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Can Your Vision Change After a Concussion?

women rubbing her head from neuro vision problemsIf you’ve hit your head in a fall while playing sports or in any other type of accident, your vision may have been impacted.

Between 69% and 82% of people who’ve experienced concussions report visual problems, such as eyestrain and double or blurred vision.

Head trauma causes the brain to move within the skull. The movement can stretch the fragile cranial nerves and can even damage brain cells. Since vision relies on efficient communication between the eyes and the brain, a concussion can disrupt these neural pathways, affecting your vision.

The resulting condition is called post-trauma vision syndrome (PTVS).

How Does a Concussion Affect Vision?

Our vision depends on our brain’s ability to accurately receive and interpret the images sent by our eyes. Therefore, anything that impacts the brain can severely affect our ability to see clearly. When we suffer head injuries caused by a traffic accident or a serious fall, the resulting head injury can impact the communication between our eyes and brain.

Although your eyes may be healthy, your vision may be blurred, or you might start seeing double or experience eye strain due to post-trauma vision syndrome.

What Is Post Trauma Vision Syndrome?

Post-trauma vision syndrome refers to a number of visual problems that tend to occur following a severe head injury. If you have PTVS, you may have trouble with:

  • Focusing – changing focus from close to far or keeping your vision clear
  • Eye teaming or binocular vision – your eyes’ ability to coordinate
  • Depth perception – judging distance or the relationship of one object to another
  • Eye-tracking – visually following an object or text on a screen or page
  • Peripheral vision – seeing things from the side of the eyes
  • Eye alignment – the eyes aren’t aligned correctly or point in different directions

Any one of these visual problems can negatively affect your ability to perform day-to-day tasks and significantly lower your quality of life. Driving, reading, watching TV, participating in sports, enjoying hobbies and even socializing can become difficult.

Why You Need a Neuro-Optometrist

A neuro-optometrist is trained to diagnose and treat visual problems related to the nervous system caused by head injuries, strokes and neurological diseases. After assessing your visual system for any aberrations, your neuro-optometrist will prescribe a customized treatment plan to strengthen your visual system and improve your quality of life.

What Treatments Improve Vision Following a Concussion?

A neuro-optometrist may prescribe any of the following to relieve symptoms after a concussion and help you see and feel better:

  • Prescription lenses – especially for blurry vision
  • Prism lenses
  • Syntonic phototherapy – the use of light to create balance in the autonomous nervous system and restore vision
  • Neuro-optometric therapy – a customized eye exercise program designed to rehabilitate your visual skills

How Long Do Visual Problems Last After a Concussion?

Typically, visual problems caused by a concussion don’t become noticeable for some time. Symptoms of visual problems can appear or remain for weeks, months or even years after the original incident. Any person who has had a concussion should be assessed by a neuro-optometrist, even if they’re not experiencing any obvious visual problems.

If you’re still experiencing any visual symptoms of post-traumatic vision syndrome, even weeks or months after your head injury, it’s essential to see a neuro-optometrist for diagnosis and treatment. If this is your case, we invite you to schedule your appointment with Dr. Moshe Roth and Dr. Steffani Tiomno at today.

Our practice serves patients from Old Bridge, East Brunswick, Woodbridge, and Edison, New Jersey and surrounding communities.

Frequently Asked Questions with Dr. Moshe Roth and Dr. Steffani Tiomno

Q: Can a concussion permanently change your vision?

  • A: In some cases, a concussion can permanently impact your vision, especially if your visual system or optic nerve has been damaged. The good news is that most visual problems caused by a head injury respond well to neuro-optometric rehabilitation therapy.

Q: Why can it take time for concussion-related vision problems to be diagnosed?

  • A: Diagnosis can depend on several factors. If someone has been in a serious accident, their physicians are focused on life-threatening injuries. As a result, all but the most obvious visual symptoms, such as vision loss, may be missed. In other cases, the signs of PTVS can be very subtle and undetectable in a routine eye exam. That’s why anyone who has experienced a concussion should have their vision thoroughly examined by a neuro-optometrist.

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    Call Us 732-993-3420

    Do You See Better When You Tilt or Turn Your Head?

    blue eye tilted head to see betterDo you find that you need to tilt or turn your head to see better? This is known as an anomalous and compensatory gesture. Many people – including children – don’t even realize they’re doing this until their neck begins to feel really sore. Naturally, it’s hard to imagine that the source of their problem is their eyes or the optic nerves.

