Tackling TBI

July 9, 2024
Optometrists play an integral role in assessing and treating patients with traumatic brain injuries.
Optometrist examining male patient's eyes

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.

Examination and evaluation


Optometric evaluation of a diagnosed TBI patient often includes, but is not limited to:

  • Comprehensive eye and vision examination
  • Extended sensorimotor evaluation
  • Visual perceptual and cognitive evaluation
  • Higher cerebral function assessment of visual information processing
  • Low-vision evaluation
  • Extended visual field evaluation
  • Electrodiagnostic vision testing
  • Baseline TBI testing
  • Visual-vestibular and balance testing

Treatment and management


Optometric treatment and management of a TBI patient may incorporate any of the following:

  • Diagnosis and treatment of ocular disease or injury
  • Treatment of a visual dysfunction using lenses, prisms, filters, occlusion, low-vision devices, optometric vision therapy, visual processing therapy and/or cognitive rehabilitation
  • Counseling and education of patient, family or caregiver about the patient’s visual difficulties, functional implications, goals, prognosis and management options
  • Consultation and coordination of care with other professionals involved in the rehabilitation and health care of the patient

TBI by the numbers

214,110

According to the CDC’s most recent data, there were approximately 214,110 TBI-related hospitalizations in 2020 and 69,473 TBI-related deaths in 2021.

75 and older

People age 75 and older had the highest numbers and rates of TBI-related hospitalizations and deaths, accounting for about 32% of TBI-related hospitalizations and 28% of TBI-related deaths.

2x

Men were nearly two times more likely to be hospitalized (79.9 age-adjusted rate vs. 43.7) and three times more likely to die from a TBI than women (28.3 vs. 8.4) 

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.



Join the network

Find resources for doctors and patients and join the AOA’s Vision Rehab Advocacy Network to stay updated on the AOA’s vision rehabilitation advocacy efforts and help promote vision rehabilitation on local, state and federal levels.
Related News

Primary care of the stroke patient

Two case studies illustrate why primary eye care providers should know the symptoms of stroke and understand the range of visual rehabilitation therapies.

Research on eye aberrations not abstract to award-winning scientists

For the sixth consecutive year, the AOA is sponsoring the Investigator Initiated Research Award. Investigators are invited to electronically submit proposals by June 15 for projects designed to increase knowledge through basic clinical and/or translational science related to the continuum of eye and vision care. Jason Marsack, Ph.D., talks about the work he and his collaborators are currently pursuing in the laboratory.

AOA, CooperVision mobilize to ‘disrupt the status quo,’ advance new standard of care for children with myopia

The Myopia Collective’s goal is to elevate the standard of care for children with myopia, shifting the focus beyond optical correction to embracing comprehensive treatment. The collective’s “Change Agents” will lead the charge. Doctors of optometry across the country provide more than two-thirds of primary eye health and vision care.