That's why it's easy to understand that most concussions have a visual aspect to them. Many of these show up on sideline tests and many of these issues resolve quickly.
I developed the See To Play Concussion Vision Protocol to be a great tool for optometrists to implement testing and therapy to help in rehabilitation. I've also developed a quick ABC's chart to be a reference guide as well.
ABC’s of Vision Concussions
A. Accommodation: Reduced reserves and facility. Quick test with +/- 1.50 flipper while reading a near
point card for 1 minute. Push plus in refraction for post-concussion prescription.
B. Binocularity: Decreased depth perception, intermittent suppression, suppression and diplopia. Quick
test with Worth 4 dot for moving or missing objects. Decreased stereopsis. Therapy: Red/green
tranaglyph reader with +/-1.50 flipper
C. Convergence: Convergence insufficiency. Quick test with pencil push-ups at straight ahead gaze,
inferior gaze and superior gaze. Therapy: brock string, See To Play Gaze Stabilization “Eye Baller”
Exercise available at Bernell.com
D. Divergence: Sluggish ability to move eyes out. Combine divergence testing with vestibular by fixating
gaze on Snellen 20/40 near point letter on tongue depressor held at 12 inches from face. Patient turns
head right and left (as in shaking head “no”) for 15 seconds then shifts gaze to Snellen 20/200 distance
letter for 5 seconds. Repeat for 1 minute. Visual edge is a good test as well.
E. Erratic Eye Movements: Decreased ability to follow near point target while tracking. Jerky movement
and drop out noticed. Therapy: See To Play Eye Baller
F. Focus/Fog: Problems staying on task and general feeling of being in a haze or fog. Quick test is the
King-Devick and Visual Edge. Therapy: Visual edge and STP Eye Baller
G. Gaze: Diminished capacity to scan surroundings causing decreased perception. Quick pursuits and
saccades: Therapy: STP Eye Baller.
H. Headache: This includes a general headache with stabbing pains through one eye (possibly waking
patient from sleep). This is usually due to an intermittent suppression with one eye. Therapy:
Red/green tranaglyph reader.
I. Irked: Patients are generally annoyed, frustrated and emotional that they have problems comprehending
injury and slower recovery.
My hope is that this this quick reference guide will help more doctors get involved with concussion care. Further vision concussion testing can be performed by using the See To Play (Peters/Price) Vision Concussion Protocol (available for free at www.seetoplay.com) or referral to a traumatic brain injury vision specialist.