Optometry’s essential role in concussion recovery

Excerpted from page 22 of the Spring 2025 edition of AOA Focus. 

For years, those of us who have specialized in binocular vision or neurorehabilitation have fought to emphasize the significance of the visual system in so many aspects of life that have been overlooked. Now, the tide has changed. From the Amsterdam Concussion Census to the education given to physical therapists, the eyes are finally seen as a more integral part of recovery—and all health care providers have a role to play. 

Optometrists have been educated to help facilitate the best function of this system, but not all providers know where we fit into the recovery process. Every optometrist—no matter your specialty or how long it has been since you have done VG Phoria testing or a DEM—can give this patient base an evaluation that the best vestibular therapist cannot: a refraction and evaluation of the accommodative and vergence system. These are the systems that will most frequently need help after a head injury. While recovery can often be much more complicated than just glasses alone, sometimes it’s not! And there is no one better to make the decision on next steps for a patient’s visual and ocular health than their optometrist. 

Building a better care team 

As I onboarded my new extern from the University of Alabama at Birmingham College of Optometry, Matt Farsworth, I let him know that we would see patients referred to us from many different providers. We have seen patients from neuropsychologists, sports medicine orthopedists, athletic trainers and physical therapists. It is so easy to just “stay in our lane,” but this is never what is best for the patient.  

Just as we would send a letter to a primary care physician who sends us a diabetic patient to evaluate, we should be co-managing with every other type of provider in the community—especially those who see the same base of patients. I have sent Matt to shadow a neuropsychologist in a concussion clinic as well as an ophthalmologist who performs strabismus surgery, both of which refer patients to our clinic. All of these relationships start by having conversations about how we can work together to make a better care team. 

In our area, we have done a great job of networking and educating other professionals on how we can work together. But there is still more work to be done. There have been many times we have seen patients who let us know they are seeing other specialists we have not yet met. The patients were finally referred to us but have been spending sometimes months doing therapy with unknown clinics and therapists. They tell us about the vision exercises they have been doing with the other providers. From brock string to pencil pushups, they explain their treatments. These patients will often be focally bound, with difficulties navigating space due to a collapse of their peripheral system. They have intermittent blur or headaches with near work. They might need glasses. Often, they have small amounts of uncorrected astigmatism or plus. No matter how many pencil pushups, no one can give them what they may really need—unless they see us. I have taught Matt to gather information. Those are the providers we will meet next. We will congratulate them for recognizing the visual system needs to be addressed. We will let them know what other treatments we can offer to further improve care. Most importantly, we will let them know when to send patients our way in the future. 

Written by Amanda Nanasy, O.D., member of the AOA’s Sports & Performance Vision 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.}