Neuro-Optometric Rehabilitation

What is the link between vision and brain injury?

Vision is the skill that allows us to see the world around us. When we observe the world, a complex series of processes takes place between the eye and the brain. The eyes take in the information, while the brain is responsible for processing and interpreting it.

When the brain is injured, the ability to interpret visual information can be affected in different ways.

Visual problems following brain injury can affect both the quality of the information received by the brain, the interpretation of the information received and the way in which the visual information is used in activities of daily living, cognitive tasks, movement, balance and orientation.

As a result, brain injury survivors can experience a number of different types of visual problems which can range from mild to severe depending on the nature of the injury. As there are such a wide range of different types of visual problems after brain injury, there is no single way of coping with them. 


Neuro-Optometric Rehabilitation is a specialized field in eye care dedicated to assisting people with brain injury, concussion and neuro-degenerative disease who experience disruption in their visual functionality.

Often times a general optometric evaluation confirming 20/20 visual acuity and good eye health is not enough to identify and remedy the impact of visual disruption on normal motor and cognitive functionality.

A Neuro-Optometric examination includes an assessment of the general visual functionality, correction of refractive error (short-sightedness, far-sightedness, astigmatism and presbyopia). It further assesses the eye muscles balances and interaction, visual field sensitivity, dynamic eye movements, integration of visual input between the two eyes, perceptual visual functionality, the input of vision on balance, spatial orientation and cognition.

Following a traumatic brain injury, a Neuro-Optometric Rehabilitation Optometrist will work with a patient to develop a treatment plan that is specially designed to improve or eliminate a patient’s specific symptoms and difficulties. Treatment may include specialized glasses to help with visual processing, and/or a Vision Rehabilitation program that incorporates both in-office and out-of-office procedures for the remediation and management of your visual problems with the goal to improve activities of daily visual living and performance.

Multi-disciplinary approach:

In brain injury, often a single approach to rehabilitation is not sufficient to address all of a patient’s needs. An interdisciplinary, integrated team approach can play a vital role in the rehabilitation of patients with various types of neurological deficits. Our Eyemind Neuro-Optometric Rehabilitation Optometrist may work with other rehabilitation team members such as neurologists, rehab physicians, nurses, physical and occupational therapists, speech-language pathologists, neuropsychologists, and audiologists.

What is a visual midline?

It has been found that frequently a neuro-motor disruption or disability will cause a shift in the perceived concept of the child’s or adult’s awareness of their visual midline. The visual midline is produced by the matching of visual information with sensory-motor information to give the person an awareness of the center of their body relative to external space. This information is vital to maintain an upright posture and balance against gravity.

What causes a shift of the visual midline?

Normal vision includes a perfect balance between the central (focal) and peripheral (ambient) visual system. A shift of the visual midline is caused by a dysfunction of the ambient visual process, which feeds the brain with information for balance an orientation. This midline shift reinforces postural imbalances causing the person to lean to one side, forward (flexion), or backward (extension) because the concept of visual midline is displaced. Therapeutic use of lenses and prisms can help to stabilize the disrupted peripheral or ambient visual process. Through use of special yoked prisms the visual concept of midline can be reoriented, thereby resulting in improved posture and balance.

Is it still necessary for therapy?

The use of special lenses, yoked prisms and/or other optical aids is not meant to take the place of physical or occupational therapies. Instead, these devices are often recommended to be used in support and in conjunction with these therapies. Through a multi-disciplinary approach of using therapeutic lenses and/or yoked prisms it has been found that the rehabilitation of the physically disabled child or adult can be more complete and efficient, enabling the person to achieve a greater potential in the least amount of time.

Who can benefit from a Neuro-Optometric assessment?

Patients with a history of: traumatic brain injury, concussion, stroke, chronic inflammation within the brain, multiple sclerosis, Parkinson’s, and other conditions that can progress to affect the nervous system (such as Lyme Disease).

Whether a person has a physical disability caused by a traumatic brain injury, cerebrovascular accident, cerebral palsy, autism, multiple sclerosis or other congenital or acquired neuro-motor problems, visual imbalances and distortions can actually reinforce the particular physical disability.

What is the different types of treatment after Brain injury?

Following the initial vision and neurological examination a treatment plan is developed with a goal of restoring essential visual function. Because every injury is unique, treatments will vary by individual.

Below are some types of treatments:

  • Special Prescription Lenses (Glasses) – Lenses can help compensate for damage to the neural system along with enhancing visual clarity and comfort. Lens filters (tints) provide help with light and glare sensitivity.
  • Prism Lenses – These are specialized glasses that change the way light enters the eye. Prisms are frequently prescribed as a component of the treatment for binocular vision problems and to eliminate double vision, as well as to provide comfort for near visual tasks such as reading. In addition, prisms are often used in treating balance issues, a common component in brain injury.
  • Patching – Patching one eye or part of the visual field of one eye is sometimes used to help those with double vision. The patch is placed to eliminate the information that results in the double image from coming into the brain. The patch is frequently placed directly upon the lens surface.
Are all Optometrists trained in Neuro-Optometric rehabilitation therapy? 

No. Optometrists trained in Neuro-Optometric Rehabilitation Therapy have continued their education in the field of understanding the neural function of vision. This continuing education emphasizes the use of lenses, prisms, and vision therapy to enhance a patient’s visual capabilities, reduce visual stress, prevent and rehabilitate vision problems.

Why do you need to see a rehabilitation specialist if your vision is affected?

Brain injury can affect a person in many ways. Depending on the extent of the injury, problems with visual information processing may contribute to and/or exacerbate symptoms of things such as eye strain, fatigue, headaches, difficulties with balance and posture, depth perception, and memory loss. Often one type of rehabilitation is not enough to address all of the individual’s needs. An interdisciplinary, integrated team approach can play a vital role in the rehabilitation of patients with concussions, stroke or other neurological deficits.

How are vision problems found after a Traumatic Brain injury?

Visual problems are often overlooked during initial treatment of a brain injury and in some cases, symptoms may not be present until sometime following the injury.  If you notice any changes in your vision following a concussion or some other head trauma, don’t ignore them and immediately contact your eye care professional. 

How long does Vision Rehabilitation last? 

Some rehabilitation may last weeks or months, while others may last years. Programs and treatments will change as a patient’s particular needs change.