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The writer Ernest Hemingway received at least nine documented traumatic brain injuries during his many career adventures. Here we speculate on the possible visual and related sequelae of these repeated injuries, their likely effect on his writing and productivity, and the impact that neurooptometry might have had on his overall healthrelated well-being. [ABSTRACT FROM AUTHOR]

Visual disturbances are amongst the most commonly reported symptoms after a traumatic brain injury (TBI) despite vision testing being uncommon at initial clinical evaluation. TBI patients consistently present a wide range of visual complaints, including photophobia, double vision, blurred vision, and loss of vision which can detrimentally affect reading abilities, postural balance, and mobility. In most cases, especially in rural areas, visual disturbances of TBI would have to be diagnosed and assessed by primary care physicians, who lack the specialized training of optometry. Given that TBI patients have a restricted set of visual concerns, an opportunity exists to develop a screening protocol for specialized evaluation by optometrists—one that a primary care physician could comfortably carry out and do so in a short time. Here, we designed a quick screening protocol that assesses the presence of core visual symptoms present postTBI. The MOBIVIS (Montreal Brain Injury Vision Screening) protocol takes on average 5 min to perform and is composed of only “high-yield” tests that could be performed in the context of a primary care practice and questions most likely to reveal symptoms needing further vision care management. The composition of our proposed protocol and questionnaire are explained and discussed in light of existing protocols. Its potential impact and ability to shape a better collaboration and an integrative approach in the management of mild TBI (mTBI) patients is also discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Visual dysfunctions are common in individuals following concussion/mild traumatic brain injury (C/mTBI). Many deficits have been uncovered in their oculomotor system, such as in the pupil and accommodation. OBJECTIVE: To describe the static and dynamic abnormalities in the pupillary and accommodative systems in those with C/mTBI. This includes both diagnostic and therapeutic aspects, with emphasis on objectively-based test findings, as well as their basic and clinical ramifications. METHODS: PubMed, Google Scholar, and Semantic Scholar databases were searched from 1980–2020, using key words of accommodation, pupil, vision therapy, vision rehabilitation, and objective testing, for peer-reviewed papers, as well as related textbooks in the area, in those with C/mTBI. RESULTS: For both systems, most static and dynamic response parameters were abnormal: they were typically reduced, slowed, delayed, and/or more variable. Most of the abnormal accommodative parameters could be significantly improved with vision therapy. CONCLUSIONS: For both systems, most response parameters were abnormal, which could explain their visual symptoms and related problems. For accommodation, the improvements following vision therapy suggest the presence of considerable visual system plasticity, even in older adults with chronic brain injury. [ABSTRACT FROM AUTHOR]

Visual disturbances are amongst the most commonly reported symptoms after a traumatic brain injury (TBI) despite vision testing being uncommon at initial clinical evaluation. TBI patients consistently present a wide range of visual complaints, including photophobia, double vision, blurred vision, and loss of vision which can detrimentally affect reading abilities, postural balance, and mobility. In most cases, especially in rural areas, visual disturbances of TBI would have to be diagnosed and assessed by primary care physicians, who lack the specialized training of optometry. Given that TBI patients have a restricted set of visual concerns, an opportunity exists to develop a screening protocol for specialized evaluation by optometrists—one that a primary care physician could comfortably carry out and do so in a short time. Here, we designed a quick screening protocol that assesses the presence of core visual symptoms present post-TBI. The MOBIVIS (Montreal Brain Injury Vision Screening) protocol takes on average 5 min to perform and is composed of only “high-yield” tests that could be performed in the context of a primary care practice and questions most likely to reveal symptoms needing further vision care management. The composition of our proposed protocol and questionnaire are explained and discussed in light of existing protocols. Its potential impact and ability to shape a better collaboration and an integrative approach in the management of mild TBI (mTBI) patients is also discussed.

Neuro-optometric rehabilitation is a recognised intervention for treating visual dysfunctions resulting from acquired brain injury and is practised by a small but enthusiastic group within the profession of optometry. The use of evidence-based medicine has become increasingly important to support the integrity and acceptance of treatment and management of patients within this population. Although this discipline has made great strides in recent times and is becoming increasingly included in multi-disciplinary management, the volume of literature initially has been relatively light and dominated by a small number of researchers. This paper considers some of the most recent research supporting the use of neuro-optometry in the management of patients with visual conditions related to acquired brain injury. As optometrists are seeing increasing numbers of patients with traumatic brain injury/concussion, significant emphasis has been placed on these areas. [ABSTRACT FROM AUTHOR]

Visual snow syndrome (VSS) is a complex neurological condition presenting with an array of sensory, motor, and perceptual dysfunctions and related visual and non-visual symptoms. Recent laboratory studies have found subtle, basic, saccadic-based abnormalities in this population. The objective of the present investigation was to determine if saccadic-related problems could be confirmed and extended using three common clinical reading-related eye movement tests having well-developed protocols and normative databases. This was a retrospective analysis of 32 patients (ages 16–56 years) diagnosed with VSS in the first author's optometric practice. There was a battery of three reading-related tests: the Visagraph Reading Eye Movement Test, the Developmental Eye Movement (DEM) Test, and the RightEye Dynamic Vision Assessment Test, all performed using their standard documented protocols and large normative databases. A high frequency of oculomotor deficits was found with all three tests. The greatest percentage was revealed with the Visagraph (56%) and the least with the RightEye (23%). A total of 77% of patients failed at least one of the three tests. The present findings confirm and extend earlier investigations revealing a high frequency of saccadic-based oculomotor problems in the VSS population, now including reading-related tasks. This is consistent with the more general oculomotor/motor problems found in these individuals. [ABSTRACT FROM AUTHOR]

