This guide and checklist has been prepared to assist rehabilitation professionals (doctors, therapists, counselors, etc.) in determining the appropriateness of referring clients for neuro-optometric rehabilitation and treatment. Reliable observation skills provide valuable information to professionals regarding clients who have sustained a traumatic brain injury, CVA or other neurological impairment. This information may be a first step in determining if visual difficulties are interfering with the rehabilitation progress of an individual.

Insults to the cortex produced by a traumatic brain injury cause stress in central and autonomic nervous systems. The effect on vision causes an interference with the ambient visual process which is part of the sensory-motor feedback loop. This disruption occurs at the level of mid-brain where vision is matched with kinesthetic, proprioceptive, and vestibular processes. As a result, a head injured person may experience diplopia (double vision), binocular dysfunction, or concentration difficulties.

In the past, these symptoms were diagnosed as individual eye problems or muscle imbalances. However, the visual system is really a relationship of sensory-motor functions which are controlled and organized in the brain. The eye alignment imbalances and other reported difficulties that result from a head injury often occur because of dysfunction of the ambient visual process affecting sensory-motor spatial disorganization. This causes an eye to turn out (exotropia) or a strong tendency to both eyes to diverge (exophoria).

The resulting binocular problems are characteristic of a syndrome — Post Trauma Vision Syndrome (PTVS).

The characteristics of PTVS include:
• Exotropia or High Exophoria
• Accommodative Insufficiency
• Convergence Insufficiency
• Low Blink Rate
• Spatial Disorientation
• Poor Fixations and Pursuits
• Unstable Peripheral Vision

The symptoms of PTVS include:
• Possible Diplopia
• Objects Appear to Move
• Poor Concentration and Attention
• Staring Behavior
• Asthenopic Symptoms

In Singapore, you can contact IGARD Vision Therapy Center for neuro-optometric rehabilitation services. The center in Singapore is headed by Dr Yap Tiong Peng who is US-board certified in vision therapy. He is a member of the Neuro-Optometric Rehabilitation Association, International, and he is also fully accredited in neuro-developmental and behavioral optometry.

Dr Yap Tiong Peng and the team at IGARD Vision Therapy (Singapore) provides vision therapy and neuro-optometric visual rehabilitation.