The likelihood that primary care optometrists will evaluate a patient with acquired or traumatic brain injury (A/TBI) history becomes more prevalent daily.
Traumatic brain injury leads to 2.5 million emergency visits annually and affects 4.4 percent of military service members.1 It is widely accepted that not all TBI cases report to the emergency room for initial treatment. A new cerebrovascular accident (CVA) or stroke occurs every 40 seconds and an estimated 7.4 million adults are stroke
survivors;2 this accounts for 3 percent of the United States population. Optometrists are in an ideal position to provide both primary care and neuro rehabilitation for A/TBI patients. As a primary care optometrist, following are five key exam findings which indicate a patient would benefit from referral to a neuro-optometrist who has expertise in
the assessment and treatment of visual disturbances associated with damage to the central nervous system.
Injury in their histories
Patients with a history of brain injury commonly experience specific visual and visual processing symptoms that persist indefinitely if untreated. Table 1 summarizes the findings from Cuiffreda et al regarding common visual symptoms.3,4 Most common visual effects of CVA are loss of central vision, loss of visual field, visual processing disorders including spatial neglect, and eye movement disorders.5 Traumatic brain injury most commonly leads to symptoms such as blurry vision, light or glare sensitivity, and double vision. A convenient way to establish the level of functional impairment due to visual consequences of brain injury is to use a symptom survey. The Brain Injury Vison Symptom Survey (BVISS) was validated for a brain injury population and pertains to both acquired and traumatic causes of brain injury. The survey can be accessed via the Neuro-Optometric Rehabilitation Association (NORA) website.6,7 A score of 31 or higher on the 28-item survey is predictive for functional impairment from brain injury. A patient with a high score on this symptom survey would benefit from additional evaluation by a neuro-optometrist.
1. Centers for Disease Control and Prevention. TBI
Data and Statistics. Available at: https://www.cdc.gov/
traumaticbraininjury/data/index.html. Accessed 1/15/120.
2. Centers for Disease Control and Prevention. Stroke.
Available at: https://www.cdc.gov/stroke/. Accessed 1/15/20.
3. Suchoff IB, Kapoor N, Ciuffreda KJ, Rutner D, Han E, Craig
S. The frequency of occurrence, types, and characteristics
of visual field defects in acquired brain injury: a retrospective
analysis. Optometry. 2008 May;79(5):259-65.
4. 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
5. Rowe F. Visual effects and rehabilitation after stroke.
Community Eye Health. 2016;29(96):75-76.
6. Neuro-Optometric Rehabilitation Asssocation. Getting
the Most out of Your Appointment. Available at: https://
7. Laukkanen H, Scheiman M, Hayes J. Brain Injury Vision
Symptom Survey (BIVSS) Questionnaire. Optom Vis Sci. 2017
8. American Optometric Association. Optometric Clinical
Practice Guideline: Care of the Patient with Learning
Related Vision Problems. Available at: https://www.aoa.org/
documents/optometrists/CPG-20.pdf. Accessed 1/15/20.
9. Maples WC, Atchley J, FIcklin T. Northeastern State
University College of Optometry’s Oculomotor Norms. J
Behavioral Optom. 1992;3(11)143-150.