Tackling TBI

Excerpted from page 42 of the Spring 2024 edition of AOA Focus

Each year, millions of Americans are affected by traumatic brain injuries (TBI), per data from the Centers for Disease Control and Prevention (CDC). A TBI, an insult to the brain that disrupts normal brain functioning, can affect any age group, race or gender. It can be classified as mild (often known as a concussion), moderate or severe. Although a blow, bump, jolt or structural injury to the head may be the initial cause of a TBI, much of the brain injury occurs after the original trauma by a progression of biological changes that can continue for weeks after the initial event.

Although sight might begin with the eyes, it actually occurs in the brain, with many areas dedicated to vision and visual processing. Because so much of the brain is involved in vision, even mild injuries to almost any part of it can significantly impact the multiple processes and pathways involved in vision and visual processing. Patients experiencing a TBI should seek care from their eye doctor, as vision impairments or dysfunctions are often the first symptoms and can persist well into the rehabilitation process. Research shows that up to 75% of all patients with TBIs suffer from visual dysfunction. These patients may experience a range of visual symptoms and disorders, including problems with visual acuity, visual fields, oculomotor function, accommodative disorders, convergence insufficiency and saccadic dysfunction.

An important part to play

Optometry’s role in TBI care begins with early prevention and diagnosis. Primary eye care, such as in-person comprehensive eye exams, can detect signs of an undiagnosed TBI as well as help to reduce visual sequalae of the impact.

Appropriate preventive care also can reduce vision-related risk factors for TBIs, such as addressing declining visual functions that can increase the risk of falls. Regular visits to the eye doctor also can provide baseline TBI testing to measure visual components that can help the TBI care team more easily detect, treat and manage future TBIs.

A comprehensive TBI team

Co-management and coordination of care among doctors of optometry and other members of the TBI care team are critical. Care for the TBI patient that is not well coordinated or integrated increases the risk for less-than-optimal recovery. This risk can be reduced by appropriate intervention by the optometrist.

Upon diagnosis, an optometrist can provide neuro-optometric care or can refer to an optometrist providing TBI care as well as other members of the TBI rehabilitation team. As part of the TBI care team, optometrists can help a patient succeed in recovery with the potential to speed up a return to normal function.

TBI by the numbers

Written by Maria Richman, O.D., a member of the AOA’s Vision Rehabilitation Committee.

Disclaimer: The information contained in this article represents the opinion of the author and not the AOA. These are not clinical practice guidelines, nor has the evidence been peer-reviewed. There are additional aspects to this topic that may not be presented, or considered, based on the specifics of the case.