How doctors of optometry can prevent traumatic brain injuries and make a difference for patients

Millions of Americans end up in the nation’s emergency departments with traumatic brain injuries (TBI)—2.5 million of them in 2014 alone. In many of these cases, impaired vision is “an important and independent factor,” presenting an opportunity for doctors of optometry to aid in prevention and provide needed care for these patients.

“Doctors of optometry are in a unique position to significantly aid the prevention of TBI and mTBI [mild traumatic brain injury] by providing regular, comprehensive eye examination, diagnosis and team-based, integrated treatments that can facilitate condensed recovery,” says Michael Dueñas, O.D., AOA chief public health officer.

“Problems that can be diagnosed during a comprehensive eye examination (e.g., accommodative and eye movement problems, among others) may be common mTBI signs that, unless diagnosed and treated, can negatively affect an individual’s academic or work performance, attendance and socialization,” Dr. Dueñas says.

And, for doctors of optometry, there is an opportunity to make a difference to their patients, according to a new report by the AOA Health Policy Institute (HPI).

Falls and older adults

For instance, vison impairment is the primary cause of falls that result in these brain injuries among older adults, the HPI reports. HPI research of Medicare Physician/Supplier data for optometry and ophthalmology found a total person utilization of services of 17.1 million in 2016.

“Therefore, in 2016 only 34.9% of the Medicare population of U.S. adults age ≥65 received the evidenced-based falls intervention linked to a comprehensive eye exam,” the HPI reports.

“Encouraging a comprehensive eye exam to the 65.1% cohort of Medicare-eligible individuals not receiving an eye exam represents one of the highest potentials to help the greatest number of older adults in unintentional falls prevention (32.1 million),” it says.

Sports-related TBI

Up to 3.8 million sports- and recreation-related mTBIs occur in the U.S. each year, with football accounting for most of that, followed by hockey, rugby, soccer and basketball.

The HPI suggests several interventions, among them baseline testing with doctors of optometry.

“Before the sports season begins and, as part of annual comprehensive eye exams for children and adults, doctors of optometry can provide ‘baseline testing,’” the HPI reports. “Baseline testing provides benchmark comparison data to future assessments related to vision, balance, concentration and memory to determine whether patients have a mTBI or TBI after a head injury or accident.”

Amanda Nanasy, O.D., director, Florida Institute of Sports Vision, team doctor for Miami CF, Miami Dolphins, UCF Knights, and immediate past chair, AOA Sports & Performance Vision Committee, agrees. The Sports & Performance Vision Committee contributed to the HPI report.

With abbreviated playing seasons, in both professional and college sports, due to COVID-19 concerns, vision care is more important than ever, Dr. Nanasy says.

“We know that athletes are at a higher risk of injury (including TBI) due to lack of normal conditioning,” Dr. Nanasy says. “They also need every edge they can get, and visual skills can make or break peak performance for many athletes.”

She adds: “A comprehensive eye exam for student-athletes should not only assure that their visual clarity and field is what it needs to be, but also allows us to easily take concussion baselines that could be helpful later doing a near point of convergence and a cover test. It's our responsibility to be a part of the sports medicine picture.”

Early intervention matters

A review of literature published between 1994 and 2017 provides evidence of the impact early detection and intervention can make.

“Timely detection of the visual symptoms of mTBI and subsequent treatment will minimize the impact that a mTBI will have on a patient’s daily life, education and ability to work; in fact, about 90% of concussion patients have visual difficulties as a result of their injury,” HPI reports. “As such, doctors of optometry are essential members of the TBI health care team.

“Doctors of optometry can conduct comprehensive eye and vision examinations, visual perceptual and cognitive evaluations to identify concussion symptoms. Many also provide vision/vestibular rehabilitation, among other management strategies, monitor a patient’s progress and provide long-term management of concussion symptoms.”