Warzones, gridirons and playgrounds: Eyes on TBI

Concussion, mild traumatic brain injury (mTBI) or an old-fashioned 'bell ringing'; regardless of terminology, optometry knows what it's dealing with when caring for patients affected by head injuries.

Public awareness of TBI's consequences has grown immensely in the past two decades, stemming from ongoing U.S. military conflicts in the Middle East concurrent with intense scrutiny of head injuries in professional—and recreational—sports and activities. With this awareness comes a greater understanding of the visual dysfunctions resulting from concussion, in turn, increasing the scope of primary care optometrists' responsibilities.

However, the treatment of TBI-related vision disorders can be one of the more challenging aspects of optometric practices, notes the AOA's Brain Injury Electronic Resource Manual Vol. 1A: Traumatic Brain Injury Visual Dysfunction Diagnosis. That's because patients suffering from TBI may experience multiple problems, including physical, cognitive, behavioral, motor and sensory anomalies. Even when vision disorders, such as binocular vision, accommodative, eye movement and visual processing problems, occur in isolation of cognitive and psychological issues, they can be complicated, the manual states.

Therefore, being aware of the common TBI-related ocular dysfunctions, asking pertinent questions during case history, and assessing or testing specifically for those dysfunctions can help formulate the diagnosis and treatment plan. In short, the primary care optometrist has the basic knowledge to treat the optical visual problems and uncomplicated ocular motor and fusion dysfunctions by initiating optometric visual therapy, the manual states.

"Optometrists need to know how to identify the signs and symptoms of TBI and be able to make an appropriate treatment plan or referral to best manage the patient," says Andrew Morgenstern, O.D., optometric subject matter expert for the Department of Defense at Walter Reed National Military Medical Center.

"The most important takeaway is that TBI is not unique to a specific population and it directly impacts our youth."

As part of a continuing education (CE) course at Optometry's Meeting^®, June 20-24, in Denver, Colorado, Dr. Morgenstern and Amanda Nanasy, O.D., team optometrist for the NFL's Miami Dolphins, will provide a unique—but incredibly topical—look at TBI and vision dysfunction from their unique backgrounds.

The course, "School of Hard Knocks: The Most Up-to-Date Info on TBI, CTE and the NFL Concussion Crisis," will discuss both the athletic and military perspective, the differences and unique circumstances that each present, and then tie them together regarding treatment.

Drs. Morgenstern and Nanasy firmly believe that all doctors of optometry need to be on the lookout for TBI and associated visual dysfunction, whether on the battlefield, gridiron or playground.

"This is a critically important course for doctors of optometry to attend," Dr. Morgenstern says.

Access the Brain Injury Electronic Resource Manual Vol. 1B: Traumatic Brain Injury Visual Dysfunction: Optometric Management and Advanced Topics.