    Why Does My Vision Improve When I Tilt or Turn My Head?

    You may turn or tilt your head for any of the following reasons:

    Eye Misalignment (Strabismus)

    When your two eyes are misaligned or “crossed” (strabismus), they aren’t able to point in the same direction. The result: each eye sends a different image to your brain, which then struggles to merge the images to create one clear, unified 3D image. Moving your head compensates for this and may enable your brain to more comfortably combine the images to see more clearly.

    This misalignment can be caused by a malfunction of the nerve that controls the muscles surrounding the eyes. Depending on which nerves and muscles are affected, the head turn or tilt is essentially an adjustment to enhance the comfort and clarity of vision.

    Duane Syndrome

    Duane syndrome is a specific type of strabismus. It is a congenital disorder of the 6th cranial nerve that controls the lateral rectus muscle. As a result, the eyes may rotate inward and outward and can lead to compensatory head movements.


    Nystagmus, involuntary jerky or shaky eye movements, can cause you to tilt your head in a specific position when the nystagmus is slow or stops. This is called a “null point.” Nystagmus can have a neurological basis, as in cases of:

    • Stroke
    • Trauma to the head
    • Brain tumor
    • Central nervous system diseases, such as multiple sclerosis


    Ptosis is often called “droopy eyelid,” and can be caused by an injury to the muscles surrounding the eyelid or to the nerves controlling these muscles. People with ptosis will compensate by looking upward to see objects as if trying to see past the eyelid.

    Refractive Errors

    Refractive errors occur when the eye is either too long or the corneal focusing power is too high or too low. They aren’t a result of a neurological problem. However, refractive errors often cause a child or adult to tilt or move their head to compensate for their blurry vision.

    These are the refractive errors that affect eyesight:

    • Astigmatism
    • Myopia (nearsightedness)
    • Hyperopia (farsightedness)
    • Presbyopia (age-related farsightedness)

    In the event of a refractive error, you or your child may also squint your eyes in an attempt to see better. Having an eye exam can determine the type of refractive error and the best way to correct the problem.

    How Can I Stop By Head From Tilting or Turning to See Better?

    If you find that you’re tilting or turning your head to see objects or read better, it’s important to schedule an eye exam to identify the cause of the problem.

    Patients with ocular neurological problems may be experiencing some of these symptoms:

    • Eye strain, headaches or migraines
    • Eye turn or blurry vision
    • Reading or attention problems
    • Difficulty moving the eyes
    • Involuntary eye movements
    • Pressure in the eyes or head
    • Uneven pupils
    • Double vision
    • Droopy eyelids
    • Facial distortion

    If your eye doctor suspects that your eye condition may be rooted in the nerves or the brain, they may recommend an appointment with a neuro-ophthalmologist, who is trained to diagnose and treat eye irregularities with a neurological cause.

    Do you want to get rid of your head tilt and treat your eye problem? Schedule an appointment at Family Eye Care today.

    Frequently Asked Questions with Dr. Moshe Roth and Dr. Steffani Tiomno

    Q: What are some causes of neurological problems that affect the eyes?

    • A: – Inflammation of the optic nerve (optic neuritis)
      – Swelling of the optic nerve (papilledema) – commonly caused by increased pressure inside the brain
      – Nerve damage leading to paralysis of eye muscles – this leads to strabismus or misaligned eyes
      – Optic neuropathy – can be caused by toxic substances such as alcohol, tobacco or B12 deficiency
      – Stroke or brain tumor

    Q: How is strabismus treated?

    • A: Strabismus, characterized by crossed or misaligned eyes, is treated by:- Eyeglasses for milder cases
      – An eye patch placed over the stronger eye to help the weaker eye become stronger
      – Orthoptics – eye exercises
      – Botox – can temporarily weaken the overactive muscle
      – Surgery on the eye muscles


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    Double Vision After Brain Surgery

    Double Vision After Brain Surgery 640×350Double vision (diplopia) can occur after a traumatic brain injury, a stroke or certain types of surgery due to a disruption in the connection between the nerves and extraocular muscles that control the eyes’ position and movements.

    Diplopia following brain surgery is usually temporary and can take a few days or weeks to resolve, depending on the source of the problem. In the meantime, people who suffer from double vision after an operation can benefit from specific glasses and neuro-optometric rehabilitation through eye exercises that help restore single vision.

