Jefferson Comprehensive Concussion Center

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Neuro-Optometric Assessment

Thursday, June 8th, 2017
Neuro-Optometric Assessments measure aspects of vision relating to the brain and visual system.
Neuro-Optometric Assessment

One of our Wills Eye based team of optometrists performs neuro-optometric assessments. Patients who are experiencing vision disturbances or other vision-related symptoms following a head injury will receive a neuro-optometric assessment as part of the comprehensive evaluation to explore oculo-motor dysfunction from neuro-ocular vision-related disorders. These can occur as the result of damage to the neurological pathways of the visual system, which are often susceptible to injury following a closed head injury such as a concussion. In some cases, patients have pre-existing vision problems that can interfere with concussion recovery.

Your provider will make any needed recommendations such as corrective lenses, prisms, and vision therapy based on the results of your neuro-optometric assessment. Your provider will work closely with other members of your clinical team to ensure a comprehensive treatment plan specific to your injury.

In addition to a traditional eye exam, your neuro-optometrist will evaluate all aspects of your vision and your brain including the following:

Accommodative dysfunction refers to difficulty with eye focusing. While patients can have 20/20 vision, some patients with concussion will note that objects become blurred or go in and out of focus or that it takes several seconds to establish a clear focus. This problem becomes more noticeably as they fatigue. These patients may experience difficulty focusing when reading or using a computer. It required special testing to detect this problem, which is why this issue is commonly missed in a traditional eye exam. A common example of accommodative dysfunction would be when a patient sees clearly when reading up close, but slowly loses clear vision as they adjust back and forth to a point in the distance such as a screen or a board.

Binocular vision refers to proper eye alignment, something your neuro-optometrist will assess for during an exam.

Convergence insufficiency refers to the inability of the eyes to each maintain a precise lock on an image as is moves toward the face. The two eyes must be locked on the image to create a 3-D image in the brain.  If the eyes are not synchronized, the image with either blur, split into two images creating diplopia, or the brain will turn off or suppress one image causing the loss of depth perception and disorientation. Convergence insufficiency can cause blurry vision, double vision, difficulty reading, and may lead to diminished depth perception when left untreated.

Diplopia is the experience of seeing two images when both eyes are open instead of one. This is known more commonly as double vision. Diplopia can occur as a stand-alone symptom or when elicited by a physician during an exam.

Photophobia refers to light sensitivity and can be a symptom of concussion. Tinted lenses and computer, phone, and tablet light filters can help reduce this symptom for patients.

Saccadic eye movement refers to the quick shifting of eye gaze from one point to another. The two eyes must be exactly synchronized during this eye movement. When this synchronization is lost, as is often the case in concussion, saccadic eye movement is disrupted. The eyes then skip, overshoot, or undershoot their intended targets. We use saccadic eye movements to read and view a computer. When this is impaired, reading slows, and becomes cumbersome causing lack of concentration and comprehension as well as headaches and eye strain.

This eye movement is used to track a moving object. It is driving through a different pathway in the brain. Each eye must lock on the moving target and maintain a 3-D image in the brain.  Loss of this synchronization, as can be seen in brain injury, causes the image to shift or move in an unexpected way. This impairs sports performance as well as driving and can cause disorientation and anxiety from any type of motion.

For Your Brain The Best Minds

For Your Brain The Best Minds