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TBI Awareness: The Importance of Working With a Neuro-Optometrist

At Advanced Vision Therapy Center in Boise Idaho, we can help with your recovery post TBI.


Traumatic Brain Injury (TBI) is a term used within the medical community to describe an injury to the brain which is not hereditary, congenital or degenerative. Traumatic Brain Injury can be result from a blow to the head, whiplash, seizure disorders, tumors, stroke, toxic exposure, or infectious diseases to name a few. The incidence of prevalence of brain injury outnumbers breast cancer, spinal cord injury, multiple sclerosis and HIV/AIDs combined.


Vision care is an important part of TBI recovery at Advanced Vision Therapy in Boise Idaho


Because Traumatic Brain Injury (TBI) is not hereditary, congenital or degenerative – anyone can experience a TBI at sometime in their life. The statistics are staggering. It is estimated that each year 1.7 million people in the United States sustain a Traumatic Brain Injury. Of these, about 75% are concussions or other forms of Mild Traumatic Brain Injury (MTBI). Most commonly, children ages 0 to 4, adolescents 15 to 19 years of age, and adults 65+ are more likely to sustain an Traumatic Brain Injury. Some reports reveal that 30% of all Traumatic Brain Injury sustained by children occur while participating in sports and recreational activities.


Because approximately 75% of Traumatic Brain Injury cases are concussions, we are going to focus our discussion on concussions. A concussion is a mild form of Traumatic Brain Injury (mTBI) which is caused by a bump, blow or jolt to the head or body that jars, shakes or moves the brain in the skull. It is important that a concussion be properly diagnosed and treated so the brain has the opportunity to recover, and to prevent symptoms from worsening.


A concussion can change the way the brain normally functions. Following the injury, symptoms can occur immediately, within a few hours, or several days or even weeks later. Symptoms can include:

  • Amnesia

  • Balance or vestibular problems

  • Blurred vision

  • Confusion

  • Concentration or memory problems

  • Double vision

  • Headache

  • Sensitivity to light

  • Slowed reaction time


Many of the symptoms associated with a concussion are related to the visual system. It is easy to understand why. Almost half of the cranial nerves affect eyesight, 4 directly and 2 indirectly. Many brain abnormalities cause vision problems. That's why it is important to seek the care of a Residency Trained Neuro-Optometrist following a Traumatic Brain Injury. Residency Trained Neuro-Optometrists complete a formal year-long training program dedicated to diagnosing and treating patients with vision problems caused by Traumatic Brain Injury. Idaho currently has one Residency Trained Neuro-Optometrist, Ryan C. Johnson OD FAAO in Boise, Idaho.


Residency Trained Neuro-Optometrists, such as Dr. Ryan C. Johnson, diagnose and treat vision problems following a Traumatic Brain Injury (TBI). These visual deficits include:

  • Accommodation (eye focusing)

  • Binocular vision (eye teaming)

  • Ocular motility (eye tracking)

  • Ocular posture

  • Visual-vestibular interaction

  • Visual field loss

  • Visual information processing (working memory/processing speed)


Let's take a look at how these visual deficits might affect an individual following a Traumatic Brain Injury (TBI).


Symptom Deficit

  • Blurred vision Accommodation/Binocular vision/Vergence

  • Difficulty reading Ocular motility/Binocular vision/Vergence

  • Difficulty with visually stimulating environments Vergence/Visual-vestibular interaction

  • Dizziness Vergence/Visual-vestibular interaction

  • Double vision Ocular posture/Vergence

  • Eyestrain/fatigue Accommmodation/Vergence

  • Missing, or blank, areas of vision Visual field deficits

  • Reduced depth perception Ocular posture/Vergence

  • Slow reading speed Visual perceptual processing/

    Binocular vision


It requires the specialized training of a Residency Trained Neuro-Optometrist such as Dr. Ryan C. Johnson who, with an in-depth understanding of neurological pathways, can properly diagnose and treat:


  • The three types of Accommodative Dysfunction: accommodative insufficiency, accommodative infacility and accommodative excess.

