43 - Post-Concussion/Mild Traumatic Brain Injury (mTBI) Assessment and Management of Vision and Oculomotor Dysfunctions for the Eye Care Provider: A Practice Recommendation
Introduction: Concussion/mTBI is a significant health problem in both military and civilian environments. Since vision functionality involves large and spatially differentiated areas of the brain, it is not surprising that visual dysfunctions are common sequela of concussion/mTBI. Visual acuity – the most frequently measured indicator of ocular health1 – is usually not reduced after concussion/mTBI and, therefore, cannot be used as a single predictor of the impact of concussion/mTBI on the visual system. Instead, an eye care provider should employ a series of tests designed to assess the visual functions most frequently affected by concussion/mTBI. This Defense Health Agency (DHA) Practice Recommendation (PR) was developed to address an identified need and educate primary eye care providers on the diagnosis and management of patients experiencing vision and oculomotor problems after concussion/mTBI.
Methods: A multi-step, consensus-driven process was employed to develop the PR. Ten subject matter experts (SMEs), with expertise in the diagnosis and management of visual dysfunctions post-TBI, participated in developing a draft of the PR, which was then distributed to primary eye care providers for clinical feedback. Comments were incorporated, and the PR was finalized by the authors. Of note, representatives from all branches of the military, Veterans Affairs (VA), academia, and private practice contributed to the development of the DHA PR.
Results: The “Post-Concussion/Mild Traumatic Brain Injury (mTBI) Assessment and Management of Vision and Oculomotor Dysfunctions for the Eye Care Provider” DHA PR includes the following five parts: 1) TBI history questions list; 2) List of medications utilized to treat certain conditions associated with concussion/mTBI and may also cause secondary visual disturbances; 3) Testing and evaluation for eye and vision dysfunctions associated with concussion/mTBI, including suggested testing, normative values, equipment, and corresponding diagnoses; 4) Suggested treatments and referrals for select oculomotor dysfunctions, and 5) Guidance for proper coding. The accompanied algorithm and references are also provided.
Conclusion: The authors propose the DHA PR presented above will be useful for primary eye care providers who do not have specialized training in the diagnosis and management of TBI-associated visual dysfunctions and routinely encounter concussion/mTBI patients in their clinical practice. The aim of PR implementation is to promote better clinical outcomes, reporting, and surveillance of concussion/mTBI-related visual dysfunctions.
Keywords: Oculomotor Dysfunctions; Practice Recommendation; Eye Care Provider; Post-Concussion
