After sustaining a concussion, patients often experience a range of debilitating visual and systemic symptoms, including dizziness, nausea, light sensitivity, and difficulty reading. Current concussion management strategies focus on treatments tailored to the patient’s specific symptoms, aiming to restore them to normal or near-normal function. However, due to the varied and multifaceted nature of concussions, there is no “one size fits all” treatment plan.
Many patients recovering from a concussion grapple with persistent visual symptoms despite undergoing physical therapy, psychotherapy, and various medical treatments. Common complaints include nausea, dizziness, or light sensitivity that never got better or a newfound difficulty with reading. These experiences underscore a significant oversight in concussion care: the underutilization of vision therapy, and the lack of awareness for thorough visual screenings during post-concussion management.
Standard post-concussion treatment often involves medication, physical therapy, and sometimes psychotherapy to address general symptoms. However, this approach may not fully address the specific visual disturbances that can arise. Vision therapy provides a targeted intervention for these visual issues, offering a specialized approach to help patients regain visual function and alleviate persistent symptoms. Without a referral to vision therapy, many patients continue to struggle with unresolved visual symptoms that hinder their recovery and daily life.
A systematic review by Barnhart et al. in 2024 found that a positive vestibular oculomotor screening is a good predictor of recovery in post-concussion patients. The researchers concluded that such screenings are not only prognostic of prolonged recovery but also reliable in eliciting concussion-related symptoms. This highlights the importance of post-concussion visual screenings and the role of visual therapy in aiding recovery.
It is crucial for healthcare providers to recognize the importance of vision therapy and consider it a key component in the comprehensive management of post-concussion patients. Modern concussion treatment should include a referral to a specialist with experience in comprehensive concussion management, a vision-specific history, and a thorough evaluation of the visual system beyond just assessing visual acuity — including ocular alignment and other visual functions. Identifying and addressing visual deficits after a concussion is essential, as they may hinder the return to play and learning for children and adolescents, and work and daily living for older adults. Knowledge of specific visual deficits allows for relevant accommodations, such as larger font, preprinted notes, extended times on assignments, and temporary use of audiobooks. Early identification and appropriate management of visual symptoms, such as convergence insufficiency or oculomotor dysfunction, can optimize visual function and improve the patient's quality of life.
References:
Barnhart, M., McLeod, T. V., & Bay, R. C. (2024). The Ability of Vestibular and Oculomotor Screenings to Predict Recovery in Patients After Concussion: A Systematic Review of the Literature. Journal of athletic training, 59 (1), 49–65. https://doi.org/10.4085/1062-6050-0429.22
Heinmiller, L. & Gunton, K. B. (2016). A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome. Current Opinion in Ophthalmology, 27 (5), 407-412. doi: 10.1097/ICU.0000000000000296.
Master, C. L., Bacal, D., Grady, M. F., Hertle, R., Shah, A. S., Strominger, M., Whitecross, S., Bradford, G. E., Lum, F., Donahue, S. P., & AAP SECTION ON OPHTHALMOLOGY; AMERICAN ACADEMY OF OPHTHALMOLOGY; AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS; and AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS (2022). Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment. Pediatrics, 150 (2), e2021056047. https://doi.org/10.1542/peds.2021-056047
Written by: Ariel Lau
Chicago College of Optometry | Class of 2025
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