    If you are experiencing diplopia after brain surgery and want to know which treatment is right for you, make an appointment with Dr. Moshe Roth and Dr. Steffani Tiomno at Family Eye Care today.

    What Causes Double Vision After Brain Surgery?

    The brain is connected to the eyes through a network of nerves — including the optic nerve — that controls the movement and alignment of the eyes. These nerves can be impacted by brain disorders, tumors and strokes, or during brain cranial surgery. Brain surgeries can disrupt the connection between the brain and the eyes, resulting in the misalignment of the eyes and double vision.

    Alternatively, the muscles surrounding the eyes that keep the eyes aligned and focused can be damaged during surgery, affecting their ability to perform accurately and effectively.

    Ordinarily, having two eyes means the brain receives two images, which it converts into one single 3D image of the world. However, an injury to the eye muscles can cause an eye misalignment, making it impossible for the brain to fuse the two images into one single, clear image — resulting in double vision.

    What Are Other Symptoms of Damage to the Visual System?

    Although the most obvious sign of damage to the visual system after brain surgery is double vision, patients may experience any of the symptoms below:

    • Eyestrain
    • Crossed eyes
    • Headaches
    • Pain when moving the eye
    • Droopy eyelids
    • Nausea
    • Eye weakness

    How to Treat Diplopia After Brain Surgery

    There are several treatments for diplopia after brain surgery.

    Prism glasses

    After an eye exam your eye doctor may prescribe prism glasses that work by altering the path of light rays and compensate for any misalignment of the two eyes. These lenses allow the brain to fuse the two images from the eyes to create a clear and single 3D view of the world around us.

    Eye Patches

    Your eye doctor may recommend wearing an eye patch because it removes the second image from a weaker eye reaching the brain. Using a patch can temporarily remove the visual disturbance and prevent you from seeing double images, but is often not the best long-term solution. It is important to follow a precise regimen for eye patch wearing and not deviate from the instructions without first consulting your doctor.

    Neuro-Optometric Rehabilitation

    One effective way to regain clear and comfortable vision after brain surgery is through neuro-optometric rehabilitation, which is a personalized eye exercise program that will strengthen the connection between the brain and your eye muscles, with the goal of improving your quality of life by regaining your clear 3D vision.

    Following a functional vision evaluation to assess visual problems, your optometrist may prescribe customized exercises to re-establish the effective communication between your eyes and brain.

    How Long Will It Take to Recover from Diplopia?

    Usually, diplopia that develops following surgery is temporary, and with treatment, regular vision can be restored in days or weeks. In cases that persist, eye patching, prism glasses and neuro-optometric rehabilitation usually resolve diplopia within weeks or months. In rare cases, eye surgery may be required to correct diplopia.

    If you are experiencing double vision after brain surgery, schedule an appointment with Family Eye Care today.

    Our practice serves patients from Old Bridge, East Brunswick, Woodbridge, and Edison, New Jersey and surrounding communities.

    Frequently Asked Questions with Dr. Moshe Roth and Dr. Steffani Tiomno

    Q: What are the different types of diplopia?

    A: All types of diplopia involve seeing two images, but there are different forms of diplopia, depending on the positioning.

    • – Horizontal diplopia – images are separated laterally
    • – Vertical diplopia – one image is higher than the other
    • – Monocular diplopia – diplopia continues in one eye when the other is closed.

    Monocular diplopia can be caused by conditions such as astigmatism, cataracts or keratoconus. Diplopia can be temporary, intermittent or constant.

    Q: What are the common causes of diplopia?

    A: Diplopia can be caused by the following: Brain trauma or brain tumor

    • – Stroke
    • – Eye problems like keratoconus, dry eye and cataracts
    • – Brain surgery
    • – Cranial nerve palsy
    • – Eyestrain

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    Long-Term Risks of Repeated Head Impacts Among Athletes

    Athletes at risk for neuro traumaIf you’ve ever had a concussion or any other type of brain injury, you likely experienced at least some of the symptoms caused by head impacts: headaches, difficulty concentrating, problems with balance, visual problems and even anger management issues.

    A single concussion is bad enough, but multiple studies published in National Academies Press (2014) revealed that experiencing as little as two concussions can sometimes lead to serious life-long problems.

    Unfortunately, head hits that occur while playing contact sports are common, and the health repercussions of these impacts can be severe.

