How Does a Traumatic Brain Injury Cause Vision Problems?

Published April 12, 2020

Children’s vision problems from traumatic brain injuries

 We often think of Traumatic Brain Injury (TBI) affecting adults, however consider these facts:

  • TBIs are the leading cause of disability and death in children ages 0–4 years and adolescents ages 15–19 years
  • It is estimated that 145,000 children and adolescents (ages 0–19 years) are living with lasting cognitive, physical, or behavioral effects of TBIs

General Statistics about TBI

  • In the United States, approximately half a million children ages 0–14 years are admitted to emergency rooms each year as a result of a TBI each year
  • Approximately 1 in 220 children are seen in emergency rooms as a result of a concussion

Gender

  • Across all age groups, the incidence rates of TBI are higher in boys than in girls.
    • Boys (0–9 years) are 1.4 times more likely than girls to have a TBI.
    • In high school and college athletics the incidence of TBI is on the rise for girls
    • Girls have higher concussion rates than boys in sports played by both sexes
  • The male-to-female ratio increased to 2.2 for older children and young adults

Severity

A study examining causes and trends of TBI-related hospitalizations in American adolescents revealed:

  • 46% of patients were categorized as mild
  • 38% as moderate
  • 16% as severe

TBI and vision 

Symptoms indicating a vision problem from a TBI:

  • Blurry vision
  • Double vision
  • Aching eyes
  • Loss of visual field
  • Sensitivity to light
  • Comprehension difficulty
  • Attention and concentration difficulty
  • Memory difficulty
  • Reading difficulties- decreased fluency and speed
  • Words appear to move or change appearance
  • Comprehension difficulties
  • Headaches with reading and other visual tasks

Which visual skills are affected by a TBI?

Strong visual skills are necessary for efficient information processing.

When processing visual information is difficult, one may strain their eyes without even knowing it, because the effort is subconscious. If the visual system is inefficient, every task can seem difficult— expending more energy than required.

The following visual skills can be affected by a TBI:

  • Eye Tracking: The ability of the eye to move smoothly across a printed page or while following a moving object.
  • Fixation: The ability to quickly and accurately locate and inspect a series of stationary objects, such as words while reading.
  • Focus Change (Accommodation): The ability to quickly change focus from distant to near images, continually.
  • Depth perception: The ability to accurately judge relative distances of objects —how far or near they are.
  • Peripheral vision: The ability to monitor and interpret what is happening in the surrounding field of vision.
  • Binocularity (Eye Tracking and Teaming): The ability to use both eyes together as a team – smoothly, equally and accurately.
  • Maintaining attention: The ability to maintain focus on a particular activity while interference, such as noise or motion, is present.
  • Visualization: The ability to accurately picture an image in the “mind’s eye,” eye retaining and storing them for future recall.
  • Near Vision Acuity: The ability to clearly see, inspect, identify, and understand objects viewed within arm’s length.
  • Distance Acuity: The ability to clearly see, inspect, identify, and understand objects viewed at a distance.
  • Vision Perception: The ability to understand and quickly process what is seen.

An optometrist’s role in the rehabilitation of a brain injury

Unfortunately, many people that work in the health care professions, including head trauma rehabilitation centers, are inadequately aware of the visual problems and visual-perception consequences that can result from a TBI.

This lack of awareness creates a gap in rehabilitative services— resulting in incomplete treatment and frustration for the patient, family and treatment team.

A behavioral or developmental optometrist, specifically trained to work with TBI patients, will play an important role in the rehabilitation effort.

Vision therapy, along with the use of specialized lenses, can help improve the eye-brain connection, and the visual processing of information. After comprehensive eye examination following a TBI, an optometrist will be able to determine how visual information is processed— alerting to the patient’s strengths and weaknesses.

Based on the findings of the evaluation, the eye doctor will prescribe a treatment regimen incorporating lenses, prisms, low vision aids and specific activities designed to improve control of a person’s visual system and increase vision efficiency. This in turn can help support many other activities in daily living.

What is behavioral or developmental optometry? 

Behavioral or developmental optometry is based upon the core principle that vision is a learned process and can be developed or enhanced at any age.

Optometrists practicing this method have continued their education beyond the basic Doctor of Optometry (O.D.) degree. This continuing education emphasizes the use of lenses, prisms, and vision therapy to enhance a patient’s visual capabilities, reduce visual stress, and prevent and rehabilitate vision problems.

As a member of the rehabilitative team, behavioral optometrists have extensive experience treating the vision problems stemming from TBI.

If your child has experienced a TBI and is suffering from visual problems, contact a developmental optometrist for a complete functional vision examination.

Treatment of visual problems will not only alleviate visual difficulties, but will also facilitate improved daily functioning.