AOA: Optometry is essential in care for patients with concussions, TBIs

The AOA took its campaign on the expanding role of optometry in the diagnosis, treatment and management of Americans with concussions and traumatic brain injuries (TBIs) to Washington D.C., during AOA on Capitol Hill, April 7-9.

First, doctors of optometry were briefed on the release of the AOA's new resource, The Role of Optometry in Concussion & Traumatic Brain Injury Care, (member login required) for patients, physicians and policymakers.

Second, the AOA briefed congressional staffers on the need to expand the role of doctors of optometry in the care of patients with concussions and traumatic brain injuries. Visual impairments are often among the first signs or symptoms of TBI.

"We know that traumatic brain injuries are a very serious public health issue," AOA President Samuel D. Pierce, O.D., said during the event. "TBIs affects millions of Americans each year—Americans from all ages and from all walks of life.

"Research shows that up to 75% of all TBI patients experience life-altering vision problems, including problems with eye-tracking, focusing and eye-teaming," Dr. Pierce said. "Given the visual impacts of TBI, doctors of optometry are a critical entryway into TBI care."

Making optometry's case

The Role of Optometry in Concussion & Traumatic Brain Injury Care, produced by members of the AOA's TBI Task Force, was presented to doctors at a briefing April 8 by Andrew Morgenstern, O.D., and Amanda Nanasy, O.D. Dr. Morgenstern is a methodologist for the AOA's Evidence-based Optometry Committee and Dr. Nanasy is chair of the AOA's Sports and Performance Vision Committee and a member of the task force.

"Ensuring optimal vision can help reduce vision-related risk factors for TBIs, such as poor vision and reduced visual fields," the authors write in the paper. "The Centers for Disease Control and Prevention recommends that older adults receive annual, comprehensive eye examinations as poor vision can increase fall risk."

The paper lays out what visual evaluations doctors can make to detect TBIs and subsequent care. The next steps for doctors of optometry?

"Doctors need to learn more," Dr. Nanasy said, referring them to the websites of AOA's Vision Rehabilitation Committee or the AOA's Sports & Performance Vision Committee.

Briefing of congressional staffers

The Capitol Hill briefing was attended by congressional staffers. But two members of Congress made appearances: Rep. Joyce Beatty, D-Ohio, and Rep. Bill Pascrell, D-New Jersey.

Rep. Beatty introduced H.R. 280 (Concussion Awareness and Education Act of 2019) on Jan. 8, which would "provide for systemic research, treatment, prevention, awareness and dissemination of information (to educate the public including parents and teachers) with respect to sports-related and other concussions." Rep. Pascrell is co-chair of the Congressional Brain Injury Task Force, which works to increase Congress' understanding of brain injury prevention, treatment, rehabilitation and research.

Both members of Congress endorsed the efforts of the AOA on TBI and looked forward to working with doctors of optometry on raising public awareness on concussions. Said Rep. Beatty: "So my fight is your fight.

"We want you to know that your work has not gone unnoticed," she said. "We can make a difference in health care, in safety and in prevention. That's one of the reasons I came today. Thank you for your advocacy, thank you for being engaged in this profession, thank you for being here today, because together we'll make a difference."

Patient perspective

The briefing also included moving, personal testimony. Sarah Renberg, a sophomore at the University of Michigan, provided a patient perspective. Renberg suffered two severe concussions and a neck injury playing elite hockey in high school. The injuries dashed her dream to play Division I college hockey.

She suffered her first concussion in 2014; her second, more major brain injury occurred 97 days after her return to hockey.

"This injury resulted in extensive physical, visual, vestibular and cognitive impairments that ripped me from the world I knew as a high achieving, able-bodied 16-year-old," Renberg said. "My most dominant vision-related symptom was a headache—a seemingly endless pounding in the back of my head, like a sledgehammer. I felt pressure in my head like it might explode, stabbing pains like knives, powerful throbbing and dull aches. On top of that, there was constant nausea and dizziness."

She could no longer discern between what was important and what was not. "So, I suffered from extreme visual overstimulation," added Renberg who credited her recovery to vision rehabilitation. Today, she is an advocate for improving concussion management.

"Vision impacts our ability to balance, move, plan, remember, learn and more," Renberg said. "Think about how much you use your vision on a given day. Then think about what you might experience if your vision system was not working the way it was supposed to."