    Here are six long-term risks of multiple concussions and repetitive head impacts:

    Chronic Traumatic Encephalopathy (CTE)

    CTE is a degenerative brain disease that affects athletes, military veterans and anyone who has experienced repeated brain trauma. Specific proteins (called tau proteins) form clumps in the brain of those with CTE, and these clumps eventually spread throughout the brain, permanently damaging and causing the death of brain cells. Progressive memory and cognition loss, depression, suicidal ideation, poor impulse control, aggression, Parkinsonism, and dementia are among the clinical indications of CTE.

    Two case reports published in Neurosurgery involving two National Football League (NFL) players were the first to use the phrase. After long careers playing football in high school, college and professionally, these players suffered from a variety of neuropsychological symptoms.

    Evidence suggests that CTE is caused by repeated head blows over a period of years, according to Clinics in Sports Medicine (2011). It’s crucial to understand that you don’t have to have a full-fledged concussion to develop this disease.


    Depression is a mental disorder that affects one’s feelings, thoughts and actions. It can limit a person’s ability to perform at work, at school and at home. Loss of interest in previously loved hobbies, changes in appetite, sleep disturbances and thoughts of death or suicide are all possible symptoms.

    Research published in Medicine and Science in Sports and Exercise (2007) discovered a growing linear association between concussion history and being diagnosed with long-term depression. Retired athletes who had three or more concussions were three times more likely than those who had never had a concussion to be diagnosed with depression. Those who had one or two previous concussions had 1.5 times the chance of being diagnosed with depression.

    Dementia Pugilistica

    Dementia pugilistica, sometimes known as ‘punch-drunk condition,’ is a neurological disease that affects people who have experienced many concussions. The term ‘pugil’ comes from Latin and means ‘boxer’ or ‘fighter.’ The condition was initially diagnosed in boxers in the 1920s. Tremors, sluggish movement, speech difficulties, disorientation, a lack of coordination and memory loss are all prominent symptoms of this disease.

    Dementia pugilistica is a kind of CTE that has some microscopic histological characteristics in common with Alzheimer’s disease. While it was first discovered in boxers who were subjected to repeated head hits in a 1973 study published in Psychological Medicine, athletes in other sports may be affected as well.

    Neurocognitive Impairments

    A concussion’s signs and symptoms can often affect one’s cognitive abilities, resulting in the inability to concentrate, disorientation, irritation and loss of balance. When you have more than one traumatic brain injury in your life, you may be more likely to experience long-term, possibly progressive, disability that impairs your ability to function.

    According to the National Academies Press (2014), studies show that recurrent head impacts in football and hockey players cause abnormalities in cognitive function in the brain. In one study, researchers discovered that the impacted athletes had neurocognitive abnormalities in both working and visual memory. In another study, affected football players were found to have problems with impulse control and balance after the sports season concluded.

    Slower Neurological Recovery

    Despite the fact that millions of people suffer concussions each year, the risks of a prolonged neurological recovery after multiple concussions are still largely unknown. Nonetheless, according to a study published by the National Academies Press in 2014, a history of many concussions may be linked to a longer recovery of brain function after another concussion. According to the findings, repeated concussions may result in lifelong neurocognitive impaieyerment.

    This is why it’s crucial to refrain from engaging in any sports or dangerous activities until you’ve fully recovered from a head impact.

    Brain Injury and Your Vision

    Head trauma and concussions can have major effects on the visual system, despite normal medical imaging results. The group symptoms causing blurred vision, eye coordination issues and dizziness following head trauma is called post-trauma vision syndrome.

    Even mild concussions can cause visual dysfunction, such as double vision, accommodative dysfunction, convergence insufficiency, sensitivity to light, eye tracking problems and delayed visual processing.

    How Can A Neuro-Optometrist Help?

    Neuro-optometry is a branch of optometry that focuses on helping individuals with neurological disorders regain their visual and oculomotor skills. Neuro-optometric rehabilitation therapy aims to improve a patient’s ability to function independently in a multisensory environment.

    At Family Eye Care, we know all too well the challenges that accompany repeated head impacts. To schedule a functional vision evaluation and determine if there is a problem with your visual system, call Family Eye Care today.

    Family Eye Care offers neuro-optometric rehabilitation therapy to patients from Old Bridge, East Brunswick, Woodbridge and Edison, New Jersey and surrounding communities.

    Frequently Asked Questions with Dr. Moshe Roth and Dr. Steffani Tiomno

    Q: What is a concussion?

