The Neuro-Optometric Rehabilitation Association International is an interdisciplinary group of professionals dedicated to providing patients who have physical or cognitive disabilities as a result of an acquired brain injury with a complete ocular health evaluation and optimum visual rehabilitation education and services to improve their quality of life.

BLOG: Five reasons OD students should consider neurorehab as a specialty

Hannu Laukkanen

by Hannu Laukkanen, OD, MEd, FAAO, FCOVD-A

This is an exciting time to be an optometry student — but also a stressful one, given the high academic standards that must be met along with the high debt load that most optometry students accumulate.

While in school, you may be wondering whether you should specialize and, if so, in what area? I would like to encourage students and recent grads to consider neurorehabilitation, for these five reasons:

It sets you apart

Particularly in areas that are already saturated with established optometrists, it is not at all unusual for young ODs to have to cobble together an income and a patient base from part-time hours at multiple practices. With so much competition, it is beneficial to have a niche that sets you apart from other recent graduates. Bringing some neuro-rehabilitative expertise to the practice(s) where you work will enable you to quickly add value by providing a service that no one else in the practice — and often no one else in the community — is providing.

The need is great

There are more than five million new brain injuries every year, and this number doesn’t even include the many cases in which people suffer a head injury but don’t seek care from a doctor or hospital. Up to 90% of patients with brain injuries will have a visual dysfunction as a result of their injury. Often, these visual problems are initially undetected because they are not apparent with standard brain imaging technologies, but the effects can persist for months or even years. As neurorehabilitation specialists, we can help these patients, but many of us are so busy that we have a 1- to 2-month wait for patients to get an appointment. This is truly an underserved population in almost every community nationwide.

It’s a feel good area of practice

Patients with persistent post-concussive syndrome can be highly symptomatic, to the point that their activities of daily living, social relationships and jobs are compromised. By prescribing lenses (differently than for non-traumatic brain injury patients), prisms, tints, selective occlusion and vision therapy, we can make a dramatic difference in the lives of these patients. Often, we can help them feel and function better relatively quickly. When patients find a neurorehabilitative optometrist who can help them, they are so grateful that they tell everybody they know!

It is intellectually stimulating

Each TBI patient is like a puzzle, with his or her own unique life history and constellation of symptoms. To solve the puzzle, you may need to incorporate expertise from almost every domain of optometric practice, from sports vision, vision therapy, contact lenses and disease to low vision. Personally, I have found it very rewarding to be able to use new and innovative combinations of treatments that best serve this patient population. It is never routine; you get to constantly expand and grow your skills, expertise and self-confidence as a clinician.

It helps you build a broad referral base

Neurorehabilitation also provides an opportunity to work with many different disciplines beyond just optometry and ophthalmology. You may get referrals (or need to refer to) physiatrists, neurologists, occupational therapists, physical therapists, audiologists or chiropractors. For those who are so inclined, it is a great opportunity to practice a more multidisciplinary type of care and to earn respect for our own profession from these co-referral relationships. Building this referral network helps ensure that young optometrists who decide to launch a practice of their own will be able to thrive.

Getting started

If neurorehabilitation sounds a little bit intimidating, I would like to reassure students that, like anything else, when you first enter practice you start with those diagnosis and management strategies that are within your comfort zone. As you continue to see patients needing neurorehabilitative care, your boundaries and clinical self-confidence will greatly expand. Over time, you will be amazed with the variety of complex problems you are confidently diagnosing, managing and successfully treating. It is a wonderfully rewarding area of optometry.

Here are five ways to get started down this path:

  • While in school, make an effort to shadow a neuro-rehabilitative optometrist;
  • Join a neurorehabilitation or neuro-optometry club if one exists at your college of optometry;
  • Attend the NORA annual conference for in-depth education on the topic (save the date: Sept. 10-13, Columbus, Ohio);
  • Attend continuing education sessions on brain injury at major optometric meetings, such as the American Academy of Optometry, the American Optometric Association or the College of Optometrists in Vision Development; and
  • Network with specialists in this field.

For more information:

Hannu Laukkanen, OD, MEd, FAAO, FCOVD-A, is a professor emeritus of optometry at Pacific University and former chief of vision therapy services. As a charter member of Pacific’s internationally recognized Vision Performance Institute, his past research has resulted in dozens of published articles in scientific journals and book chapters and hundreds of scientific lectures and courses. He is a member of the board of directors for the Neuro-Optometric Rehabilitation Association, the Northwest Congress of Optometry and Brain-Injury Connections-Northwest (a support organization for brain injury).

Disclosure: Laukkanen is an educational consultant to the Tianjin Eye Hospital but has no other relevant financial interests to disclose.

Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.