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Concussion Care a Growing Part of Practice

Approximately 1 million emergency room visits by children each year are related to traumatic brain injury (TBI), and 75 percent of all patients with TBIs suffer from visual dysfunction, says Maria Richman, OD, FAAO, of Manasquan, New Jersey. Brain insult and injury can affect a person’s posture, balance, gross motor and fine motor skills, cognition, attention, concentration, learning, working and daily activities.

Many of these are preventable injuries, says Dr. Richman, and it is well within the purview of the primary care optometrist to talk about preventing injuries with susceptible populations—such as small children who might climb out of cribs or fall down stairs, young athletes and the elderly. However, many interactions with patients often come well after the injury. There’s a growing body of evidence that shows optometrists can play a key role in helping to identify if a concussion has occurred, provide treatment and monitor how well the patient is progressing in the recovery. When Dr. Richman has post-concussion patients on the schedule, she will greet them in the waiting room and follow them as they walk to the exam room. “I can often observe the effects of vision deficits, possibly related to the head injury. I also allot extra time when scheduling patients with concussions as they may be having difficulties during the examination, including fatigue, dizziness, light sensitivity or attention issues,” she says. “When these occur, frequent breaks are helpful and will make the testing more accurate and productive.”

Optometrists routinely perform much of the necessary baseline testing information in a comprehensive exam, such as visual acuity, pupil testing, visual fields, accommodative amplitude, saccades, binocular measurements and more. “These findings are valuable to the optometrist evaluating and managing children with concussions with other members of the traumatic brain injury health care team,” Dr. Richman says. “Optometrists should be making school nurses and coaches, sports teams and others aware that they gather important baseline pre- and post-concussion information on their patients.” Or write a letter to the patient’s pediatrician that says, “‘For your files, here is the concussion baseline testing I measured on our mutual patient.’ This is not only good public relations for optometrists but can quite likely improve the child’s care and treatment.”

Even if the optometrist isn’t included in the TBI care team soon after the incident, those records can still be helpful. “I recently had a child who hit his head about six months ago, and I only found out because the parents had to reschedule the contact lens appointment because there was a conflict with his post-concussion appointment. I had all the baseline measurements on this child already, and if I was a part of the TBI care earlier, I could have repeated these tests and I potentially could have helped quantify and assist in the treatment and healing process,” Dr. Richman says.

Today, education is available to make most optometrists comfortable with these types of evaluations. Dr. Richman, past chair of the American Optometric Association (AOA) Vision Rehabilitation Committee, notes that at the national and state levels, the AOA and its state affiliates typically have Vision Rehab Sections and committees. Also, the College of Optometrists in Vision Development (covd.org) and the Neuro-Optometric Rehabilitation Association (noravisionrehab.org) offer tremendous resources to practitioners and patients alike.

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