To report the retrospectively-based, clinical diagnostic findings for the horizontal, distance, fusional facility (DFF) test in the non-TBI (traumatic brain inury), ABI (acquired brain injury) population. The DFF test (4 pd base-out/2 pd base-in) was assessed and compared retrospectively in the first author's optometric practice in three clinical populations: (1) post-mTBI, visually-symptomatic (n = 52), (2) post-ABI, non-mTBI, visually-symptomatic (n = 34), and (3) visually-normal, visually asymptomatic (n = 44). The DFF values in each group were significantly different from each other (p < 0.05). The mean non-TBI, ABI group value was significantly lower than found in the mTBI group, and both were significantly lower than the mean found in the normal cohort (p < 0.05). There was a significant reduction in DFF with increased age (p < 0.001). ROC values for the AUC ranged from excellent to acceptable (0.94–0.74). The DFF test is a new and useful way to assess horizontal, distance, dynamic, fusional facility in those with presumed non-mTBI, ABI neurological conditions to assist in its diagnosis. [ABSTRACT FROM AUTHOR]

The area of neuro-optometry, a subspecialty of optometry, has started a long time ago and continued to serve patients with neurological dysfunctions of the visual system through various methods and applications. The efficiency of neuro-optometric rehabilitation has been proved by a wealth of scientific presentations and publications in the area of neuroscience. However, this subspecialty of optometry has not yet been appreciated and recognized in many regions of the world. This scientific article outlines neuro-optometry, neuro-optometrist’s duties, and neuro-optometric rehabilitative implications in order to highlight the importance of neuro-optometric rehabilitation, to shed a light on one of the missing responsibilities of optometrists in the area of neuroscience, to present the significance of references and sources worked in this area of science, and to define relevant duties for optometrists who wish to work in this sector.

The area of neuro-optometry, a subspecialty of optometry, has started a long time ago and continued to serve patients with neurological dysfunctions of the visual system through various methods and applications. The efficiency of neuro-optometric rehabilitation has been proved by a wealth of scientific presentations and publications in the area of neuroscience. However, this subspecialty of optometry has not yet been appreciated and recognized in many regions of the world. This scientific article outlines neuro-optometry, neuro-optometrist's duties, and neuro-optometric rehabilitative implications in order to highlight the importance of neurooptometric rehabilitation, to shed a light on one of the missing responsibilities of optometrists in the area of neuroscience, to present the significance of references and sources worked in this area of science, and to define relevant duties for optometrists who wish to work in this sector. [ABSTRACT FROM AUTHOR]

Background: Visual midline shift syndrome (VMSS) is an uncommon sequela of mild traumatic brain injury (mTBI). Untreated, VMSS may contribute to vague complaints of visual discomfort and balance or postural dysfunction. Identifying and treating this condition may improve visual outcomes and quality of life for an mTBI patient. Case Report: A 24-year-old female Soldier with a history of at least one concussive event and complaints of drifting when walking, photophobia, asthenopia, and persistent visual blur presented to the optometry clinic via a referral from her nurse case manager. Her initial visit failed to yield any reliable information regarding her symptoms due to fatigue, over-medication, and distraction, so we delayed any treatment until she could return in a better state of mind. Over her next four visits, we conducted a full ocular health examination and an extensive neuro-optometric evaluation, and we diagnosed her with convergence insufficiency and VMSS. We then issued corrective lenses and yoked prism in a stepped fashion. She responded progressively better to each intervention, and one month after her final visit, she was largely visually asymptomatic. Conclusions: A deliberate approach to care and a thorough neuro-optometric examination is indicated for any patient manifesting visual sequelae of mTBI during their initial comprehensive ophthalmic examination. Proper treatment of subtle dysfunctions evident only upon careful evaluation and consideration of all of a patient’s concerns can have a positive impact on the patient’s quality of life. [ABSTRACT FROM AUTHOR]

Very few health professionals, including those in rehabilitation hospitals, concussion clinics, brain injury centers, settings for children with special needs and those dealing with neurologically compromised patients are adequately aware of visual problems resulting from congenital or acquired conditions. Unfortunately, this creates a gap in rehabilitative services, resulting in incomplete treatment and frustration for the patient, family and treatment team. This article will help the reader better understand neuro-optometry, when a referral to a neuro-optometrist will be helpful, and how to better understand the information report after a neuro-optometry evaluation. [ABSTRACT FROM AUTHOR]