    • A: A concussion is a type of brain injury in which a blow to the head causes a momentary loss of brain function. When a person’s brain is violently moved back and forth or twisted inside the skull due to a direct or indirect force, an injury occurs. A concussion causes disruption in brain function and should be treated as a serious injury. Following a concussion, proper healing and recovery time are critical in preventing additional injury.

    Q: What does a neuro-optometrist do?

    • A: A neuro-optometrist can assess functional binocularity, spatial vision and visual processing abilities, as well as functional binocularity and visual processing abilities. Following diagnosis, a comprehensive management program will be prescribed. Neuro-optometrists can also diagnose general eye health problems and correct refractive errors with glasses or contact lenses to increase visual acuity.

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    How Concussions Can Affect Self-Esteem

    How Concussions Can Affect Self Esteem 640X350When you consider the abundant functions of the brain, it’s no surprise that even slight damage to its sensitive tissues can wreak havoc on one’s physical and mental health. Many people experience some degree of emotional distress after suffering a head injury. But how can you tell if your symptoms are serious?

    If you or a loved one has ever experienced a concussion, we urge you to learn more about the emotional and physical side effects it may bring, and discover how a neuro-optometrist can help.

    What Occurs During a Concussion?

    The nerves of the brain are surrounded by soft and fatty tissues, and these fragile nerves are further protected by a layer of fluid and the bony skull. During a sudden and forceful jolt or bump to the head or neck region, such as whiplash, the brain continues to move while the head has stopped moving. This causes the brain to slam into the inner walls of the skull or be shaken back and forth, resulting in a concussion.

    This mild form of traumatic brain injury can damage or destroy brain cells, and may also negatively impact the healthy protective tissues surrounding the damaged cells.

    Although concussions are considered ‘mild’ because they aren’t life-threatening, they can cause debilitating symptoms like headaches, nausea, vomiting, light sensitivity, blurred vision, balance problems, confusion and emotional distress, among others.

    The Link Between Concussions and Self-Esteem

    A concussion can negatively affect emotional well-being and self-esteem, both directly and indirectly.

    A post-concussion patient may find it difficult to do the things they once enjoyed, like exercising, reading, doing schoolwork or even watching TV. Withdrawing from these activities, even temporarily, may result in feelings of depression, anxiety, and reduced self-worth. When you can’t read, concentrate or complete day-to-day activities as you once did, your limitations can become your main focus.

    Concussions can also directly damage areas of the brain responsible for emotional regulation, directly affecting how a person relates to themselves and others.

    A study published in Brain Injury (2014) concluded that a person’s self-concept may be impacted following a concussion/traumatic brain injury and that patients should seek treatment for emotional distress following a head injury.

    Signs of Lowered Self-Esteem

    Because each brain is unique, it’s hard to tell how a concussion will affect the patient, both in the short and long term. Here are a few signs that may reveal emotional distress and reduced self-esteem following a concussion:

    • Withdrawal from social events
    • Avoiding activities that were once enjoyable
    • Lack of motivation
    • Feeling unloved or unwanted
    • Feeling hopeless
    • Negative self-talk
    • Neglecting personal hygiene or appearance
    • Inability to accept compliments
    • Feelings of shame, depression or anxiety

    If you or a loved one displays any of the above symptoms, rest assured that help is available.

    How We Help Post-Concussion Patients

    Recovering from a concussion can be difficult, but neuro-optometric rehabilitation therapy can help by improving the neural communication between the eyes and the brain and how an injured brain processes visual information.

    Concussions can significantly affect the eye-brain connections, resulting in symptoms like dizziness, inability to concentrate, light sensitivity and headaches, as well as emotional distress.

    A neuro-optometrist can improve the functioning of the visual system in ways that other professionals aren’t trained to, thereby reducing — even eliminating — these debilitating symptoms.

    By training the brain and eyes to efficiently work in unison, visual skills will improve and you’ll find it easier to do things like reading, watching TV, using a computer and concentrating without taking as many breaks.

    If you or a loved one has ever sustained a concussion, a functional vision evaluation may be called for to rule out visual dysfunction. Even if you’ve been told that nothing can be done by other health care professionals, we may be able to help, even years after the injury.

    Let us help you get back to doing the things you love. To schedule a functional visual evaluation, call Family Eye Care today.

    Family Eye Care offers neuro-optometric rehabilitation therapy to patients from Old Bridge, East Brunswick, Woodbridge, and Edison, New Jersey and surrounding communities.

