For healthcare professionals working in concussion rehab, the eyes might just be the most underutilized diagnostic tool available. Visual system dysfunction is one of the most common — and modifiable — causes of persistent post-concussion symptoms. Yet vision is often overlooked in standard assessments.

This quick look blog explores the critical role of vision in concussion recovery, what areas clinicians should be testing, and when a referral to a neuro-optometrist is warranted. If after reading this post you want to dive deeper into the topic, check out the longer take by Mike Bradford here.

Why Vision Matters in Concussion Care

More than 50% of individuals with persistent concussion symptoms have impairments in at least one visual domain (1). From blurry vision and headaches to dizziness and poor concentration, visual deficits can prolong recovery and affect return to work, school, and sport.

Common signs of post-concussion visual issues include:

  • Eye strain with screens or reading
  • Difficulty focusing or tracking
  • Sensitivity to motion or light
  • Headaches triggered by visual tasks

Clinically, these symptoms are often driven by oculomotor impairments like convergence insufficiency, saccadic dysfunction, or impaired smooth pursuits (2,3).

📚 A study by Master et al. found that adolescents with unaddressed visual deficits post-concussion had longer recovery times and struggled significantly with school reintegration (4).

What Clinicians Should Be Assessing

A thorough post-concussion visual assessment doesn’t require specialized equipment — just the right knowledge and a simple battery of tests. At a minimum, clinicians should screen for:

  • Smooth Pursuit: Slow tracking of a moving target
  • Saccades: Quick, voluntary eye movements between points
  • Convergence: Ability to bring eyes inward for near tasks
  • Accommodation: Adjusting focus from near to far
  • Vestibulo-Ocular Reflex (VOR): Stabilizing gaze with head motion

Many of these are covered under the Vestibular/Ocular Motor Screening (VOMS) tool — a fast, reliable way to flag visual and vestibular impairments (5).

🔗 Assess Smooth Pursuit Eye Movements

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When to Refer to a Neuro-Optometrist

While most concussion-trained rehab professionals can assess and initiate basic oculomotor rehab, referral is essential when:

  • Vision symptoms persist beyond 2–3 weeks
  • Patient demonstrates marked difficulty with reading or tracking
  • There’s no progress with in-clinic therapy

Neuro-optometrists or developmental optometrists can provide:

  • In-depth binocular vision testing
  • Prescription of therapeutic lenses or prism
  • Supervised oculomotor therapy

🏥 Find a Certified Concussion Neuro-Optometrist Here

📚 Pearce et al. (2021) showed that youth receiving integrated oculomotor rehab had significantly better symptom resolution and return-to-school outcomes than those who did not (6).

What the Evidence Tells Us

Vision is not just a passive sense — it plays a major role in balance, cognition, and symptom perception. Deficits in the visual system are associated with:

  • Higher PCSS scores (symptom inventories)
  • Longer recovery timelines
  • Poor school and workplace reintegration

Leddy et al. (2022) demonstrated that early identification and intervention for visual system impairments accelerated recovery time and reduced chronic symptom risk (7).

As a clinician, overlooking vision means overlooking one of the most fixable pieces of the concussion puzzle.

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If You’re a Patient…

…and this blog resonates with what you’re experiencing:

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References
  1. Ventura RE, Balcer LJ, Galetta SL. The neuro-ophthalmology of head trauma. Lancet Neurol. 2014;13(10):1006–1016.
  2. Ciuffreda KJ, Ludlam DP, Yadav NK. Traumatic brain injury: visual consequences, diagnosis, and treatment. Prog Brain Res. 2016;231:361–384.
  3. Capó-Aponte JE, Urosevich TG, Temme LA, et al. Visual dysfunctions and symptoms during the subacute stage of blast-induced mild traumatic brain injury. Mil Med. 2012;177(7):804–813.
  4. Master CL, Master SR, Wiebe DJ, et al. Vision diagnoses are common following concussion in adolescents. Clin Pediatr. 2016;55(3):260–267.
  5. Mucha A, Collins MW, Elbin RJ, et al. A brief vestibular/ocular motor screening assessment to evaluate concussions. Am J Sports Med. 2014;42(2):444–453.
  6. Pearce KL, Sufrinko A, Lau BC, et al. Multimodal rehabilitation for youth with oculomotor deficits following concussion. Front Neurol. 2021;12:732614.
  7. Leddy JJ, Haider MN, Hinds A, et al. Early visual and vestibular screening is associated with faster recovery from sport-related concussion. Clin J Sport Med. 2022;32(3):248–256.