Background and Purpose: Sacroiliac joint dysfunction (SIJD) is a condition affecting 15-30% of patients withlow back pain seen in outpatient clinics. Currently there is no well-defined standard of care. The purpose of this case report is to discuss the multidisciplinary management between an athletic trainer and an optometrist for an athlete with bilateral SIJ dysfunction and a visual midline shift syndrome. Case Description: A 21-year-old collegiate baseball player reported to the athletic training room, presenting with low back pain of three day duration, with tenderness over both posterior superior iliac spines (PSIS) (left > right). His pain at its worse was a 7/10 on the Numeric Pain Scale (NPS). The pain increased to the point that it limited his activities of daily living (ADLs) including getting dressed, putting on his shoes, sleeping, and getting in and out of a car. Interventions: The athlete was initially treated using traditional muscle energy techniques (MET) based intervention to correct SIJD, and lumbar stabilization exercises directed by a licensed athletic trainer, as well as manipulation by a chiropractor. Three weeks of treatment did not prove to be beneficial with only a minimal (1 point on the NPRS) decrease in pain. The athlete was then referred to the head athletic trainer for consultation who prescribed orthotics, for bilateral rear-foot valgus, and Postural Restoration (PR) therapeutic exercises. After two weeks of orthotic use and PR exercises the athlete’s pain decreased one additional point on the NPRS. Due to lack of progress, an optometrist was then consulted. The neuro-optometrist prescribed 2 diopter base-down prisms to be worn two hours a day, for four weeks. After four weeks of prisms and new exercises, the athlete was asymptomatic and returned to full pain-free baseball participation without further complications. Outcomes: The Oswestry Disability Index Questionnaire (ODI) was 48% at initial (severe disability), 40% at five weeks and 0% at discharge. The Numeric Pain Scale (NPS) score went from 7/10 to 0/10. Discussion: The athlete demonstrated only minimal relief of symptoms following MET, therapeutic exercises, and chiropractic manipulation. Intervention using prism glasses and PR exercises, designed to optimize posture and correct his visual midline shift syndrome, led to complete resolution of his symptoms. Evidence Level: 3B [ABSTRACT FROM AUTHOR]

Due to the very nature of the patients that they treat, neuro-optometrists may become involved with the United States legal system. The patient may retain an attorney, often to interact with a third-party payer responsible for medical treatment reimbursement or monetary damages. An attorney may also retain a neuro-optometrist for forensic purposes. This paper explores areas of the legal system and specific case management that an optometrist should be familiar with when working with patients that suffer from a brain injury. Aspects of the relationship between the optometrist and an attorney will be explored. [ABSTRACT FROM AUTHOR]

Visual disturbances are amongst the most commonly reported symptoms after a traumatic brain injury (TBI) despite vision testing being uncommon at initial clinical evaluation. TBI patients consistently present a wide range of visual complaints, including photophobia, double vision, blurred vision, and loss of vision which can detrimentally affect reading abilities, postural balance, and mobility. In most cases, especially in rural areas, visual disturbances of TBI would have to be diagnosed and assessed by primary care physicians, who lack the specialized training of optometry. Given that TBI patients have a restricted set of visual concerns, an opportunity exists to develop a screening protocol for specialized evaluation by optometrists-one that a primary care physician could comfortably carry out and do so in a short time. Here, we designed a quick screening protocol that assesses the presence of core visual symptoms present post-TBI. The MOBIVIS (Montreal Brain Injury Vision Screening) protocol takes on average 5 min to perform and is composed of only "high-yield" tests that could be performed in the context of a primary care practice and questions most likely to reveal symptoms needing further vision care management. The composition of our proposed protocol and questionnaire are explained and discussed in light of existing protocols. Its potential impact and ability to shape a better collaboration and an integrative approach in the management of mild TBI (mTBI) patients is also discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abbas Farishta and Farivar.)

The author stresses the importance of words in communication and how they should be used in optometry. He says that optometric organizations need to be careful and deliberate when choosing a name which reflects who they are and what they do. He relates that for several years they were debating the words used to describe what they do to help their patients achieve success and to improve their quality of life. He emphasizes the need to change the words they use to conform with the scientific knowledge available to us.

The brain is equipped with a complex system for processing sensory information, including retinal circuitry comprising part of the central nervous system. Retinal stimulation can influence brain function via customized eyeglasses at both subcortical and cortical levels. We investigated cortical effects from wearing therapeutic eyeglasses, hypothesizing that they can create measureable changes in electroencephalogram (EEG) tracings. A Z-Bell SM test was performed on a participant to select optimal lenses. An EEG measurement was recorded before and after the participant wore the eyeglasses. Equivalent quantitative electroencephalography (QEEG) analyses (statistical analysis on raw EEG recordings) were performed and compared with baseline findings. With glasses on, the participant's readings were found to be closer to the normed database. The original objective of our investigation was met, and additional findings were revealed. The Z-bell SM test identified lenses to influence neurotypical brain activity, supporting the paradigm that eyeglasses can be utilized as a therapeutic intervention. Also, EEG analysis demonstrated that encephalographic techniques can be used to identify channels through which neuro-optomertric treatments work. This case study's preliminary exploration illustrates the potential role of QEEG analysis and EEG-derived brain imaging in neuro-optometric research endeavors to affect brain function.