If it seems like you’ve been hearing the word “concussion” a lot lately, you’re not alone. Concussion care is becoming more common than ever before for a variety of reasons.
For one thing, there is now much more data and reporting on concussions. The Journal of Neurology reported 4 million people in the US reporting concussion annually—and that’s just people who go to the ER. In fact, the current numbers are probably underreported. Many people who suffer a concussion simply never get treatment.
However, for patients who do come in for concussion care (who are often symptomatic), it’s important that they’re given a comprehensive exam.
What is the OD’s role in treating concussion patients?
15% of people have symptoms after a concussion. 70-90% of concussion patients experience vision problems afterward. The optometrist might be one of the first to detect lingering problems after a concussion.
Most of the patients concussion specialist Dr. Alexandra Talaber sees are referrals from diagnosed concussions. Often, these patients are already experiencing visual symptoms and other concussion-related symptoms.
Primary care optometrists can help manage and treat these patients before and after referral. The effects of a concussion can take hours or even days to appear, so taking a comprehensive history is the best way to catch any issues, along with conducting a few diagnostic tests.
Visual symptoms are extremely common in patients post-concussion. These symptoms last from two or three weeks to a month at most.
Symptoms of a concussion
- Vision issues: light sensitivity, blurriness, double vision, dizziness, nausea, motion sensitivity, near work difficulties, trouble balancing
- Cognitive deficits and memory loss
This is when it’s really helpful to have a baseline assessment on hand. If you don’t have any information available, it’s time to hone in on their history. There are also a few diagnostic tests you can run on concussion patients.
Diagnosing concussion patients
Besides the standard diagnostic tests, there are a few other things you might notice in concussion patients.
- Visual skills: Cover tests for both distance and near, binocular vision, alignment, competency, extraocular movement, cranial nerve functioning, saccadic functions, convergence insufficiency, and more
- Dry eyes: Since these patients tend to “stare” at things more, their blink rate is much lower. Be sure to check for dry eyes in concussed patients!
- Light sensitivity: Patients will often come in wearing sunglasses or hats.
It’ll behoove you to add a few concussion-targeted questions to patient history taking. Have you had a concussion? Are you experiencing migraines? Are they triggered during near work or around bright lights?
It’s important to bring up the topic with patients. Many concussion patients aren’t aware of their options and simply choose to just accept and adapt to these vision changes.
Who are your patients?
With more risk comes more likelihood. The highest prevalence of concussions occurs in male teens who are 15-19 years old. Older patients often experienced a motor vehicle accident or are suffering from whiplash. Pediatric neuro-optometrists’ patients will usually be zero to four years old.
Curiously, concussions are more common in men than women, but women tend to exhibit worse symptoms.
As a concussion care specialist, most of your patients will be referrals who are already experiencing visual symptoms. However, as Dr. Talaber describes, there’s a level of pride in some of these patients, especially the ones who are dragged in by their parents.
Some think that they can just push through or ignore the symptoms, but they eventually catch up.
Treating concussion patients
Tinted lenses can be a huge help. Dr. Talaber recommends a 10% blue tint for indoors, which will allow the patient to handle brighter lights. FL 41 glasses offer a rose tint that’s helpful for patients, as well. Low refractive lenses, such as ¼ or .12, are also great options for these patients.
It’ll really help to have relationships with people who are doing VT fellowships or who are affiliated with the Neuro-Optometric Rehabilitation Association (NORA)—having referrals ready to go will be helpful as you come across these patients. Additionally, if you are looking into becoming a concussion care specialist, these connections will help you get started!
Treatment really depends on the individual patient. Some of the most difficult patients you’ll see are those who have been experiencing their symptoms for over a year.
Still interested in concussion care?
Dr. Talaber recommends finding resources to help you along the way. These are a few options:
- College of Optometrists in Vision Development (COVD)
- Neuro-Optometric Rehabilitation Association (NORA)
- Neurovision Rehabilitation Guide
- Concepts in Vision Therapy (Dr. Leonard Press) (ebook version is also available through Apple Books)
Be empowered and know about all the tools and resources out there!
Are you interested in vision therapy or concussion care? Leave a comment or ask a question below!