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December 2022; 12 (6) Commentary

Consensus Statement on Visual Rehabilitation in Mild Traumatic Brain Injury

Prem S. Subramanian, Jason J.S. Barton, Paul Ranalli, Craig Smith, Courtney E. Francis, Benjamin Frishberg
First published August 31, 2022, DOI: https://doi.org/10.1212/CPJ.0000000000200071
Prem S. Subramanian
Departments of Ophthalmology, Neurology, and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, CO; Sue Anschutz-Rodgers University of Colorado Eye Center (PSS), Aurora, CO; Department of Surgery (Division of Ophthalmology) (PSS), Uniformed Services University of the Health Sciences, Bethesda, MD; Departments of Medicine (Neurology) (JJSB), Ophthalmology and Visual Sciences, Psychology University of British Columbia, Vancouver, Canada; Departments of Medicine (Neurology) (PR), Otolaryngology, Ophthalmology and Visual Sciences, University of Toronto, Ontario, Canada; Department of Medicine (CS), University of Washington School of Medicine, Seattle; Departments of Ophthalmology and Neurological Surgery (CEF), University of Washington School of Medicine, Seattle; Department of Neuroscience (BF), University of California San Diego School of Medicine, San Diego; and The Neurology Center (BF), Carlsbad, CA.
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Jason J.S. Barton
Departments of Ophthalmology, Neurology, and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, CO; Sue Anschutz-Rodgers University of Colorado Eye Center (PSS), Aurora, CO; Department of Surgery (Division of Ophthalmology) (PSS), Uniformed Services University of the Health Sciences, Bethesda, MD; Departments of Medicine (Neurology) (JJSB), Ophthalmology and Visual Sciences, Psychology University of British Columbia, Vancouver, Canada; Departments of Medicine (Neurology) (PR), Otolaryngology, Ophthalmology and Visual Sciences, University of Toronto, Ontario, Canada; Department of Medicine (CS), University of Washington School of Medicine, Seattle; Departments of Ophthalmology and Neurological Surgery (CEF), University of Washington School of Medicine, Seattle; Department of Neuroscience (BF), University of California San Diego School of Medicine, San Diego; and The Neurology Center (BF), Carlsbad, CA.
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Paul Ranalli
Departments of Ophthalmology, Neurology, and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, CO; Sue Anschutz-Rodgers University of Colorado Eye Center (PSS), Aurora, CO; Department of Surgery (Division of Ophthalmology) (PSS), Uniformed Services University of the Health Sciences, Bethesda, MD; Departments of Medicine (Neurology) (JJSB), Ophthalmology and Visual Sciences, Psychology University of British Columbia, Vancouver, Canada; Departments of Medicine (Neurology) (PR), Otolaryngology, Ophthalmology and Visual Sciences, University of Toronto, Ontario, Canada; Department of Medicine (CS), University of Washington School of Medicine, Seattle; Departments of Ophthalmology and Neurological Surgery (CEF), University of Washington School of Medicine, Seattle; Department of Neuroscience (BF), University of California San Diego School of Medicine, San Diego; and The Neurology Center (BF), Carlsbad, CA.
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Craig Smith
Departments of Ophthalmology, Neurology, and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, CO; Sue Anschutz-Rodgers University of Colorado Eye Center (PSS), Aurora, CO; Department of Surgery (Division of Ophthalmology) (PSS), Uniformed Services University of the Health Sciences, Bethesda, MD; Departments of Medicine (Neurology) (JJSB), Ophthalmology and Visual Sciences, Psychology University of British Columbia, Vancouver, Canada; Departments of Medicine (Neurology) (PR), Otolaryngology, Ophthalmology and Visual Sciences, University of Toronto, Ontario, Canada; Department of Medicine (CS), University of Washington School of Medicine, Seattle; Departments of Ophthalmology and Neurological Surgery (CEF), University of Washington School of Medicine, Seattle; Department of Neuroscience (BF), University of California San Diego School of Medicine, San Diego; and The Neurology Center (BF), Carlsbad, CA.
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Courtney E. Francis
Departments of Ophthalmology, Neurology, and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, CO; Sue Anschutz-Rodgers University of Colorado Eye Center (PSS), Aurora, CO; Department of Surgery (Division of Ophthalmology) (PSS), Uniformed Services University of the Health Sciences, Bethesda, MD; Departments of Medicine (Neurology) (JJSB), Ophthalmology and Visual Sciences, Psychology University of British Columbia, Vancouver, Canada; Departments of Medicine (Neurology) (PR), Otolaryngology, Ophthalmology and Visual Sciences, University of Toronto, Ontario, Canada; Department of Medicine (CS), University of Washington School of Medicine, Seattle; Departments of Ophthalmology and Neurological Surgery (CEF), University of Washington School of Medicine, Seattle; Department of Neuroscience (BF), University of California San Diego School of Medicine, San Diego; and The Neurology Center (BF), Carlsbad, CA.
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Benjamin Frishberg
Departments of Ophthalmology, Neurology, and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, CO; Sue Anschutz-Rodgers University of Colorado Eye Center (PSS), Aurora, CO; Department of Surgery (Division of Ophthalmology) (PSS), Uniformed Services University of the Health Sciences, Bethesda, MD; Departments of Medicine (Neurology) (JJSB), Ophthalmology and Visual Sciences, Psychology University of British Columbia, Vancouver, Canada; Departments of Medicine (Neurology) (PR), Otolaryngology, Ophthalmology and Visual Sciences, University of Toronto, Ontario, Canada; Department of Medicine (CS), University of Washington School of Medicine, Seattle; Departments of Ophthalmology and Neurological Surgery (CEF), University of Washington School of Medicine, Seattle; Department of Neuroscience (BF), University of California San Diego School of Medicine, San Diego; and The Neurology Center (BF), Carlsbad, CA.
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Citation
Consensus Statement on Visual Rehabilitation in Mild Traumatic Brain Injury
Prem S. Subramanian, Jason J.S. Barton, Paul Ranalli, Craig Smith, Courtney E. Francis, Benjamin Frishberg
Neurol Clin Pract Dec 2022, 12 (6) 422-428; DOI: 10.1212/CPJ.0000000000200071

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Abstract

Optometric visual rehabilitation therapy has been used for a variety of visual disorders. Descriptively named entities such as posttrauma visual syndrome, visual midline shift syndrome, and vertical heterophoria syndrome are frequently diagnosed by neuro-optometrists and/or behavioral optometrists in patients after stroke or head injury or in the setting of dizziness and/or headache. The scientific underpinnings of these diagnoses and treatments are weak, and published clinical studies comprise case reports and case series without comparison to control populations. Neuro-ophthalmologists are frequently questioned by patients about the utility of such treatment strategies. Many ophthalmologists and neurologists also are involved in the care of patients who carry these diagnoses and undergo these visual therapies. Involved physicians may benefit from guidance about the rationale, evidence, and level of evidence for the efficacy of these therapeutic approaches.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Submitted and externally peer reviewed. The handling editor was Associate Editor Jack W. Tsao, MD, DPhil, FAAN.

  • Received March 9, 2022.
  • Accepted July 20, 2022.
  • © 2022 American Academy of Neurology
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