    Frequently Asked Questions with Dr. Moshe Roth and Dr. Steffani Tiomno

    Q: What other conditions can neuro-optometry treat?

    • A: Neuro-optometrists help patients who’ve survived a stroke, sustained varying degrees of brain injury or have a neurological condition that impedes visual function. All of these conditions can adversely impact visual skills and may cause symptoms that hinder independent functioning and reduce one’s quality of life. By rehabilitating the visual system, a neuro-optometrist can provide relief and promote a greater degree of recovery to these patients.

    Q: Do all optometrists provide neuro-optometric rehabilitation therapy?

    • A: No. A neuro-optometrist is a Doctor of Optometry with specialized training in the area of visual system rehabilitation. A general optometrist performs eye exams, diagnoses and manages eye diseases and prescribes corrective lenses to patients. General optometrists do not have the training or experience to perform neuro-optometric rehabilitation therapy.

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    How Can Lyme Disease Affect Your Vision?

    How Can Lyme Disease Affect Your Vision 640Lyme disease is rampant in New Jersey. It was first identified in Lyme, Connecticut and has become rampant throughout the Atlantic seaboard.

    Lyme disease is an infection caused by a tick bite infected with the bacterium Borrelia burgdorferi. According to the American Lyme Disease Foundation, the bacteria is transmitted to humans through the bite of infected black-legged ticks. The ticks are carried by Deer and it is therefore called a Deer Tick. It can also be carried by and transmitted by other furry animals, such as dogs.

    Lyme disease initially affects the skin near the bite site. In about 30% of the cases, it leaves a characteristic “wheel-like” bite appearance. If left untreated, the infection can extend to the nervous system, joints and other organ systems.

    What are the Symptoms of Lyme Disease?

    Lyme disease symptoms usually include a rash at the site of the bite that looks like a bull’s eye. Further symptoms may include:

    • Fever
    • Fatigue
    • Joint pain
    • Headache
    • Sore throat
    • Swollen glands

    As the disease progresses, one may develop memory loss, attention problems and numbness in the hands, feet and arms. It can cause Bell’s palsy, which means that half of the face muscles are affected.

    How Does Lyme Disease Affect Vision?

    Lyme disease is typically divided into 3 stages: (1) early localized, (2) early disseminated and (3) late disseminated. According to the American Academy of Ophthalmology (AAO), Lyme disease can affect the eyes at any stage.

    The severity of eye problems can vary greatly. Different symptoms appear at different phases of the infection. The following are examples of possible Lyme disease eye complications:


    Conjunctivitis, often known as pink eye, is an inflammation of the white part of the eye known as the conjunctiva. Conjunctivitis usually appears within the first several weeks of the infection. It affects about 10% of those who have Lyme disease. Symptoms include red eyes, itchy eyes and discharge.

    Light Sensitivity

    Sensitivity to light can occur.


    Lyme Disease can cause inflammation of the eye structures. Eye inflammation commonly appears in the third or late stages of the disease. Inflammation of the optic nerve can cause vision loss. Optic neuritis symptoms include eye pain, color vision loss, and flashing lights.

    Inflammation of the retinal vessels (within the eye) can also cause impaired vision and floaters. Bell’s palsy-like symptoms might arise if the facial nerves become inflamed. Symptoms may make it difficult to close the eye, causing the cornea to become dry and potentially infected.

    Visual Treatment of Lyme Disease

    Medical treatment for Lyme disease doesn’t always address Lyme-related visual problems. If thes eproblems go untreated, vision may be impaired long after medical treatment is completed.

    Any inflammation in the body can affect the limbs and organs. This is especially true for the brain and the visual system, which are often affected by Lyme disease.

    That’s where Neuro-Optometry can help.

    Neuro-Optometry evaluates how our eyes and brain function together. When Lyme disease affects that connection, a patient’s balance may be affected, causing their vision and depth perception to be affected as well.

    Neuro-Optometrists offer a specialized program of neuro-visual therapy, called Neuro-Optometric Rehabilitation. This rehabilitation program is specific for individuals who have had a neurological incident that has affected their vision and its functioning/processing. It may also include special lenses, prisms, and a special form of light therapy, Syntonic Phototherapy.

    This is especially true in the case of children. Lyme disease can disrupt important developmental cycles, resulting in visual problems and the likelihood of developmental delays and learning difficulties.

