Neuro-Optometric Assessment

The visual process is commonly affected following an acquired brain injury (concussion, trauma, stroke, etc) or as part of a neurological condition (Parkinson's Disease, multiple sclerosis, seizure disorders, etc). Changes to the visual system can result in blurred vision, double vision, discomfort, headaches, poor depth perception, balance difficulties, changes in peripheral (side) vision and limited ability to perform visual tasks throughout the day (reading, driving, computer use, etc). Early diagnosis and treatment of these vision conditions is a critical component of overall recovery. Lingering vision conditions impede rehabilitation therapies (physical therapy, occupational therapy, speech therapy, etc) as well as prolong the return to normal daily activities.


A Neuro-Optometric Assessment with Advanced Vision Therapy Center is specifically designed to assess neurological changes to the visual system. Several areas of visual performance are evaluated using age-standardized tests. This allows the doctor to identify visual system deficits and prescribe a treatment plan specific to the individual. Visual system deficits impede rehabilitative therapies and overall recovery. That's why it is important that the results of the Neuro-Optometric Assessment be shared with the rehabilitation team (physical therapist, occupational therapist, speech therapist, etc). A collaborative, multi-disciplinary team approach to care is an important part of the patient's recovery plan.


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)

Why Have a Neuro-Optometric Assessment?

A Neuro-Optometric Assessment is crucial for identification of vision conditions that are unlikely to be identified by other members of the care team or during a routine eye examination. Early identification of vision problems allows for early intervention. Undiagnosed vision problems can impede overall recovery or prevent the return to previous activities. Keep in mind that vision is our dominant sense. Vision dysfunction can limit success with many activities of daily living; including driving, reading, hobbies, or returning to work. Vision also plays a central roll with balance (visual-vestibular process) and eye-hand coordination (visual-motor integration). Anyone participating in vestibular therapy or occupational therapy after an acquired brain injury should have a Neuro-Optometric Assessment as part of early rehabilitative efforts to ensure the greatest success.


Fortunately, many of the vision conditions that result from an acquired brain injury can be improved with proper treatment. A Neuro-Optometric Assessment allows the doctor to identify vision system deficits and then prescribe a targeted treatment plan. Treatment for post-trauma vision changes can include task specific eyeglass prescriptions to improve visual comfort and performance, or active rehabilitation in the form of Neuro-Optometric Vision Rehabilitation. A Neuro-Optometric Assessment is the first step to visual recovery.

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 skills): Accommodation, or eye focusing, is commonly affected following an acquired brain injury. Accommodative dysfunction can result in blurred or fluctuating vision as well as eye strain or visual fatigue. While accommodative abilities are expected to decline with age (creating the need for reading glasses), an acquired brain injury can dramatically reduce this visual ability in an instant.

  • Depth Perception (3D vision): Many patients report challenges with depth perception or balance difficulties following an acquired brain injury. Post-trauma changes in depth perception can erode one's confidence with daily tasks such as driving, participating in sports, hobbies, and routine physical activity. Depth perception, and the causes for reduced depth perception, are evaluated during a Neuro-Optometric Assessment.

  • Fusion: Fusion is a fundamental visual skill that allows for clear, comfortable, single binocular vision. Fusion is the ability of the neuro-visual system to use the visual signal from both eyes in a coordinated manner. Fusion deficits following an acquired brain injury can result in double vision, headaches, eye strain, poor balance or coordination and even nausea. It is important to note that fusion deficits can be constant or intermittent. It is important that a Neuro-Optometric Assessment be performed to evaluate the stability and function of the binocular vision system.

  • 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): Ocular motility can be affected in several ways following an acquired brain injury. Coordinated eye movements rely on an in-tact and fully functional neuro-visual system. In some cases, such as a cranial nerve palsy, eye movements can be restricted; the individual is unable to move the eyes into a certain position. More commonly, eye tracking abilities are disrupted. Eye tracking is affected so often in acquired brain injury that eye tracking tests are used during the diagnostic process (for example, concussion diagnostic protocols). Deficits in ocular motility can result in reading difficulties or double vision.

  • Ocular Posture (resting position): Ocular posture, also called 'eye alignment', describes the resting position of the right and left eye relative to one another. If an acquired brain injury causes a misalignment of the eyes, the patient can experience headahces, eyestrain, fatigue and double vision. Ocular posture must be carefully evaluated during a Neuro-Optometric Assessment as small deficits can cause big problems in daily life.

  • Vergence (eye teaming): Vergence is a skill used on a daily basis to maintain single vision. Convergence describes the ability to cross one's eyes to view objects at near (reading, computer, etc) while divergence describes the ability to uncross one's eyes to view distance objects (television, driving etc). Vergence dysfunction results in double vision, eyestrain, fatigue, headaches, or dizziness. We assess all aspects of vergence using age-standardized testing to determine the most appropriate treatment plan to improve eye teaming abilities.

  • Visual Acuity: The clarity of sight is one of the first visual skills assessed during a Neuro-Optometric Assessment. Changes in visual clarity following an acquired brain injury can have several causes. A thorough evaluation of visual performance allows our doctor to determine the source of visual changes.

  • 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.

  • Processing Speed: A Neuro-Optometric Assessment with Advanced Vision Therapy Center not only assesses how efficiently information is taken in by the visual system, but also how quickly and efficiently it is interpreted by the brain. Visual processing speed is a skill that allows us to quickly make sense of visual information. This is important for making time-sensitive decisions (such as while driving or completing timed activities).

  • Visual Perception: Visual perception is the ability to understand what is being viewed (make sense of visual information). Deficits in visual perception, for example, can cause difficulties with crowded environments. Visual perceptual skills include: 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). 

When Should a Neuro-Optometric Assessment be Performed?

A Neuro-Optometric Assessment should be performed early in the recovery process. It is important to determine the integrity of the visual system (how fragile is the visual system, to what degree is performance affected, etc) and to accurately diagnose visual system deficits. A primary goal of recovery is to re-establish a stable neuro-visual system (including visual, visual-motor, and visual-vestibular abilities); critical to the recovery efforts of rehabilitative therapies such as physical therapy, occupational therapy, speech therapy, etc. and overall improvement. It is important to remember that visual system deficits impede rehabilitative therapies and prolong the road to recovery.

Improvement Starts Here

With over 25 years of proven success, you can trust Advanced Vision Therapy Center to provide the care you need.

Our Clinical Director is Idaho's only residency trained optometrist in vision therapy and neuro-optometry and is a Fellow of the American Academy of Optometry.  His residency at University of California, Berkeley means he has the expertise and experience to treat even the most complex cases.

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Contact Us

7960 W. Rifleman Street, #155
Boise , Idaho , 83704 USA
Phone:  208-377-1310
Fax:  208-321-1952