by Tanya Polec, OD, FCOVD
Visual symptoms from a concussion can vary considerably from one case to the next and be difficult to describe (Patients often say, “Things just aren’t the same.”). Moreover, visual symptoms, if untreated, can linger long after the individual has recovered from the concussion.
Unfortunately, I know this from personal experience.
In third grade, after a playground accident, I went from being an advanced reader to a struggling one. Words that had previously marched across the page in an orderly fashion now jumped around, leaving me mystified. My teacher thought I was being “difficult.” I was eventually labeled as having a learning disability. I worked very hard to succeed despite these struggles, and I had the advantage of lots of parental support.
But it wasn’t until age 13 when I finally saw a functional optometrist and was diagnosed with significant eye tracking and teaming deficits that my family and I understood that my reading troubles were likely the result of that long-ago concussion when I fell off the monkey bars, rather than a true learning disability.
That experience — and the realization that many other kids may not be performing to their potential — led me into a career as a concussion specialist and functional vision optometrist. And it has also made me a big believer in the power that we as optometrists can have by simply offering baseline screening to our young patients.
Sports leagues and school teams are increasingly requiring baseline concussion testing for athletes. The testing they advocate is a step in the right direction, but it most often focuses on attention, memory and cognitive performance, rather than visual skills. Additionally, it leaves out lots of children and teens who are at risk for concussion from injuries off the playing field, from car or bicycle accidents or a simple playground fall, like mine.
In just a few minutes, optometrists can perform a baseline screening during a general examination that would provide information on changes in visual function and post-trauma. Probes for key visual skills (ie, eye tracking, teaming, near point of convergence, saccades, pursuits and fixation) are a good basis.
There is also some relatively inexpensive technology available to provide a numerical value for easy comparison. For example, RightEye’s eye tracking system (Brain Health EyeQ) tests pursuit, saccades and fixation, while HTS (Home Therapy Solutions) makes numerous computerized vision therapy assessments, one being the BVA Test. Both of these more comprehensive screenings can be performed by a technician without taking much of the doctor’s time.
For more extensive baseline testing, perceptual skills can be evaluated using the Test of Visual Perceptual Skills. Patients can be retested after a concussion or referred for further evaluation and therapy when the results suggest a problem.
Baseline testing is a great way of proactively evaluating your patients’ functional abilities before anything happens to them and keeping them on track to perform at their best.
For more information:
Tanya Polec, OD, FCOVD, is a neuro-optometric concussion specialist at VQ Learning Sports Rehab in Tucson, Ariz., where she specializes in treating a wide range of visual system issues that are caused by traumatic brain injury. She is a member of the advisory board for the Neuro-Optometric Rehabilitation Association. Polec is also a vision consultant for Sports Medicine Rehabilitation and Concussion Center and works with University of Arizona athletes, the professional Tucson Roadrunner Hockey Team, as well as members of the U.S. Army from Ft. Huachuca.
Disclosure: Polec reports no relevant financial disclosures.