Current Treatment Options in Neurology

, Volume 4, Issue 4, pp 271–280 | Cite as

Vision disturbances following traumatic brain injury

  • Neera Kapoor
  • Kenneth J. Ciuffreda

Opinion statement

  • Vision disturbances following traumatic brain injury (TBI) include anomalies of accommodation, version, vergence (nonstrabismic, as well as strabismic), photosensitivity, visual field integrity, and ocular health.

  • Traumatic brain injury patients with complex diplopia patterns, noncomitant strabismic anomalies, and advanced ocular health anomalies are either monitored by or referred to neuro-ophthalmologists and ophthalmologists for evaluation and possible surgical or medical intervention, as needed.

  • Anomalies of accommodation, vergence, version, photosensitivity, and field of vision are amenable to noninvasive, rehabilitative interventions, such as vision therapy, which is rendered by optometrists and is described in this article. Further, vision therapy may be performed in isolation or in conjunction with the application of the following: Fusional prism spectacles (for diplopia) Tinted spectacles (for photosensitivity) Yoked prism spectacles (for visual-spatial hemispheric inattention, with or without a manifest visual field defect), as appropriate

  • Dependent on the severity of vision impairment post-TBI, other types of rehabilitation, such as vestibular, physical, cognitive, and occupational rehabilitation, are deferred pending the stabilization of vision function to an appropriate level.

  • Rehabilitative optometric intervention is appropriate and beneficial for many TBI patients. Therefore, it should be offered as a possible evaluation and treatment option to investigate the patient’s symptoms and determine the prognosis for treatment, as would be done with any other therapeutic modality.


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References and Recommended Reading

