2018

Optometry's big impact on the treatment of concussion patients

Reading a recent journal article by Dr. Neera Kapoor of the New York University School of Medicine, we were struck by her description of the explosion of research into the treatment of the visual symptoms following concussions by developmental optometrists using vision therapy and rehabilitation. There have been so many studies demonstrating the effectiveness of these approaches and clinics like our's across North America are making a big difference in the lives of concussion patients. Here is a passage form Dr. Kapoor's article:

Over the past decade, ... an increased amount of clinical research demonstrating the efficacy of optometric intervention in the concussion/mTBI population has been and continues to be performed nationwide. Dissemination of optometric knowledge and skills in the literature has awakened an exponentially increasing awareness, interest, and demand from patients and health care providers for neuro-optometric intervention following concussion/mTBI. Further, given the potential for multiple functional deficits following concussion/mTBI, understanding how to collaborate within a larger, diverse team of neuro-rehabilitation professionals becomes important as optometry begins to participate more actively in the inter-professional management of concussion.
Dr. Kapoor cited only a small number of the dozens of studies that have been conducted. Here is a sampling for the research minded:


  1.  Ciuffreda KJ, Rutner D, Kapoor N, et al. Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry 2008; 79:18-22. 
  2.  Storey EP, Master SR, Lockyer JE, Podolak OE, Grady MF, and Master CL. Near point of convergence after concussion in children. Optometry and Vision Science 2017; 94 (1): 96-100. 
  3. Gallaway M, Scheiman M, and Mitchell GL. Vision therapy for post-concussion vision disorders. Optometry and Vision Science 2017; 94 (1): 68-73. 
  4.  Cohen AH. Vision rehabilitation for visual-vestibular dysfunction: The role of the neuro-optometrist. NeuroRehabilitation 2013; 32: 483–492. 
  5. Thiagarajan P, Ciuffreda KJ, CapoAponte JE, Ludlam DP, Kapoor N. Oculomotor neurorehabilitation for reading in mild traumatic brain injury (mTBI): An integrative approach. NeuroRehabilitation 2014; 34:129-146. 
  6.  Thiagarajan P, Ciuffreda KJ. Effect of oculomotor rehabilitation on accommodative responsivity in mild traumatic brain injury. J Rehabil Res Dev 2014; 51(2):175- 192. 
  7. Thiagarajan P, Ciuffreda KJ. Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury. J Rehabil Res Dev 2013; 50(9):1223-1240. 
  8. .Thiagarajan P, Ciuffreda KJ. Versional eye tracking in mild traumatic brain injury (mTBI): effects of oculomotor training (OMT). Brain Injury 2014; 28(7): 930–943. 
  9.  Scheiman MM, Talasan H, Mitchell GL, Alvarez TL. Objective assessment of vergence after treatment of concussion-related CI: a pilot study. Optometry and Vision Science 2017; 94(1): 74-88. 
  10.  Ciuffreda KJ, Ludlam DP, Thiagarajan P, et al. Proposed objective visual system biomarkers for m 

Tuesday, March 21, 2017

Optometric Management of a Post-Concussion Patient: A Case Report

A case report on the optometric vision therapy treatment of the visual symptoms of a concussion patient was published in the December 2016 issue of the journal, Vision Development & Rehabilitation. We treat many concussion patients in our vision therapy and rehabilitation practice in Vancouver and the results of this case report are consistent with the results that we see in our clinic.

Concussions are a mild injury to the brain which have been known to cause visual problems such as blur, double vision, reading problems, sensitivity to light, visual memory problems and other visual deficits like reductions in contrast perception. It is estimated that 15% of concussion patients experience a visual problem as a result of their concussion.

The patient that was the subject of the case report suffered several sports-related concussions that caused a variety of problems with the patient's visual system. The patient was diagnosed with with low myopic astigmatism, convergence insufficiency, fusional instability, oculomotor dysfunction, and photosensitivity. Treatment included tinted spectacle correction for full-time wear and conventional oculomotor-based vision therapy. 

When vision therapy concluded, the patient was free of symptoms. And this effect was still present at a three-year follow-up appointment. The results demonstrate the efficacy of a comprehensive optometric approach in concussion treatment. The results also demonstrate the ability of the visual system to heal when the proper therapy is used for treatment. 

Saturday, June 18, 2016

Concussion: Parents Speak Out about the Visual Link to Recovery


Will Smith’s new movie Concussion is likely to make parents think twice about having their children involved in contact sports like football and soccer. But what about kids who have already suffered a concussion and are struggling to get back to learning? Parents of these children are stepping forward to share their experiences with the hope of helping others.

“Research has shown that approximately 70% of young athletes who suffer a concussion have eye coordination, focusing, and eye movement problems1 . Yet most parents are left on their own choose a health care professional who can help their child correct these problems,” shares Dr. Kara Heying, OD, FCOVD, President of College of Optometrists in Vision Development.

Evyn of Tulsa, Oklahoma had struggled for two years after suffering a concussion at the age of 13, sustained while playing soccer. She saw twelve physicians and specialists, including her pediatrician, two ophthalmologists, a neuro-ophthalmologist, a neurologist, and a sports medicine doctor before an optometrist finally referred her to a developmental optometrist.

Read more.

Sunday, April 5, 2015

Vision Problems May Be More Common In Children With An ASD

April is autism awareness month


Here is what you need to know about autism and vision in a nutshell.

Since autism spectrum disorders (ASDs) affect how we process and respond to sensory information, it’s important to evaluate exactly what visual sensory information is going in.

Recent studies have found that refractive errors, such as near-sightedness, far-sightedness, and/or astigmatism, may be more common in those with an ASD. The same goes for strabismus (often called cross-eye) and amblyopia (lazy eye). These problems can be treated, corrected, and sometimes even prevented. Especially if we can catch them early in life.

For more information on how optometrists like us can help treat vision disorders in people with ASD, click here: http://www.visiontherapy.ca/autism.html

Watch these videos for more information: