Doctors of optometry: Teammates in the post-concussion care huddle

January 29, 2019
They can help determine when patients are ready to return to play, to work and to the classroom.
Doctors of optometry teammates in the post-concussion care

Just a relative snap ahead of super Sunday's championship game, the National Football League released its annual report on the state of its efforts to tackle the number of concussions players are suffering in this high-collision sport.

The League reported a 29% decline in concussions among players during the past regular season, due to better-performing helmets, rule changes and review of preseason practices. That report and Sunday's highly anticipated championship between the Los Angeles Rams and New England Patriots present an opportunity for doctors of optometry to score points with patients by educating them about the sequelae of traumatic brain injuries (TBI).

Not only can doctors of optometry fill the gap in patient knowledge on how Americans can protect themselves against injury, they also can identify and treat the visual symptoms associated with TBI.

Concussions are a type of TBI, a disturbance in brain function due to a blow or strike to the head. Doctors of optometry are essential to the post-concussion treatment team. Most Americans suffer TBI from falls, traffic accidents and being struck by or against an object, according to the Centers for Disease Control and Prevention. Some symptoms last a few days; others a lifetime.

"Coordination of care for vision rehabilitation is an important aspect of care—where optometry works with other therapists and doctors as part of a team," says Carl Garbus, O.D., chair of the AOA Vision Rehabilitation Committee.

Doctors of optometry bring a winning contribution to the post-concussion huddle, says Amanda Nanasy, O.D., AOA Sports & Performance Vision Committee chair and team doctor of optometry for the Miami Dolphins and the University of Central Florida Knights.

"We bring something valuable to the table that other providers can't: a solid, refractive and accommodative evaluation as well as an ocular health exam," Dr. Nanasy says.

Visual symptoms of TBI

What kind of symptoms are doctors of optometry looking for?

Dr. Nanasy cites blurry vision, double vision, trouble focusing and being overwhelmed by visual stimuli in surroundings.

Adds Dr. Garbus: "Light sensitivity is a common problem. Migraine headaches and visual headaches can be aggravated by light and affect daily activities. Control of eye movements, eye alignment and focusing are additional problems that affect reading, concentration, spatial judgment and balance. Visual midline shift is another component that affects movement, balance and posture.

"All of these conditions are classified as post-trauma vision syndrome (PTVS)," he says. "The conglomeration of symptoms affects daily performance and endurance. Visual fatigue and general fatigue are common."

Treatment playbook

Doctors of optometry can provide relief from the functional vision-related deficits associated with TBI.

Some symptoms are relieved by prescribing special types of lenses (for light sensitivity and to relax the visual system, Drs. Nanasy and Garbus says. Other symptoms can be sacked by vision therapy, which can help the visual-perceptual system get back online.

Those treatment options also may include some or all of the following, according to Dr. Garbus:

  • Prism lenses are used in prescription glasses to improve postural control and help with balance and gait. Prisms also may help with visual field expansion.
  • Partial occlusion is used to reduce visual overstimulation and binocular confusion, when the binocular system is not functioning normally.
  • Vision rehabilitation is prescribed to improve visual function and to help integrate with vestibular and proprioceptive systems.

"The earlier that the vision rehabilitation program is started, the better," Dr. Garbus says.

When in doubt, patients should seek out their doctors of optometry, Dr. Nanasy says. They can help facilitate a speedy recovery to the field, to work or to the classroom. 

"Head injuries don't just come from direct impact but from whiplash and blast injuries as well," she adds.

Access AOA resources

View and download a recently updated concussion fact sheet, designed to help patients understand the role of optometry in concussion diagnoses, management and care.

Join the AOA Vision Rehabilitation Advocacy Network to access AOA resources and to advocate for better policies, regulations and laws.

Join the AOA Sports & Performance Vision Advocacy Network, where you can access AOA resources and receive advocacy updates.

Read more about the benefit of regular, comprehensive eye examinations.

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