Understanding Visual Dysfunctions from Traumatic Brain Injury

Traumatic brain injury (TBI) from a bump, blow, jolt to the head, or from a penetrating brain injury, can happen to people of all ages. Such injuries typically result from car accidents, playing sports, or from a fall. Children and older adults are especially at risk.

Changes in memory or cognition may come to mind first as outcomes of TBI. But visual dysfunction also is a common consequence of concussion and other head injuries. In fact, “vision impairment and visual dysfunction resulting from TBI are often neglected and attributed to loss in cognition or to the previous trauma,” says Andrea Zimmerman, OD, FAAO.

Optometrists, occupational therapists, neurologists, and other healthcare professionals need to be aware of the changes to vision that can occur alongside TBI, and how to identify and address visual dysfunction and impairment in people with TBI.

Vision changes after TBI include blurry vision, loss of peripheral vision, double vision, sensitivity to light, and fatigue when reading or doing other activities that require intense visual attention. Some patients have difficulty with eye movements. All people with TBI should have a comprehensive eye examination.

“Treatment with various low vision devices and vision training can be helpful for improving the visual function and quality of life for these patients, says Dr. Zimmerman. “It’s also important to realize that visual dysfunction may be created or exacerbated, particularly with mild TBI.”

What’s more, vision changes interconnect with neurological, physical, and psychological difficulties that can accompany TBI. People may have headaches, trouble with balance, or difficulty reading others’ facial expressions that are related, in part, to impaired vision. They often feel self-conscious about these changes and may become socially isolated or depressed.

“TBI and vision loss can have a profound impact on emotions, self-care, activities, relationships, and identity,” says Laura Newman, PhD. “When a person must halt their career or leave college, or not be able to pick their kids up from school, there’s a great shift in their sense of self. Mental health and other healthcare professionals have a significant role in helping patients by allowing them to mourn their losses while at the same time enabling them to see that new gains can be made.”

Dr. Newman recalls a patient who was successful in a fast-paced corporate job before a brain injury and visual field loss forced him to quit working. “He went through a period of very extreme loss and mourning,” she says. But eventually, with his remaining vision, the patient was able to explore art—a new interest—through photography and painting. “He very much values the life he has now,” says Dr. Newman.

Dr. Newman encourages healthcare professionals to remember that “the opportunity for people to have exciting new engagements is not lost, even when somebody suffers a severe disability such as traumatic brain injury combined with vision loss.”

To prepare healthcare professionals to address the many ways vision is affected by TBI, Lighthouse Guild has developed a one-hour online continuing education program on traumatic brain injury and visual dysfunction. Designed for optometrists, rehabilitation professionals, and others, the eLearning program focuses on approaches for identifying and assessing visual dysfunction and impairment i patients with TBI, for differentiating visual symptoms from symptoms related to brain injury, and for addressing these symptoms. Four Lighthouse Guild healthcare professionals who concentrate their practices on treating patients with low vision present the program: a neurologist, Helen Chang, MD; a low vision optometrist, Andrea Zimmerman, OD, FAAO; an occupational therapist, Inna Babaeva, OT, PhD; and a clinical psychologist, Laura Newman, PhD. 

The course introduces these key topics:

• Identifying visual dysfunctions and the associated symptoms commonly seen after TBI
• Basic approaches for assessing visual function in patients with TBI
• Common treatments for visual dysfunction and impairment related to TBI, including vision therapies
• The psychological impact of TBI and visual dysfunction

“Vision loss accompanies and intersects with many other health conditions, and a care team that addresses both physical and mental health, as well as rehabilitation needs, can best help people live more independent lives,” says AnneMarie O’Hearn, Vice President Education and Training at Lighthouse Guild.

This course is accredited for continuing education for optometrists by COPE #118557 and is also approved by the Commission on Rehabilitation Counselor Certification (CRCC) for 1 hour #60007914172.

Learn more about the online program, Traumatic Brain Injury (TBI) and Visual Dysfunction