March is brain injury awareness month, and this year it seems there is an unprecedented amount of focus on traumatic brain injuries both in youth and professional sports. This is a wonderful development and a step in the direction of taking better care of both our kids and our professional athletes. However, one area of the concussion issue that seems to be getting glossed over is how closely connected vision dysfunctions can be with traumatic brain injuries, and how addressing visual issues can make an enormous impact on the severity of symptoms concussion patients must deal with.
To highlight this issue, I’ve got a story of a girl who did just what any sporty high school kid would do when she got a concussion while playing soccer: she didn’t tell anyone. “Jessie,” as I’ll call her, was a high school freshman who played soccer and was a straight-A student. At the end of practice one day, she was hit in the head by a ball and immediately experienced a “splitting headache,” along with some dizziness and visual changes, as well as mild fatigue. These symptoms didn’t worsen but didn’t fully resolve either, and so Jessie kept it to herself because she didn’t want to have to sit out of the upcoming game. The next day, she headed a ball several times and immediately felt “out of it.” She again experienced sudden dizziness, nausea, and a headache. Our euphemism for this would be “seeing stars,” which now seems a massive understatement given our understanding of what is happening to a person’s brain as they experience this. Again, Jessie kept these symptoms to herself. Three days later, Jessie was walking to class and blacked out on the way there. She was taken to the ER and referred to an orthopedic doctor who specializes in sports injuries. Upon his recommendation, she was told to wait until she was asymptomatic for 3-4 consecutive days before she began the graduated return to play protocol.
Unfortunately for Jessie, her symptoms did not begin to alleviate, as her doctor had expected. Even without returning to soccer that season, her schoolwork began to be overwhelming to her. She had been diagnosed with mild Convergence Insufficiency prior to her head injury, complaining of headaches and blurry vision, but these symptoms had essentially disappeared after being prescribed glasses. However, they were back with a vengeance after her head trauma. She had not been able to complete a single school day since being hit in the head; her headaches, double vision, and nausea were constant and unbearable. She was complaining of memory loss and agitation, both of which were atypical for her. She was losing her balance frequently and had become quite clumsy as well.
Through it all, she was trying to slog through her school work, having gotten her teachers to significantly lighten her course load to only core classes. Still, it was too much. Jessie’s mom came home one evening to find her daughter slouched over the kitchen table with a towel wrapped around her head, sobbing because of her unrelenting headache and because she was not able to do her school work. It simply was not sustainable.
When we think about head trauma, especially as it relates to sports, it makes sense to us that one would have a headache for a few days. What doesn’t immediately cross most people’s minds is the impact head trauma can have on one’s visual system. The wiring for the visual system is pervasive in the brain. So, it doesn’t take much trauma to the head to affect how well we can coordinate two eyes. Vision gives us 80 percent of the information we gather as human beings. So, when the two eyes are unable to work together to give us this information, the results can be devastating.
Soon after the towel incident, over a month since the initial concussion, Jessie began vision therapy at our clinic. On her intake evaluation, she scored a 60 out of a possible 60 on the Convergence Insufficiency Symptom Survey, where <16 is normative. Shortly after beginning therapy, Jessie began to see improvements in her symptoms right away. At her first 8-week progress check, she was able to read for longer without headaches and she was no longer seeing words blur or move on the page. By 16 weeks, she was reporting that her headaches were quite rare, and would go away quite quickly. Her depth perception, tracking, and eye teaming were all within normal ranges. She now scored a 9 on the CISS, and had seen improvements in every single area of complaint. On our changes checklist, she had checked every area of improvement, except for the one marked “decrease in hyperactivity.” Next to this she had pencilled in, “Increase!” She was back to her normal, goofy self. Gone were the days of the hopeless, tired, in-pain girl who couldn’t make it through a school day. She recalled that both her grades, and her confidence in herself “sky-rocketed.”
As our conversations regarding traumatic brain injuries increase throughout this month and beyond, as we talk to parents or evaluate whether or not our children should join soccer or football, I hope we remember the important role vision plays in this discussion. Vision does not evade impact when trauma happens.
If you or someone you know has had a concussion or head trauma and struggles with symptoms of double vision, blurred vision, headaches or feeling visually overwhelmed find a developmental optometrist near you at covd.org.
Today’s blog post was jointly written by Carrie Hall, an optometric vision therapist, and by Benjamin Winters, OD, FCOVD.