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Traumatic Brain Injury and Vision Therapy


I have already discussed in detail the numerous visual problems an individual can have after a traumatic head injury even if the eyeballs are healthy. Traumatic Brain Injury (TBI) affects the manner in which the eyes and brain communicate.

The question then becomes simple: “How can we fix these disturbed connections?”
The answer: “Not easily.”

So we are now venturing into one of the more controversial subjects in TBI- Vision Therapy or Vision Training?

There are a number of optometrists who treat people with vision disorders that cannot be simply managed by medication, surgery, or glasses. These practitioners have patients come into their offices for 30-minute sessions to help retrain the eyes of people having visual problems.

These sessions often involve eye movement exercises, specialized equipment to retrain the eye muscles and eye movement, as well as computer-generated visual tasks. The effort is to rehabilitate the eye after a brain injury. In many ways it is similar to an orthopedic surgeon sending a patient for Physical Therapy after severe whiplash. As we all know, surgeons cannot always fix everything, and patients can increase muscle movement and decrease pain with special therapy.

Well, the eye is a little different, not as easy to fix. For years, optometrists have been working with school age kids who have difficulty reading. Not because these children aren’t smart or can’t see, they may simply have trouble scanning a page.

Much is written about these children in the optometric research literature, and some students show definite improvement. Certain optometrists have gotten involved with adults who after automobile accidents have difficulty reading. Again, some of the results are encouraging.

But there is a debate- such therapy is time-consuming (30 minute sessions over many weeks or months at approximately $150 per session). Costs can run into thousands of dollars, and are not usually covered by medical insurance.

I am an Ophthalmologist who specializes in seeing TBI patients- I personally don’t have the time to perform Vision Therapy. To be very honest, there is often a disagreement between ophthalmologists and optometrists on how effective therapy can be.

I’ve reviewed the literature and like to keep an open mind. I recognize many optometrists are dedicated to Vision Therapy, strongly believe in their work, and are committed to helping their patients.

Regarding TBI and Vision Therapy, I think the option should be explained to the patient. I can diagnose and evaluate TBI as a medical expert, but besides reassurance and fitting the patient with glasses, I have little to offer. Many of these patients need to return to work, and the cost of Vision Therapy should be considered in their life plan.

We can’t simply turn our backs and say nothing can be done.

Until better therapy comes along, Vision Therapy is a possible road back to visual health. Ophthalmologists such as myself don’t generally perform this line of treatment, and it can be expensive.

I’ve tried to be fair, I have no difficulty in recommending Vision Therapy to my patients, there are no guarantees, but I value the professional services of optometrists and I keep an open mind on working together. As a medical legal expert I can help judge if a patient may be a candidate for therapy and what the cost may be. Because I don’t directly financially benefit from collecting fees for these services, I believe I can be fair.

TBI patients are not always easy to care for- I always try to provide good advice.

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