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Vision and Concussion

Concussion is defined by a bump, blow, or jolt to the head, face, neck, or elsewhere on the body that causes the head and brain to move rapidly back and forth, causing mechanical stretching of nerve axons (diffuse axonal injury) and disruptive biochemical changes. It is classified as a Minor Traumatic Brain Injury (mTBI), although the effects may certainly not be minor.

There are typically no structural brain abnormalities seen on neuroimaging studies such as CAT scan or standard MRI.  Up to 15% of patients diagnosed with mTBI may have persistent disabling problems. When symptoms such as dizziness, headaches, fatigue, cognitive impairment, trouble sleeping, and vision problems persist beyond 4 weeks, the term post-concussion syndrome or disorder is applied. Symptoms may occur immediately or may not occur for days or weeks after the injury, and can be
a different presentation with each individual.

70% of our brain is dedicated to vision and vision processing, and 80% of all sensory processing in the entire body is directly affected by information coming in from the eyes. Thus, it is not surprising that a
concussion affects the visual system in some way.  At least 50% of people who have sustained a concussion have visual dysfunction and visual symptoms.

Vision is not just about seeing 20 20. There are two aspects of vision that typically interact in harmony:

  • central or focal vision: seeing fine details
  • peripheral or spatial vision: information about our surroundings, where we are in space, where objects are relative to us, and how we would like to move through space. This information is established by an interplay of vision, proprioception (body position), posture, and the vestibular or balance system.

People suffering from Post-Trauma Vision Syndrome (PTVS) typically experience an imbalance in these aspects of vision, where they are embedded in the focal central vision, and  not using the grounding, stabilizing spatial vision.  Sensory integration, responsible for our automatic way of tracking with our eyes, keeping vision stable with head or body motion, and reaction responses (e.g. sports, driving), can be disrupted.  This is why standard optometric testing can reveal 20/20 vision, but yet the person can experience significant symptoms.  PTVS can impact daily function, including work, social, and recreational activities. The type and severity of symptoms can vary from individual to individual.  When vision doesn’t work, it interferes.

Although not all post-concussion symptoms are visual in nature, problems with the visual system can contribute to or can be the result of the following:

  • dizziness
  • headaches
  • blurry vision
  • double vision
  • balance and depth perception issues
  • light sensitivity
  • intolerance to looking at screens
  • difficulty with eye tracking
  • motion sensitivity (intolerant to moving things in the environment, watching sporting events on TV, or scrolling on a screen)
  • discomfort in crowded or busy areas; bothered by busy patterns
  • difficulty remembering visual information

Reading, in particular, can be significantly impacted by a concussion.  Symptoms can occur including losing place, re-reading content, word shakiness/movement/blur, double vision, eyestrain, watery eyes, headache, nausea, and visual or whole body fatigue.  Aspects such as concentration and working memory can also influence reading function.  If the brain experiences visual stress during the reading process, then there will be less brain energy and real estate to attend to the content that is being read.

Insurance Coverage

Vision assessments and therapy may be included in some insurance plans, however this depends on the individual's policy.

We complete and submit OCF-18 forms for cases of MVA (motor vehicle accident). We are not currently set up for direct billing and require payment for all visits.