Stressed Out

Concussions that affect the ocular—or visual—system can create issues with the eyes’ ability to work together. Patients can also experience difficulty focusing on or tracking objects.

“Ocular motor symptoms are very common after a concussion,” says Anne Mucha, DPT, an expert in concussion assessment and rehabilitation and the coordinator of Vestibular Rehabilitation at the UPMC Sports Medicine Concussion Program. “As many as half of all people who’ve sustained concussions have some ocular motor symptoms, and for approximately 15 percent ocular motor symptoms are their number one problem.”

Typically, patients with ocular profiles report pressure headaches in the front of their heads; feeling more tired than normal; and becoming more symptomatic while doing visual activities—such as math or science problems at school or working on multiple screens at work.

Here are some of the most common ocular motor problems experienced after a concussion:

Convergence

The eyes converge when viewing objects up close, such as with reading. With convergence problems, patients may see a double image as a target moves closer to them. Typically, without a concussion, objects can be brought very close to the eyes without doubling.

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Accommodation

Accommodation problems cause an object to become blurry as it is viewed up close. Accommodative and convergence problems are often experienced together and can impact reading and other close-vision activities.

Pursuits and Saccades

The eyes use pursuit eye movements to follow objects, while saccade movements allow the eyes to shift rapidly from one object to another. Tracking objects, reading a book, scrolling on a computer, or even watching for a moving car while crossing the street can be difficult when patients have problems with pursuit and saccade eye movements.

Misalignment

Eye misalignment occurs when one eye drifts so that the eyes aren’t perfectly aligned. Dr. Mucha says many people have a small amount of eye misalignment that will often go unnoticed for life until a concussion overlays it. “When people with a preexisting eye misalignment sustain a concussion, they are at high risk of having ocular-motor symptoms because their brain may have difficulty compensating for the misalignment like it did before,” she explains. This can result in symptoms, such as headaches and eye strain, and difficulty with activities, such as taking notes in class or focusing on the chalkboard. If left untreated, it could result in avoiding visual work, which could affect the person’s ability or willingness to read.

“Kids with alignment or convergence issues may choose to stop using their eyes as much and become more auditory learners,” says Dr. Mucha. “They often don’t enjoy reading because their eyes work less efficiently, and their eyes get tired faster. But making sure the eyes are working well together is important for depth perception, sports performance, and eye-hand coordination.”

Early diagnosis is the key to the best outcome. “The longer someone waits to address these issues, the more difficult it is to recover full function,” she says.

Treatment

Experts at the UPMC Sports Medicine Concussion Program screen for ocular-motor symptoms and design neuro-vestibular therapy plans to help the eyes work together better. These eye exercises, combined with vestibular therapy to improve motor functions that control balance, movement, and spatial orientation, are usually enough to restore visual performance. Occasionally, a patient may need glasses or more formal vision therapy and can be referred to partnering neuro-optometrists for treatment.

The UPMC Sports Medicine Concussion Program offers a comprehensive approach to concussion—and they don’t just follow the best practice protocols for diagnosis, management, and rehabilitation: They create them.

Visit our website to learn more or call us at 412-432-3681 for an appointment.

About Sports Medicine

Sports and physical activity bring with them a potential for injury. If you are looking to prevent, treat, or rehabilitate a sports injury – or improve athletic performance – UPMC Sports Medicine and the UPMC Sports Medicine Concussion Program can help. We serve athletes and active people of all ages and experience levels. Our experts partner with the Pittsburgh Steelers, Pittsburgh Penguins, Pitt Panthers, and about 100 other high school, college, and regional teams and events throughout Pennsylvania – working daily to build better athletes.