August 03, 2018
2 min read

BLOG: 5 reasons to refer to a neuro-optometric rehabilitation OD

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Shirley Ha
Shirley Ha

by Shirley Ha, HBSc, OD, FCOVD

Here are five situations that are relatively common in clinical practice where a referral to or a consult with a neuro-optometric rehabilitation optometrist might be in order.

Concussion. Patients who have had a concussion, labeled mild traumatic brain injury (mTBI), may continue to experience serious visual processing-related motion sickness or photosensitivity even after being “cleared” to return to work, school or sports. A neuro-optometric evaluation can help resolve symptoms and ensure that there are no continued functional problems.

Patients don’t always connect nausea and dizziness to their eyes. It is important to educate the families about the vision connection — perhaps starting with baseline screenings with families already in your practice who play sports or whose kids play sports.

Traumatic brain injury (TBI). Ninety percent of patients with TBI — an injury from an external blow to the head, such as in a car accident, sports injury or a fall — suffer from visual dysfunctions. These may include blurred vision, sensitivity to light, headaches with visual tasks or visual field loss. The medical team understandably focuses on life-threatening issues first, but it is important to also address the visual symptoms that can affect patients’ quality of life.

Progressive neurological impairments. Patients with Parkinson’s, Alzheimer’s or multiple sclerosis can have detrimental vision-related functional deficits that affect eye movements, mobility, perception, speed of processing and cognition. They also deserve a neuro-optometric consult to see if they can benefit from neuro-vision rehabilitation that may help expand the connectivity in their declining brain areas.

Strabismus. Outside of any physical or structural damage to the nerves innervating the extraocular muscles (EOMs) or the EOMs themselves, optometrists know the problem is not in the EOMs, but rather a maladaptation where the brain doesn’t accurately tell the EOMs where to look and see. Strongly consider a neuro-optometric referral before recommending strabismus surgery.

Patients who avoid specific vision-related situations. Patients often cope with functional deficits by simply stopping the activity that is bothersome. For example, a patient who struggles with double vision or teaming problems at near may just stop reading books. Someone with a neurosensory deficit may avoid crowds. These patients may benefit from a neuro-rehabilitation assessment to rule out vision as the root cause and to widen their opportunities to enjoy these activities. This is because vision is learned and developed through experience.

These situations all present great opportunities to support and comanage patients with your neuro-optometric colleagues. To find a neuro-optometric rehabilitation optometrist near you, visit Or consider expanding your own awareness and clinical skills around these topics at the Neuro-Optometric Rehabilitation Association Annual Conference, to be held Sept. 20 to 23 in St. Louis.


Ciuffreda KJ, et al. Optometry. 2007;doi:10.1016/j.optm.2006.11.011.

For more information:

Shirley Ha, HBSc, OD, FCOVD, who practices in Burlington, Ontario, is the Membership Committee chair for NORA and a member of the board of the Canadian Optometrists in Vision Therapy and Rehabilitation.

Disclosure: Ha reports no relevant financial disclosures.