Vision Therapy

See the section below for how to access vision diagnosis and therapy

Neuro-optometrists

Optometrists specializing in vision rehabilitation due to brain injury or neurologic disorders, referred to as neuro-optometrists, will perform a comprehensive exam to assess your eyes for problems and determine whether you could benefit from neuro-optometric vision therapy. Primary care optometrists do not regularly perform these tests of visual function, but rather evaluate the health and structure of the eye. A visit to your general eye doctor may not be sufficient to determine if you have functional problems with your visual system. If there are structural issues with your eyes, or if you need a surgical consultation, the neuro-optometrist might refer you to an ophthalmologist.

The neuro-optometrist will develop an individualized treatment plan involving vision therapy exercises, adding new exercises as you improve. Your neuro-optometrist may collaborate with a physical or occupational therapist to work with you on vision exercises.

To learn more about neuro-optometrists and find a provider in your area, see our section below, How to Access Vision Diagnosis and Therapy.

Physical therapists

A more affordable option for vision therapy may be working with a physical therapist, as insurance companies more often cover these providers. Physical therapy can help improve some vision issues but is often not as comprehensive as vision therapy prescribed by a neuro-optometrist. Please also note that in some states, it is illegal for physical therapists to perform vision therapy without the oversight of an optometrist.

It’s a good idea to ask potential physical therapists if they have experience working with vision problems after a concussion. A knowledgeable PT may be effective at treating concussion-related vision issues. However, not all PTs are knowledgeable or trained in this area. If the vision therapy exercises assigned by your PT are not the correct exercises for your specific eye issue, it can make your symptoms worse. If, after a month, your symptoms are getting worse from doing vision exercises prescribed by your PT or not improving as expected, consider consulting with a neuro-optometrist.

If you get an examination at a multidisciplinary clinic, such as a concussion clinic or outpatient rehabilitation clinic, they may refer you to an in-staff physical therapist. If you are seeking a physical therapist on your own, look for a physical or vestibular therapist with experience working with vision issues in concussion patients. Please note that many patients have symptoms due to cervical-oculomotor (neck-related vision issues) and not vestibular-oculomotor dysfunction. An orthopedic physical therapist specializing in treating whiplash injury or neck-related issues may also be a resource for any unresolved issues. 

Working with an experienced physical therapist with a visio-vestibular specialization will more likely be covered by insurance. However, sometimes patients will need glasses and prism lenses, which a physical therapist is unable to provide. Additionally, as mentioned, some patients may need the expertise of a vision therapy-trained optometrist to fully remediate symptoms. 

To find a provider in your area, see the next section.

How to access vision diagnosis and therapy

Affordability

Vision therapy is usually effective, but its cost may be an issue for some people. Neuro-optometrists are sometimes covered by health insurance, but it can get expensive if you pay out of pocket, depending on the practice from which you seek care.

There are ways to reduce the cost of vision therapy. You can ask about discounts or customized payment plans–they may be willing to compromise on cost. 

Hybrid Office/Telehealth Treatment

Another option is to look for a neuro-optometrist who offers home-based vision therapy. In this modality, after your in-person diagnosis, the neuro-optometrist will teach you personalized vision therapy exercises that you would do at home. Next, in a telehealth or in-office follow-up visit, your neuro-optometrist can observe you to make sure you are doing the exercises correctly at home. Your neuro-optometrist would then follow up with you on a regular basis and adjust your therapy plan as you progress–but with fewer overall follow-up visits than a traditional weekly in-office vision therapy plan.

Neuro-optometrists

You can self-refer to a neuro-optometrist; neuro-optometrists do not require a referral. Look for neuro-optometrists who are fellows or members of the Neuro-Optometric Rehabilitation Association (NORA) or the College of Vision Development (COVD). You can also look for a neuro-optometrist who is residency trained in vision rehabilitation, neuro-optometry, vision therapy, or binocular vision.

To look for this specialized residency training, check the bio of the neuro-optometrist on the clinic’s website. A residency is a year-long post-doctoral program where the optometrist studies specific neuro-optometric rehabilitation under the guidance of an attending physician, which is regulated by the Association of Colleges and Schools of Optometry (ASCO). A residency is different from fellowship training in the organizations mentioned above, where an optometrist is a member of the organization and did a home-based self-study program. An optometrist can be both residency and fellowship trained, or one or the other. 

Since every brain injury is different, not every patient requires or benefits from the same treatment. Finding the right treatment can be frustrating for a patient since they may get different treatment depending on the training and clinical experience (number of patients seen) of the neuro-optometrist they see. Below are links to the search tools for fellows or members of NORA and COVD.