Neuro-Optometric Assessment

A Neuro-Optometric Assessment is best performed by an optometrist who has been residency-trained in neuro-optometry. Dr. Johnson is the only optometrist in Idaho with this advanced training in neuro-optometry

The types of patients that should have a neuro-optometric assessment include those with a history of: traumatic brain injury, concussion, stroke, chronic inflammation within the brain, neuropathy secondary to systemic disease (such as diabetes), tumor or other space occupying lesion within the brain, multiple sclerosis, Parkinson's, and other conditions that can progress to affect the nervous system.

Neuro-Optometric Assessment

During your Neuro-Optometric Assessment, Dr. Johnson will evaluate every aspect of vision that can be affected by damage to the central nervous system, which include:

  • Visual acuity (Clarity of vision): There are several causes of decreased vision following a neurological event (such as acquired brain injury). It is important to determine the cause of the decreased vision as it will allow the doctor to discuss prognosis and potential for improvement.
  • Refractive error (Prescription): Sometimes the decrease in vision is due to the need for an updated prescription. When designing a prescription following a neurological event, our doctor will be able to address both the clarity of your vision as well as your binocular vision abilities (binocular vision dysfunction can result in double vision, headaches, eyestrain, and fatigue).​
  • Visual field loss: The area of the brain that has been affected as well as the extent of the damage will determine the pattern of your visual field loss. Depending on where the damage has occurred, you may experience difficulties to the left, right, both sides, the upper, or the lower portion of your visual field.
  • Photophobia (Light sensitivity): Individuals who have experienced acquired brain injury often complain of light sensitivity, even when indoors. Choosing the proper tinted lens is one of the first steps towards finding relief.
  • Reading difficulties: There are several causes of reading difficulties following an acquired brain injury. Some of these challenges are visual in nature, others visual-perceptual, and others are language based. If your goal is to begin reading again, it is important to address the visual causes of your struggles. Many of the visual causes of reading difficulties following acquired brain injury can be successfully treated with specific glasses or vision therapy.
  • Diplopia (Double vision): Double vision can indicate an undiagnosed neurological condition or may result from a known neurological event. In either case, the cause of the double vision needs to be identified. After identifying the cause of the double vision, our doctors will be able to discuss which of the multiple treatment options are best for you.
  • Cranial nerve palsies: There are 6 cranial nerves (3 for each eye) that are responsible for controlling the 12 extraocular eye muscles (6 per eye). These nerves and muscles are responsible for controlling where your eyes “look”. Damage to even one nerve or muscle will result in an uncoordinated control of eye position and as a result you may see double.
  • Nystagmus (Jerky eye movements): There are multiple causes of nystagmus, some of which are considered normal (or physiologic) while others are the result of underlying neurological pathology. The clinical presentation of nystagmus will allow our doctors to determine the underlying cause and make appropriate recommendations for both minimizing the nystagmus as well as managing your overall health.
  • Ptosis (Drooping eyelids): A sudden onset of a drooping lid can be a sign of a more significant underlying condition. Prior to your visit with our doctor it is helpful to gather old photographs to establish a time-line of when the ptosis started.
  • Dry eye: Dry eye following a neurological event can result in several symptoms, which include: reduced vision, fluctuating vision, eye irritation, gritty or sandy feeling, burning, or watering eyes.
  • Accommodative dysfunction (Eye focusing): Accommodative dysfunction will result in blurry vision, primary when performing tasks at near. 
  • Convergence palsy (Inability to comfortably use eyes at near): Convergence palsy can result in double vision during near activities, headaches, eyestrain, fatigue, and dizziness. Fortunately, convergence palsy is a condition that can be successfully managed by a doctor with the knowledge of binocular vision and neuro-optometry.
  • Eye movement disorders: There are several eye movement disorders associated with acquired brain injury. Literature has shown the reduced ability to track objects as one of the many results of an acquired brain injury. It has also shown the these eye movement disorders respond positively to vision therapy.
  • Visual perceptual deficits & agnosia: Neurological events not only affect the eyes, but also the connection between the eyes and the brain as well as the areas of the brain responsible for producing and interpreting vision. When these areas of the brain are damaged, it will alter the way in which you perceive your visual world. Fortunately, recent research in the area of neuroplasticity has shown that new connections can be formed within the brain to regain abilities that were once thought to be lost permanently.