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COVID-Induced Brain Injury and Persistent Visual Problems

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Dr. S. Moshe Roth, OD, FCOVD

I have seen patients who have “recovered” from COVID but despite that, have persistent visual and visually-induced problems.  Their symptoms are similar to individuals who have suffered a Brain Injury.  Examples of an Acquired Brain Injury (ABI) are stroke and brain tumor.  A Traumatic Brain Injury (TBI) can be caused by a fall or a car crash.  A concussion is a “mild” Traumatic Brain Injury.

Individuals who have had COVID-19 may suffer vision problems such as blurred vision, double vision, poor depth perception and sensitivity to light.  Other  common visually-induced symptoms are difficulty paying attention, headaches, brain fog, memory problems, and forgetfulness.  Some people complain of vertigo and dizziness.  The reason for that is that the visual system is directly linked to the balance system, located in the inner ear.  These visual issues are very different from eyeglass problems.  Patients may report these symptoms to their doctors but may be frustrated in getting relief.  Most of the information available online relates to the eye itself, termed “ocular” (conjunctivitis, retinitis, etc.) rather than visual problems that occur in the brain.

Most people who have had COVID recover completely within a few weeks.  Patients expect to feel back to normal but some people continue to experience symptoms.  They struggle even weeks and months later, and are often at a loss where to seek help.  The virus can damage the lungs, heart and brain, which increases the risk of long-term health problems.  COVID deprives the body of oxygen.  Ventilators are used to mitigate the effects on the lungs, but the effects of oxygen deprivation on the brain are less publicized.  It stands to reason that anoxia (lack of oxygen) is the underlying reason for the brain-based problems and the vision complications.

More general symptoms include: difficulty breathing, difficulty making it through the day without having to take a nap, and difficulty exercising.  Patients present with symptoms of lightheadedness and feeling lethargic for months after the illness.  They often talk about its impact on their mental health.

The term “Long Haulers” is used to describe individuals who have persistent post-COVID symptoms.  The National Institutes of Health refers to long-term COVID-19 symptoms as PASC; Post-Acute Sequelae of SARS-CoV-2.  More common terms are: post-COVID syndrome, long COVID-19, or long-term COVID.

Neuro-Optometry and Neuro-Ophthalmology sound similar but are really 2 different subspecialties.  Dr. Eric Singman, MD PhD, a Neuro-Ophthalmologist at the Johns Hopkins Wilmer Eye Institute in Baltimore MD, best explained the difference between these two professions when he said: “Neuro-Ophthalmologists can diagnose what HAD happened, but Neuro-Optometrists can change what CAN happen”.  Neuro-Optometrists help individuals who have suffered a brain injury, to regain abilities through Neuro-Optometric Rehabilitation Therapy.  People who have suffered COVID-Induced Brain Injury are helped in a similar manner to those individuals who have suffered Acquired Brain Injury, Traumatic Brain Injury, and concussion.

Dr. Roth is a Neuro-Optometrist and is a Fellow of the College of Optometrists in Vision Development.