  • Ocular Motility (eye tracking): pursuits / saccades (originating in the pons portion of the brain stem, located above the medulla oblongata and below the midbrain).

  • Fixation: originating in the parietal lobe and prefontal cortex (for attention)

  • The two types of vergence: convergence and divergence. Convergence is turning the eyes inward when looking near. Divergence is turning the eyes outward when looking in the distance.

  • Visual-information processing: 70% of sensory input to the brain is vision related. Vision information is processed (directly or indirectly) in every lobe of the brain. Visual-information processing affects visual memory, visual discrimination, visual spatial relations, figure ground, and visual closure.

  • Visual-vestibular interaction: vision integrates with balance through the Vestibular Ocular Reflex (VOR). The Vestibular Ocular Reflex maintains stable, bifoveal retinal images during head and body movement. A few of the symptoms resulting from Visual-Vestibular Dysfunction include:

    • Closing or covering one eye

    • Difficulty tracking

    • Diplopia (double vision)Disequilibrium

    • Dizziness / nausea

    • Eyestrain / fatigue

    • Loss of place when reading

    • Motion sickness

    • Oscillopsia

    • Sensitivity to visual motion

    • Skipping lines or words when reading

    • Slow reading rate

    • Vertigo


A Residency Trained Neuro-Optometrist, such as Dr. Ryan C. Johnson, can accurately diagnose vision problems caused by a Traumatic Brain Injury (TBI) and prescribe an individualized treatment plan. Prescribed treatment can include:

  • Separate distance and reading glasses. It is not uncommon for patients suffering from a Traumatic Brain Injury to need very different prescriptions for upclose, reading tasks versus far away, distance activities.

  • Prescription lenses that include precise prism correction.

  • A prescribed vision rehabilitation program of vision therapy. Vision therapy is most effective when prescribed and overseen by a Residency Trained Neuro-Optometrist.


If you, or someone you know, has suffered a Traumatic Brain Injury (TBI) we encourage you to seek the care of a Residency Trained Neuro-Optometrist. Traumatic Brain Injury results in life-changing symptoms and deficits. It is important to remember that proper diagnosis is the first step to recovery. A Residency Trained Neuro-Optometrist, such as Dr. Ryan C. Johnson, is uniquely qualified to both properly diagnose and prescribe an effective, individualized treatment plan. We're here to help, and just a phone call away.


Dr Ryan C. Johnson at Advanced Vision Therapy Center is uniquely qualified to help with your recovery post TBI.

Posted by Advanced Vision Therapy Center at 9/22/2017 4:48:00 PM
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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.

Read what our patients have to say.

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  At Advanced Vision Therapy Center our results speak for themselves. Jonah, however, wanted to share his story with you. We invite you to watch this short video to learn more about Jonah's experience and success.   ... Read More
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  Many people have heard of vision therapy, but don't know a lot about it. As with any type of therapy, the effectiveness of the program is dependent upon several factors. It is advisable to ask questions and do your homework. Vision therapy programs vary greatly from provider to provider.   ... Read More
  Everyday in our schools students are presented with information that they are required to look at, interpret, and process that information. For years it was believed that the eyes had nothing to do with learning. That is definitely not the case. Did you know it is estimated that 80% of what we learn is through visual information?     ... Read More
  Convergence Insufficiency (CI) is a common eye-teaming problem which occurs when the eyes are unable to maintain the ocular posture necessary for reading or near tasks. Convergence Insufficiency results from misalignment of the eyes when focusing on up close, such as when reading. The eyes have a strong tendency to drift outward when reading or doing close up work. The exact cause is unknown.    ... Read More
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7960 W. Rifleman Street, #155
Boise , Idaho , 83704 USA
Phone:  208-377-1310
Fax:  208-321-1952