New resource offers guidance on ocular and vision dysfunction following brain injury

In a yearlong initiative, doctors of optometry at the Vision Center of Excellence, Defense Health Agency, have released a new resource applicable to both the military and civilian eye care communities. 

The practice recommendation, “Ocular and Vision Dysfunction Management Following Blast Exposure and Traumatic Brain Injury,” provides consensus-based clinical guidance to help eye care providers deliver consistent, high-quality care across the military health system and beyond.  

“Optometry plays a significant role as a partner in the diagnoses, management and treatment of the over 500,000 military-related traumatic brain injuries (TBI) over the past 20-plus years,” says Andrew Morgenstern, O.D., an author of the document. “Optometry is a primary component of the continuum of care of the patient suffering from post-TBI-related vision dysfunction.” 

The 22-page document summarizes the best available scientific evidence and expert clinical consensus to support decision-making when a full clinical practice guideline is not available or when rapid guidance is needed, says co-author Rita Mallia, O.D. “It is a great resource that provides all the required information for management and rehabilitation in one comprehensive guide,” Dr. Mallia says. 

Applicable to military and civilian optometrists 

The practice recommendation covers the full spectrum of ocular injuries and vision dysfunction following blast exposure and TBI. It includes guidance on oculomotor dysfunction, recommendations for the evaluation and management of ocular trauma, urgent and non-urgent eye conditions, neuro-ophthalmic disorders, vision impairment, referral pathways, standardized clinical workflows and evidence-based management across the continuum of care. It also incorporates information from the groundbreaking Ocular Motor Rehabilitation Definition report.  

📖 Read Ocular Motor Rehabilitation Definition as Applied to the Defense Health Agency/Vision Center of Excellence Practice Recommendations

“The practice recommendation is applicable to civilian optometrists because its recommendations apply to all TBI or blast exposures, including those sustained from sports injuries, motor vehicle crashes, falls and other routine causes of trauma,” Dr. Morgenstern says. “It’s screening questions and minimum testing framework can help identify post-concussion problems, such as accommodative dysfunction, convergence insufficiency, photophobia, visual-field loss and eye-movement disorders.” 

Key recommendations from the document include: 

• Perform a comprehensive eye examination for all patients with suspected TBI-related visual complaints. 
• Recognize that ocular injuries and vision dysfunction are common after TBI. 
• Identify and treat urgent ocular and neuro-ophthalmic conditions before addressing rehabilitation. 
• Screen for common post-TBI visual disorders, including oculomotor, accommodative, binocular vision, visual field, and photophobia-related dysfunctions. 
• Use standardized testing, evidence-informed management strategies, and appropriate referral pathways. 
• Coordinate multidisciplinary care when necessary to optimize visual recovery and improve functional outcomes. 
• Apply these recommendations to support, but not replace, clinical judgment and individualized patient care. 

 “Vision problems following blast exposure and TBI are common, often subtle and can significantly affect a patient’s function and quality of life,” Dr. Mallia says. “Early recognition through a comprehensive eye examination and a standardized, evidence-informed approach to evaluation, management, rehabilitation and referral can improve patient outcomes while promoting consistent care across providers.” 

Guidance updated by a multidisciplinary team including doctors of optometry as well as other experts 

The new practice recommendation was developed by updating and combining two separate clinical recommendations to create a single resource that provides consistent, standardized and up-to-date information on the management of ocular and visual dysfunction following blast exposure or TBI. 

The process was led by doctors of optometry at the Vision Center of Excellence with support from a multi-disciplinary team of experts, including ophthalmologists, occupational therapists, physical therapists and TBI experts from federal agencies and academia.