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What is Neuro-Optometric Rehabilitation?

Neuro-Optometric Rehabilitation is a sub-specialty of optometry that focuses on the variety of visual disorders that occur as a result of brain injuries, developmental delay or other neurological disorders.

Our eyes are a part of the brain. When some-one suffers any type of injury to the brain, whether it is a stroke, car accident, or develop-
mental delay, their vision will be adversely affected.

A Neuro-Optometric Evaluation involves in-depth testing which evaluates how well your vision functions and to what degree it is interfering with the overall performance of activities of daily living such as reading, balance and movement, tying shoes, pouring liquids, etc.

The Neuro-Optometric Evaluation is unique because, in addition to a traditional eye exam, basic binocular visual skills, and eye health, it places the patient into performance testing to determine how the visual process is interacting with other sensory feedback mechanisms.   In addition, visual information processing skills are evaluated as they relate to vocational and avocational tasks.

Double vision is a common occurrence after stroke or head injury. It is vital to the rehabilitation process that double vision is treated as soon as possible; otherwise the overall rehabilitation will be significantly delayed. Double vision can cause problems with:

  • Hand-writing
  • Anxiety with visual tasks
  • Reach and grab inaccuracies
  • Balance and movement difficulties like drifting when walking, stumbling or falling
  • Driving difficulties with lane positioning, proper speed maintenance, multitasking, navigation
This is an example of what it can look like for someone who is trying to drive with double vision:

People who suffer from Acquired Brain Injury (ABI), Neuro-Developmental or Neuro-Degenerative Disorders commonly have various Functional Vision Problems leading to decreased performance of Activities of Daily Living (ADL’s).  Sometimes when one suffers a head injury their sense of where the middle of their body is can change. This can cause:

  • Dizziness or nausea
  • Spatial disorientation
  • Consistently stays to one side of hallway or room
  • Bumps into objects when walking
  • Poor walking or posture: leans back on heels, forward, or to one side when
  • walking, standing or seated in a chair
  • Perception of the floor being tilted
  • Associated neuromotor difficulties with balance, coordination and posture

Vision problems associated with brain injuries can be disabling and increase dependency as well as risk of secondary injury unless treated.

Treatment can involve special therapeutic lenses (worn similar to glasses) or may involve a more in-depth program. Neuro-optometric rehabilitative therapy is a non-invasive process for the rehabilitation of visual, perceptual, and motor disorders. Working one on one with our vision therapist, you learn how to regain control of your vision.

Signs of Post Trauma Vision Problems

  • Double vision
  • Headaches
  • Blurred vision
  • Dizziness or nausea
  • Light sensitivity
  • Attention or concentration difficulties
  • Staring behavior (low blink rate)
  • Spatial disorientation
  • Losing place when reading
  • Can’t find beginning of next line when reading
  • Comprehension problems when reading
  • Visual memory problems
  • Pulls away from objects when they are brought close to them
  • An eye turn
  • Difficulty shifting focus from near to far
  • Words move or blur when reading
  • Unstable peripheral vision
  • Associated neuro-motor difficulties with balance, coordination and posture
  • Perceived movement of stationary objects
  • Consistently stays to one side of hallway or room
  • Bumps into objects when walking
  • Poor walking or posture: leans back on heels, forward, or to one side when walking, standing or seated in a chair
  • Perception of the floor being tilted
  • Visual perceptual or visual processing problems
  • Visual Field Neglect or Loss
  • Visual motor integration disorders



Very few in the health care professions, including head trauma rehabilitation centers, are adequately aware of visual problems resulting from Traumatic Brain Injury and the visual-perception consequences. Unfortunately, this creates a gap in rehabilitative services, resulting in incomplete treatment and frustration for the patient, family and treatment team.

The vision care professional can play an important role in the rehabilitation effort. Through vision therapy and the proper use of lenses, a behavioral & Neuro-developmental optometrist specifically trained to work with Traumatic Brain Injury patients can help improve the flow and processing of information between the eyes and the brain.

Vision therapy can be a very practical and effective. After evaluation, examination and consultation, the optometrist determines how a person processes information after an injury and where that person's strengths and weaknesses lie. The optometrist then prescribes a treatment regimen incorporating lenses, prisms, low vision aides 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.



Good visual skills are necessary for efficient information processing. When processing visual information is difficult, one may "try harder," straining without even knowing it because the effort is subconscious. If the visual system is inefficient, every task can seem difficult, using more energy than required. Visual skills affected by Traumatic Brain Injury include:

  • Tracking:  the ability of the eye to move smoothly across a printed page or while following a moving object.
  • Fixation: quickly and accurately locating and inspecting a series of stationary objects, such as words while reading.
  • Focus Change: looking quickly from far to near and back without blur.
  • Depth perception: judging relative distances of objects - how far or near they are.
  • Peripheral vision: monitoring and interpreting what is happening in the surrounding field of vision
  • Binocularity: using both eyes together as a team - smoothly, equally and accurately.
  • Maintaining attention: keeping focused on a particular activity while interference, such as noise, is present.
  • Visualization: accurately picturing images in the "mind's eye," eye retaining and storing them for future recall.
  • Near vision acuity: clearly, seeing, inspecting, identifying and understanding objects viewed within arm's length.
  • Distance acuity: clearly seeing, inspecting, identifying and understanding objects viewed at a distance.
  • Vision perception: understanding what is seen.

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