Neuro-Optometric

Who Should Have a Neuro-Optometric Assessment?

A Neuro-Optometric Assessment is recommended for anyone who has experienced an acquired brain injury (concussion, trauma, stroke, etc). The visual system and visual performance are affected in the majority of brain injury cases. It is important to note that not all changes result in blurred vision. For this reason, it is important to have a Neuro-Optometric Assessment even if vision seems to be clear following a brain injury.

A Neuro-Optometric Assessment is also recommended for anyone with a neuro-degenerative condition. Vision deficits can occur suddenly or progress gradually over time. Slowly progressive vision conditions can be difficult for the patient to identify as they adapt to their degrading vision over time. Because of this, patients with neuro-degenerative conditions are often unaware of changes to their vision. A Neuro-Optometric Assessment is not only beneficial to identify current visual limitations, but also serves as an important baseline measure to monitor future progression.

Keep in mind that not all vision conditions cause blurred vision. There are a number of symptoms that result from vision changes secondary to neurological conditions. It is especially important that a Neuro-Optometric Vision Assessment be performed for individuals experiencing the following signs and symptoms:

• Fluctuating vision
• Increasing difficulties wearing pre-injury glasses or contacts
• Double vision (even intermittent)
• Eye strain, discomfort or soreness
• Headaches after visual tasks
• Visual fatigue
• Balance difficulties
• Avoidance of visual tasks (such as reading, computer work)
• Covering or closing one eye (especially while reading)
• Frequent blinking or squinting
• Abnormal posture during near tasks (tilting or turning the head, leaning very close to the page, constant moving and re-positioning while working)
• Reading difficulties (skipping lines, loss of place, difficulties with fluency or comprehension)
• Difficulties identifying visual information to the sides (trouble with peripheral vision)
• Difficulties with scanning visual environment (required for safe driving)
• Prolonged processing speed with visual tasks (difficulties making timely decisions)

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What is Tested During a Neuro-Optometric Assessment?

A Neuro-Optometric Assessment consists of testing specific to post-trauma vision changes. It is important to note that these types of tests are not included in a typical routine eye exam. For this reason, an eye examination with a primary eye care provider does not replace a Neuro-Optometric Assessment to identify and accurately diagnosis post-trauma vision changes.

Our team evaluates several aspects of visual function during a Neuro-Optometric Assessment using age-standardized testing. The visual skills tested are used throughout each day to efficiently take in and interpret visual information. Skills tested include:

Accommodation (Eye Focusing)

While seeing clearly is important, it is equally important to keep things clear. Accommodation, or eye focusing, allows an athlete to keep the game in focus. The strength, speed and accuracy of accommodation are especially important when viewing objects moving at high speeds (such as a ball or puck) or when scanning the field of play.

Depth Perception (3D)

Often called “3D vision”, depth perception is dependent on the ability to use both eyes together in a very precise manner. Depth perception is important in every sport. Precise depth perception allows you to identify the exact location of an object (for example a ball) so that you can hit, kick or catch it. Depth perception also tells that athlete where they are in space, which is especially important when in motion.

Fusion

Fusion is the ability to use both eyes together - is the foundation of depth perception and binocular vision (utilizing both eyes in a coordinated manner). Stable fusion allows the athlete to take in visual information in a reliable and consistent way. Instability of fusion disrupts athletic performance and can lead to inconsistent performance or difficulties with specific aspects of your game.

Ocular Health

A traumatic brain injury can affect multiple aspects of ocular health; traumatic cataract, traumatic glaucoma and retinal detachments are just a few examples. A thorough evaluation of ocular health should be performed following an acquired brain injury.

Ocular Motility (Eye Movements)

Eye movements must be fast, accurate, and coordinated while participating in sports. Eye movements are used to quickly scan the field of play or to track a moving object. The saying 'keep your eye on the ball' stresses the importance of efficient eye movements during competition.

Ocular Posture (Resting Position)

Ocular posture, or the resting position of the two eyes, is evaluated to determine the presence or absence of strabismus (eye turn). Eye position is also related to how hard you must work to coordinate your eyes. Depth perception, fusion, ocular motility, vergence, and visual acuity are all affected by ocular posture.

Vergence (Eye Teaming)

The strength and flexibility of the eye teaming system should be evaluated. Deficits in eye teaming will result in double vision, eyestrain, fatigue, headaches, or dizziness. Deficiencies of the vergence system will affect sports performance either globally or during specific aspects of your game (such as putting in golf).

Visual Acuity (Clarity)

Clear vision is the foundation of both visual performance and overall performance. Simply put, if you cannot see well you cannot expect to play well. While 20/20 vision is adequate for daily life, most competitive athletes benefit from seeing better than 20/20. Athletes rely on clear vision to perform at their best.

Processing Speed

Once visual information is taken in, it must be processed by the brain. Visual processing speed refers to how quickly and efficiently an athlete is able to make sense of visual information. In other words, how much information can an athlete process in a given amount of time. Processing speed allows for split second decisions and reactions to a changing visual environment.

Spatial Awareness/Visual Attention

People often comment that an athlete has 'vision' or 'sees the game'.They are referring to the player's spatial awareness and visual attention. Sports often require an athlete to divide their visual attention between central objects (such as the ball) and peripheral objects (such as incoming defenders). Seeing the game allows an athlete to play at a high level.

Visual Field (Side Vision)

Peripheral, or side vision, can be affected following an acquired brain injury. Strokes, or cerebrovascular accidents, often result in visual field defects. Patients with visual field loss after a brain injury can complain of blurred vision, darkening of vision or a shadow in one area of vision. Visual field loss negatively impacts mobility and driving. Additionally, visual field loss increases the risk for repeat falls.

Visual Perception

This group of skills includes visual discrimination (determining likeness), spatial relations (determining differences), form constancy (determining sameness even when changed in size or orientation), visual memory, visual sequential memory, figure-ground (extracting valuable information from the background), and visual closure (ability to put the pieces together to form the whole). These perceptual skills are essential for athletic success.

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