By: Suzanne Kim, O.D., Director of the MEDARVA Low Vision Center
According to the Centers for Disease Control and Prevention, there were approximately 2.8 million traumatic brain injury-related emergency department visits, hospitalizations and deaths in the United States in 2014, the most recent year for which data is available. Changes are, you know someone who has experienced this type of injury.
A traumatic brain injury, or TBI, is described as a direct impact to the head that disrupts the brain’s normal function. Visual problems, including difficulty reading or light sensitivity, are typically some of the first symptoms patients have after suffering a TBI. Other symptoms may include headaches, dizziness, problems with memory or thinking, hearing issues, and changes in mood or personality.
Until recently, treatment for concussions, the mildest form of TBIs, involved resting in a dark room for a week or until concussion-related symptoms disappeared. Current research shows that seeking out a concussion care specialist and starting appropriate therapies within 48 hours of an injury is the best approach to treating concussions and their symptoms.
Take my patient, Mary, a 55-year-old who began having seizures that led to multiple concussions. When I first met her, she couldn’t ride in a car without closing her eyes, couldn’t tolerate any movement without taking anti-nausea medication, and arrived in my office wearing two pairs of sunglasses and a large hat to reduce sensitivity to light. Her symptoms were so severe she initially couldn’t even tolerate therapy. Mary’s concussions had caused damage to the part of her brain involved in eyetracking, visual processing and perception so we began a weekly vision therapy program designed to work in conjunction with physical therapy to reduce her symptoms.
As many as 75% of people with a TBI have visual symptoms. Many people don’t realize that dizziness and balance issues are heavily connected to vision through the vestibular-ocular reflex. Patients who have these symptoms, or others such as difficulty reading or focusing, are often referred to me by health care specialists who recognize the need for more comprehensive vision treatment.
During my initial exam, I look at how a patient’s eyes are working together and determine if any visual processing issues exist. I ask patients if they are having trouble reading, if their vision is worse at the end of the day, have eyestrain or if they are having double vision. Based on my findings, I may recommend a 10-week vision therapy program to help patients process information more clearly. Through weekly visits and follow-up exercises at home, patients reduce or eliminate visual issues with the goal of returning to work or sports or better managing activities of daily living.
After nearly five months of vision therapy, Mary was able to ride in a car without closing her eyes or taking anti-nausea medication. She no longer needed her hat to shield her eyes from bright light, and she even started a support group for TBI patients.
Because visual issues can impact everything from balance to light sensitivity, I recommend seeing a concussion care specialist and receiving a comprehensive eye exam within 48 hours of a TBI. The sooner you begin treatment, the sooner you’ll be able to comfortably return to everyday life.
Dr. Suzanne Kim is Board Certified by the National Board of Examiners in Optometry, as well as being a member of the following professional societies: the American Optometric Association, California Optometric Association, Neuro-Optometry Rehabilitation Association, and College of Optometrists in Vision Development. Dr. Kim was also the recipient of the Low Vision Eschenback Award for clinical excellence in low vision.