Can Glasses After a Traumatic Brain Injury Help? The numbers of people affected each year in United States by a traumatic brain injury (TBI) is staggering – approximately two million people annually. The most common causes of a traumatic brain injury include automobile accidents, sports injuries, and falls. However, symptoms of a traumatic brain injury are experienced by patients who have a cerebrovascular accident (stroke), cerebral palsy, multiple sclerosis, and those who take prescription medications. Sadly, approximately 10 to 25 percent of traumatic brain injury patients continue to have significant post-concussive symptoms one year following the date of injury.

Let's take a look at the most common post-concussive symptoms experienced by traumatic brain injury (acquired brain injury, mild whiplash and concussion) patients:

•  Top on the list is accommodative-convergence insufficiency and is typically overlooked by most eye doctors and therapists. Patients complain of decreased or blurry vision at near distance (think reading and/or computer use). Why? Because the portion of the brainstem that controls focusing ability of the lens in the eye is injured by the trauma. It is important to note that these injuries rarely show on MRI scans so everything is considered “normal” - to everyone except the patient.
• Abnormal posture can be observed among many post-traumatic brain injury or concussion patients. Following the injury the patient will lean forward, backward, or to one side when sitting, standing or walking. They may develop abnormal head posture – often tilting the head to one side. These are all compensatory techniques in an attempt to clear or stabilize vision and eliminate symptoms.
• Double vision is also a common post-traumatic brain injury or concussion symptom. Double vision affects balance, coordination, and movement. Following a traumatic brain injury the brain does not have the time to adapt gradually to the abnormal vision changes. The vision changes occur suddenly and the patient experiences onset of double vision.
• Light sensitivity (photophobia) is also very common following an injury to the brain. Patients often times prefer to wear sunglasses, even while indoors. They can also be sensitive to glare.
• Visual-perceptual abnormalities are quite common following a traumatic brain injury or concussion. Following the injury the patient has difficulty processing visual input and difficulty with spatial organization or position in space. The patient may have difficulty mentally focusing on the task at hand (visual attention) or recalling visual information (visual memory). Patients often describe this as being in a “fog”.
• Visual image misalignment is also common among patients who have experienced a traumatic brain injury or concussion. Symptoms of visual image misalignment include anxiety, dizziness, headaches, problems with balance, and even nausea.
• Visual field loss is another common symptom of a traumatic brain injury or concussion. This can cause a patient to have “blank or black” areas of vision either up, down or out to the side (peripheral vision). Some patients are aware of the visual field loss while others are not. Visual field loss can cause the patient to bump into objects – walls, chairs, tables, etc.
• Visual neglect is a specific type of visual perceptual change and quite common following certain types of brain injuries. Patients become unaware of their left visual space. It is important to note this is NOT the same as visual field loss.

So, where do you turn for help? Following a traumatic brain injury the patient should be evaluated by an eye doctor who diagnoses and treats vision problems specific to brain injury and concussions. Residency trained neuro-optometrists and neuro-ophthalmologists are specialists with additional training in treating patients with brain-related vision problems. It is important to see a neuro-vision specialist because depending on the location and severity of the traumatic brain injury, areas of the brain involved with vision, visual processing and visual perception can be damaged – cranial nerves, optic nerve tract or other neuro pathways involved with vision.

There are a variety of vision problems that can occur at various points during recovery following a traumatic brain injury (acquired brain injury, whiplash, concussion). It is important to remember that a traumatic brain injury destabilizes the visual system. During recovery the patient can experience changes in the symptoms reported as well as fluctuating vision. This can occur over a period of months to years following the initial injury. Patients who do not treat the underlying vision conditions must rely on compensatory devices or strategies, typically achieved by working with an occupational therapist, vestibular therapist, or a physical therapist. Patients who elect this type of rehabilitation plan often find that they hit a “ceiling” with regard to recovery. That's because the visual system impacts and limits the success of occupational therapy, vestibular therapy, and physical therapy. In other words, the therapists are attempting to treat symptoms rather than address the underlying cause of the problem....an unstable visual system that requires specialty care.

Following a traumatic brain injury, an evaluation with a residency trained neuro-optometrist or neuro-ophthalmologist can identify visual system deficits. Initial treatment can include: 

• Prescription eyeglass lenses. It is not uncommon for the eye doctor to recommend one pair of glasses for distance activities and a second pair of glasses for up-close activities. This approach allows for very specific prescriptions to accommodate and support the fragile visual system during recovery. 
• Prism prescription eyeglass lenses. Prism is used to help with double vision or visual field loss. Prism should be prescribed by either a residency trained neuro-optometrist or a neuro-ophthalmologist. This is critical. Most eye doctors (either general optometrists or general ophthalmologists) have little training or experience when it comes to accurately prescribing prism. Depending on the prism prescribed, the prism prescription may be either ground into the actual eyeglass lens or a press on prism may be placed on top of the prescription eyeglass lens. Either way, the manufacturing of the prism lens or the placement of the press on prism is exacting. There is no room for error.

As an immediate course of treatment, prescription eyeglass lenses or prism prescription eyeglass lenses can help relieve symptoms and allow for greater gains and success during occupational therapy, vestibular therapy, or physical therapy.

For patients who cannot achieve long-term stabilization of the visual system with prescription eyeglass lenses or prism prescription eyeglass lenses, a treatment plan of vision rehabilitation may be prescribed. Vision rehabilitation (vision therapy) should be done under the supervision of a residency trained neuro-optometrist. Prescribing vision rehabilitation for a fragile, unstable visual system should not be left to occupational therapists, vestibular therapists, or physical therapists who lack the specialized training in the field of neuro-vision and vision abnormalities resulting from traumatic brain injury (acquired brain injury, whiplash or concussion).

Treatment and recovery following a traumatic brain injury (acquired brain injury, whiplash, concussion) requires a team of experts within their areas of specialty. It is important to keep in mind that recovery is a process (whether that be months or years) and depends on the severity of the injury and the course of treatment the patient chooses.