Vision and Brain Injury

As a developmental optometrist, I have observed that the fastest growing segment of the population benefiting from vision therapy to be patients who have experienced a traumatic brain injury.  Insults to the brain can occur in many different ways.  Common causes include car accidents (closed head injury, whiplash), concussions (mild to severe), stroke and aneurysm to name a few.  Due to the extensive visual pathways within the brain, any type of adverse neurological event, whether mild or severe, will likely have an impact on the visual system.  Brain injury can result in an altered state of consciousness and may result in impairment of cognitive abilities, sensory processing or physical function.

Vision problems are often overlooked during the initial stages of treatment for traumatic brain injuries.  Often times the problems are initially hidden, which further delays treatment.  Many brain injury patients are left with double vision, binocular vision difficulties and severe accommodative (focusing) problems.  Initially physicians and therapists choose to patch one eye in order to eliminate adverse symptoms.  This strategy not only delays proper treatment, but also decreases a person’s peripheral vision which further hinders their mobility, often while they are already experiencing mobility challenges.

Visual Symptoms Associated with Brain Injury


Peripheral vision loss, or visual field loss, refers to a portion of our visual world which has been removed, essentially a large blind spot.  The position and magnitude of this blind spot places the person at increased risk of further injury and harm from bumping into objects as well as being struck by approaching objects.  Various treatments are available to help people deal with visual field loss.  Treatment may involve scanning and tracking exercises into the area of loss as well as prisms and special glasses to help with orientation and mobility concerns.  Remediation requires effort, time and patience on everyone involved with the situation.

Double vision is a serious and intolerable condition that can be caused by strabismus (misalignment of the eyes), ophthalmoplegia (paralysis of a specific eye muscle limiting eye movements), gaze palsy (inability to gaze into certain directions), and decompensated binocular skills in patients with brain injury, stroke and other neurologically compromising conditions.  Prisms, lenses and/or vision therapy can often help the patient achieve fusion (alignment of the eyes) and alleviate the double vision.   

Visual Balance Disorders
Visual balance disorders can be caused by a Visual Midline Shift Syndrome (VMSS), eye movement disorders, nystagmus (involuntary oscillation of the eyes), and disruptions of central and peripheral visual processing.  Treatment will depend on the visual diagnosis and etiology. Lenses, prisms and visual rehabilitation activities are used in the remediation of these disorders.