  1. 1.
    Baker RS, Epstein AV: Ocular motor abnormalities from head trauma. Surv Ophthalmol 1991, 35:245–267.PubMedCrossRefGoogle Scholar
  2. 2.
    Zost MG: Diagnosis and management of visual dysfunction in cerebral injury. In Diagnosis and Management of Special Populations. Edited by Maino DM. St. Louis: Mosby Yearbook; 1995.Google Scholar
  3. 3.
    Bohnen S, Twijnstra A, Wijnen G, et al.: Tolerance for light and sound of patients with persistent post-concussional symptoms 6 months after mild head injury. Neurology 1991, 238:443–446.CrossRefGoogle Scholar
  4. 4.
    Hellerstein LF, Freed S, Maples WC: Vision profile of patients with mild brain injury. J Am Optom Assn 1995, 66:634–639.Google Scholar
  5. 5.
    Sabates NR, Gonce MA, Farris BK: Neuro-opthalmological findings in closed head trauma. J Clin Neurol Ophthalmol 1991, 11:273–277.Google Scholar
  6. 6.
    Schlageter K, Gray K, Shaw R, Sammet R: Incidence and treatment of visual dysfunction in traumatic brain injury. Brain Inj 1993, 7:439–448.PubMedGoogle Scholar
  7. 7.
    Suchoff IB, Kapoor N, Waxman R, Ference W: The occurrence of visual and ocular conditions in a non-selected acquired brain-injured patient sample. J Am Optom Assoc 1999, 70:301–308. Supporting evidence, including a brief literature review, for the occurrence of various vision problems in patients with acquired brain injury.PubMedGoogle Scholar
  8. 8.
    Harrison RJ: Loss of fusional vergence with partial loss of accommodative convergence and accommodation following head injury. Binoc Vis 1987, 2:93–100.Google Scholar
  9. 9.
    Lepore FE: Disorders of ocular motility following head trauma. Arch Neurol 1995, 52:924–926.PubMedGoogle Scholar
  10. 10.
    Waddell PA, Gronwall DM: Sensitivity to light and sound following minor head injury. Acta Neurol Scand 1984, 69:270–276.PubMedCrossRefGoogle Scholar
  11. 11.
    Suter PS: Rehabilitation and management of visual dysfunction following traumatic brain injury. In Traumatic Brain Injury Rehabilitation. Edited by Ashley MJ, Krych DK. Boca Raton: CRC Press; 1995:198–220.Google Scholar
  12. 12.
    Gianutsos R, Ramsey G, Perlin R: Rehabilitative optometric services for survivors of brain injury. Arch Phys Med Rehabil 1988, 69:573–578.PubMedGoogle Scholar
  13. 13.
    Jackowski MM, Sturr JF, Taub HA, Turk MA: Photophobia in patients with traumatic brain injury: uses of light-filtering lenses to enhance contrast sensitivity and reading rate. Neurorehab 1996, 6:193–201.CrossRefGoogle Scholar
  14. 14.
    Zihl J, Kerkhoff G: Foveal photopic and scotopic adaptation in patients with brain damage. Clin Vis Sci 1990, 5:185–195.Google Scholar
  15. 15.
    Ciuffreda KJ, Suchoff IB, Marrone MA, Ahmann E: Oculomotor rehabilitation in traumatic brain-injured patients. J Behav Optom 1996, 7:31–38.Google Scholar
  16. 16.
    Padula WV: Neuro-optometric rehabilitation for persons with TBI or CVA. J Opt Vis Dev 1992, 23:4–8.Google Scholar
  17. 17.
    Diller L, Weinberg J: Hemi-inattention and rehabilitation: the evolution of a rational treatment program. In: Advances in Neurology, vol 18. Edited by Weinstein EA, Freidland RP. New York: Raven Press; 1977.Google Scholar
  18. 18.
    Gianutsos R, Suchoff IB: Visual fields after brain injury: management issues for the occupational therapist. In Understanding and Managing Vision Deficits: A Guide for Occupational Therapists. Edited by Scheiman M. Thorofare: Slack; 1998.Google Scholar
  19. 19.
    Gur S, Ron S: Training in oculomotor tracking: occupational health aspects. Isr J Med Sci 1992, 28:622–628.PubMedGoogle Scholar
  20. 20.
    Rossetti Y, Rode G, Pisella L, et al.: Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect. Nature 1998, 395:166–169. Supporting evidence for the prescription of yoked prisms for a temporary period in patients with clinical signs of neglect with or without visual field defects.PubMedCrossRefGoogle Scholar
  21. 21.
    Rossi PW, Kheyfets S, Reding MJ: Fresnel prisms improve visual perception in stroke patients with homonymous hemianopia or unilateral visual neglect. Neurology 1990, 40:1597–1599.PubMedGoogle Scholar
  22. 22.
    Webster JS, Jones S, Blanton P, et al.: Visual scanning training with stroke patients. Behav Ther 1984, 15:129–143.CrossRefGoogle Scholar
  23. 23.
    Weinberg J, Diller L, Gordon W, et al.: Training sensory awareness and spatial organization in people with right brain damage. Arch Phys Med Rehabil 1979, 60:491–496.PubMedGoogle Scholar
  24. 24.
    Welch RB, Goldstein G: Prism adaptation and brain damage. Neuropsychologia 1972, 10:387–394.PubMedCrossRefGoogle Scholar
  25. 25.
    Gianutsos R: Visual field deficits after brain injury: computerized screening. J Behav Optom 1991, 2:143–150.Google Scholar
  26. 26.
    Kerkhoff G, MunBinger U, Haaf E, et al.: Rehabilitation of homonymous scotomata in patients with postgeniculate damage of the visual system: saccadic compensation training. Restorative Neurol Neurosci 1992, 4:245–254.Google Scholar
  27. 27.
    Kapoor N, Ciuffreda KJ, Suchoff IB: Egocentric localization in patients with visual neglect. In: Visual and Vestibular Consequences of Acquired Brain Injury. Edited by Suchoff IB, Ciuffreda KJ, Kapoor N. Santa Ana: Optometric Extension Program Foundation; 2001.Google Scholar
  28. 28.
    Stein JF: Representation of egocentric space in the posterior parietal cortex. Q J Exp Physiol 1989, 74:583–606.PubMedGoogle Scholar
  29. 29.
    Ventre J, Flandrin JM, Jeannerod M: In search for the egocentric reference: a neuropsychological hypothesis. Neuropsychologia 1984, 22:797–806.PubMedCrossRefGoogle Scholar
  30. 30.
    Karnath HO: Subjective body orientation in neglect and the interactive contribution of neck muscle proprioception and vestibular stimulation. Brain 1994, 117:1001–1012.PubMedCrossRefGoogle Scholar
  31. 31.
    Snyder LH, Batista AP, Andersen RA: Coding of intention in the posterior parietal cortex. Nature 1993, 386:167–70.CrossRefGoogle Scholar
  32. 32.
    Snyder LH, Grieve KL, Brotchie P, Andersen RA: Separate body-and world-referenced representations of visual space in parietal cortex. Nature 1998, 24:887–890.Google Scholar
  33. 33.
    Jackowski MM: Altered visual adaptation in patients with traumatic brain injury: photophobia, abnormal dark adaptation, and reduced peripheral visual field sensitivity. In Visual and Vestibular Consequences of Acquired Brain Injury. Edited by Suchoff IB, Ciuffreda KJ, Kapoor N. Santa Ana: Optometric Extension Program Foundation; 2001.Google Scholar
  34. 34.
    Borish IM: Clinical Refraction. New York: Professional Press Books/Fairchild Publications; 1970.Google Scholar
  35. 35.
    Suchoff IB, Gianutsos R, Ciuffreda KJ, Groffman S: Vision impairment due to acquired brain injury. In The Lighthouse Handbook on Vision Impairment and Rehabilitation. Edited by Silverstone B. New York: Oxford University Press; 2000. Supporting evidence reviewing the various vision problems following acquired brain injury and the associated ocular anatomy and physiology, where appropriate.Google Scholar
  36. 36.
    Ciuffreda KJ, Tannen B: Eye movement basics for the clinician. St. Louis: Mosby Year Book; 1995.Google Scholar
  37. 37.
    Fayos B, Ciuffreda KJ: Oculomotor auditory biofeedback training to improve reading efficiency. J Behav Optom 1998, 9:1–10.Google Scholar
  38. 38.
    Ciuffreda KJ: Visual vertigo syndrome: a clinical demonstration and diagnostic tool. Clin Eye Vis Care 1999, 11:41–42.CrossRefGoogle Scholar
  39. 39.
    Ciuffreda KJ, Levi DM, Selenow A: Amblyopia: basic and clinical aspects. Boston: Butterworth; 1991.Google Scholar
  40. 40.
    Press LJ: Applied Concepts in Vision Therapy. St. Louis: Mosby; 1997.Google Scholar
  41. 41.
    Gianutsos R: Functional and subjective visual fields: practical methods for the assessment of vision and promotion of metavision in brain injury survivors with visual field loss. In Visual and Vestibular Consequences of Acquired Brain Injury. Edited by Suchoff IB, Ciuffreda KJ, Kapoor N. Santa Ana: Optometric Extension Program Foundation; 2001.Google Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Neera Kapoor
    • 1
  • Kenneth J. Ciuffreda
  1. 1.Department of Clinical SciencesState College of Optometry, State College of New YorkNew YorkUSA

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