Acquired Brain Injury & Hidden Visual Problems

Acquired Brain Injury can come in many forms. Below are some common diagnoses:

  • Traumatic Brain Injury
  • Mild Acquired Brain Injury
  • Mild Closed Head Injury
  • Post Concussive Syndrome
  • Cervical Trauma Syndrome
  • Post Traumatic Vision Syndrome
  • Stroke
  • Cerebral Palsy
  • Cerebral Vascular Accident

Acquired brain injury is an insult to the brain. It can result from a blow to the head, stroke, or neurological dysfunction. This can produce a diminished or altered state of consciousness, and may result in impairment of cognitive abilities, sensory processing and/or physical function. Impairments may be mild or severe; most are amenable to rehabilitation. Specific effects can be:

  • Disturbance of behavioral or emotional functioning
  • Partial or total functional disability
  • Physiological maladjustment
  • Visual dysfunction

Often, visual problems resulting from acquired brain injury are overlooked during initial treatment of the injury. Frequently these problems are hidden and neglected, lengthening and impairing rehabilitation. Vision is an important source of sensory information. Consisting of a sophisticated complex of subsystems, the visual process involves the flow and processing of information to the brain.

Acquired brain injury can disrupt the visual process, interfering with the flow and processing of information. Symptoms indicating a vision problem include:

  • Blurred vision
  • Sensitivity to light
  • Reading difficulties; words appear to move
  • Comprehension difficulty
  • Attention and concentration difficulty
  • Memory difficulty
  • Double vision
  • Aching eyes
  • Headaches with visual tasks
  • Loss of visual field

Good Visual Skills

Good Vision Good visual skills are necessary for efficient information processing. When processing visual information is difficult, one may try harder, straining without even knowing it because the effort is subconscious. If the visual system is inefficient, every task can seem difficult, using more energy than required.

Visual skills affected by acquired brain injury include:

Tracking: the ability of the eyes to move smoothly across a printed page or while following a moving object.

Fixation: quickly and accurately locating and inspecting a series of stationary objects, such as words while reading.

Focus change: looking quickly from far to near and back without blur.

Depth perception: judging relative distances of objects how far or near they are.

Peripheral vision: monitoring and interpreting what is happening in the surrounding field of vision.

Binocularity: using both eyes together as a team smoothly, equally, and accurately.

Maintaining attention: keeping focused on a particular activity while interference, such as noise, is present.

Visualization: accurately picturing images in the mind’s eye, retaining and storing them for future recall.

Near vision acuity: clearly seeing, inspecting, identifying, and understanding objects within arm’s length.

Distance acuity: clearly seeing, inspecting, identifying, and understanding objects viewed at a distance.

Vision perception: understanding what is seen.

Optometry and Rehabilitation

Optometrists in the health care professions, including head trauma rehabilitation centers, treat the visual problems resulting from acquired brain injury and the visual perceptual consequences. Without solid visual assessment and treatment, a gap can occur in rehabilitative services, resulting in incomplete treatment and frustration for the patient, family, and treatment team.

The vision care professional plays an important role in the rehabilitation effort. Through vision therapy and the proper use of lenses, a behavioral optometrist specifically trained to work with brain injury patients can help improve the flow and processing of information between the eyes and the brain. Visual therapy can be very practical and effective.

After evaluation, examination and consultation, the optometrist determines how a person processes information after an injury and where the person’s strengths and weakness lie. The optometrist then prescribes a treatment regimen incorporating lenses, prisms, low vision aides, and specific activities designed to improve control of a person’s visual system and increase vision efficiency. This in turn can help support many other activities in daily living.

What is Behavioral Optometry?

Behavioral optometry is based upon the core principle that vision is a learned process and can be developed or enhanced at any age. Optometrists practicing this method have continued their education beyond the basic Doctor of Optometry (O.D.) degree. This continuing education emphasizes the use of lenses, prisms and vision therapy to enhance a patient’s visual capabilities, reduce visual stress, prevent and rehabilitate vision problems.

As a member of the rehabilitative team, behavioral optometrists have extensive experience treating the vision problems stemming from acquired brain injury.

Other vision articles:

How vision can be affected by midline shift in brain injury

Other resources to visit online:

The Optometrist’s Network Vision and Brain Injury Pages

Neuro- Optometric Rehabilitation Association


Article written by Dr. Errol Rummel, O.D., FAAO, FCOVD, NORA Clinical Skills Certified in Neuro-optometric Rehabilitation. A member of the Neurotrauma Registry, and owner of Rummel Eye Care.