5 things doctors of optometry should know about concussions

Fall sports season offers a timely reminder for doctors of optometry to be alert to patients' risk of concussions.

Knowing how to properly diagnose and manage traumatic brain injury (TBI) is increasingly important for doctors of optometry working on multidisciplinary care teams. To help guide these clinical responsibilities and others, the AOA Vision Rehabilitation Section (VRS) produced the  Brain Injury Electronic Resource Manual (BIERM).

The BIERM now has two volumes available. Volume 1A, Traumatic Brain Injury Visual Dysfunction Diagnosis, addresses optometry's overall involvement in management and rehabilitation of patients with TBI, while Volume 1B, Traumatic Brain Injury Visual Dysfunction: Optometric Management and Advanced Topics provides an overview of high-yield optometric management protocols that are important to incorporate into the care of patients with visual sequelae of closed head trauma.

Brenda Heinke Montecalvo, O.D., AOA Vision Rehabilitation Section immediate past chair, discusses five things doctors of optometry should know about concussions:

1. Know the causes and risks. Football may be the obvious culprit, but certain girls' sports also put teens at risk of head trauma. Girls' soccer games have one of the highest rates of concussions among high school sports, and high school cheerleading practice leads the way as the riskiest sport among girls (tied with girls' field hockey practice). And remember that even basic falls and everyday accidents can lead to concussion.
   
   
2. When diagnosing a concussion, go beyond visual acuity, visual field and visual motor tests. Examine a patient's visual thinking process, including spatial  orientation, visual memory and problems with figure-ground organization. "There are over 20 different visual skills that can be affected after a TBI," Dr. Montecalvo says. The Visual Motor Integration Test and Test of Visual Perceptual Skills are two assessments that can provide good information about visual perceptual skills, she says.
   
   
3. Know whom to refer a patient to. Have updated contact information ready for local neurologists and retina specialists.
   
   
4. Consider proactively testing patients' reaction time. A threshold visual field test can be used to screen peripheral reaction time and awareness for most children older than 7, Dr. Montecalvo says. A University of Cincinnati study of the school's football team showed lower concussion rates after incorporating visual training into practice, teaching players to improve their peripheral vision, eye-hand coordination, visual processing and ocular motor performance. The training allowed players to avoid a hit or at least prepare to take a hit, as opposed to being blind-sided.
   
   
5. Raise awareness in your community about concussions' effects on vision. Present educational sessions at community events, and ask patients about head injuries and falls during routine exams: "Have you had your bell rung hard this year?"

"When it comes to concussions, optometrists can be proactive in helping prevent and provide early assessment and treatment," Dr. Montecalvo says. "By providing regular comprehensive eye health and visual examination for athletes, they may be able to prevent long-term negative effects from injury."