• This is the area where most optometrists spend most of their time.
• They ensure that your eyes are structurally healthy and that there are no signs of disease.
• If you need it, they ensure that they can give you lenses to bring you to 20/20, both when looking near, far, and in-between
- Common issues here in mTBI are increased myopia (near-sightedness) or new/increased hyperopia (far-sightedness) (Jean-Louis et al., 2016).
- Glasses may be required for refractive issues deemed to be “minor” in the non-concussion population (see article on Glasses & Rehabilitation)
- This is because methods we use to compensate for slight blurriness may not be “on-line” in post-concussion syndrome.
- Patients with Visual Processing issues like vestibular dysfunction or visual motion sensitivity usually don’t tolerate progressive addition lenses (Jean-Louis et al., 2015).
• They may help with symptoms you may be having like dry eye, etc.
• Some patients have difficulty seeing out of both eyes at the same time, and many don’t realize it as such, they just recognize symptoms.
Why the Need to Check More Than This?
- Optometrists will often prescribe more specialized lenses or modification to your lenses to help you get on with things until you are able to rehabilitate the issue and no longer need the glasses.
• However, most optometrists do not check the next three rungs higher up on this pyramid.
• A simple way to think about it so to reflect on how they examine your eyes.
One will notice that this doesn’t match the way we use our eyes in every day life.
- Usually you are seated without moving your head
- You are a fixed distance from a chart that is not moving
- There are no distracting things going on
- Lighting is ideal
- You have a lot of time to focus on what you’re looking at
- The things you are looking at have been calculated to be precise and accurate
• For the most part, if we can get you to 20/20 vision, then we assume visual efficiency and processing is fine.
• This assumption is true for most of the population which is why we get away with it.
• This assumption, however, is not true for post-concussion patients.
• Hence, we have to check the next three levels – Oculomotor based-vision/Visual Efficiency & Non-oculomotor-based vision/Visual Integrity – when investigating post-concussion patients’ symptoms.
• Often, a specialized optometrist, specializing in this area handles this.