    If you or your child has been diagnosed with Lyme disease, contact Family Eye Care, to learn whether it has affected your vision.

    Family Eye Care serves patients from Old Bridge, East Brunswick, Woodbridge, and Edison, New Jersey and surrounding communities.

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    Call Us 732-993-3420

    What Is Post Traumatic Vision Syndrome?

    What Is Post Traumatic Vision Syndrome 640×350Every year, millions of people around the world sustain a traumatic brain injury (TBI). The majority of these are “mild” brain injuries, known as “concussions”. A large portion of the brain is dedicated to vision-related processing and therefore concussions and other traumatic brain injuries often result in some degree of visual dysfunction.

    PTSD (Post-Traumatic Stress Disorder) is often accompanied by visual disturbances, known as PTVS, Post-Traumatic Vision Syndrome.

    What is Post Traumatic Vision Syndrome?

    Post Trauma Vision Syndrome occurs when there is a disruption of the visual process. This disruption affects the neurological system that brings information to the brain and sends information from the brain to the muscles that control eye movements. It causes difficulty with maintain fixation (the ability to ‘lock on’), binocular fusion (the ability to use the two eyes together as a team), and accommodation (the ability to physically focus).

    What Are the Symptoms of PTVS?

    Even if someone is able to see with good clarity in each eye(20/20), a TBI can cause the following visual dysfunctions:

    • Blurred vision
    • Double vision
    • Low blink rate
    • Depth-perception issues
    • Difficulty with eye-tracking
    • Sensitivity to light (photophobia)
    • Eye strain, especially while reading or using a computer

    Non-visual symptoms may include:

    • Dizziness
    • Headaches
    • Poor balance
    • Disorientation
    • Difficulty reading
    • Difficulty driving
    • Difficulty concentrating
    • Visual memory problems
    • Difficulty navigating through crowded or tight spaces

    How Does a Neuro-Optometrist Treat PTVS?

    A Neuro-Optometrist assesses eye health, acuity, and a wide range of visual abilities. These include eye alignment, convergence function, focusing ability, peripheral awareness and more.

    A program on Neuro-Optometric Rehabilitation enables the individual to regain visual skills that were damaged by the brain injury. Special eyeglasses with prism or tint may be prescribed to improve spatial and/or binocular vision. Special light therapy, Syntonic Phototherapy, often gives gives patient relief from some symptoms.

    Treating PTVS as soon as possible helps reduce the problems and enables the individual to regain quality of life. Neuro-Optometric Rehabilitation can even be effective months or years after a TBI.

    Schedule a consultation with Family Eye Care to start treatment for your PTVS today.

    Family Eye Care serves patients from Old Bridge, East Brunswick, Woodbridge, and Edison, New Jersey and surrounding communities.

    Frequently Asked Questions with Dr. Moshe Roth and Dr. Steffani Tiomno

    Q: What is Neuro-Optometric Rehabilitation Therapy?

    • A: Neuro-Optometric Rehabilitation is a personalized program to develop, improve and refine underdeveloped or lost visual skills. This specialized treatment involves vision procedures and visual aids (i.e. prisms) and Syntonic Phototherapy to improve visual processing and perception by strengthening of the eye-brain connection.

    Q: Is my concussion impairing my reading?

    • A: Many patients who suffer PTVS have reading difficulties after their injury. Words might appear to be moving on the page or blurry. Difficulty remembering what you just read and having to re-read material is very common.

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    Menier’s Disease Patient Testimonial from Neuro-Otologist

    We’re here with AG and she’s gonna relate her story. She’s now completing her program and vision therapy. She was originally referred by a neurologist as a specialist, as a specialist in not only hearing, but rather the balance system, uh, particularly after somebodies suffered, some sort of brain injury. But doesn’t necessarily have to be a brain injury, could be like you’ve described many years disease. So why don’t you share with us, what precipitated, what brought you to our office, how you feel now, what benefits, how you work this into your life?

    I think I’ve always had some sort of an issue with my eyes working together, even as a child. When I first got glasses, I would always close one. I’d read to actually have everything in focus. And then quite recently I was having some bad vertigo spells, and I was diagnosed with the nearest case and the doctor, Meniere’s disease, checked my vision because I was having many headaches and also on the eval to read basically a full email for work or even work on many Excel sheets or, um, I was tired, irritable at the end of the day. And really couldn’t, couldn’t do very much, I couldn’t drive.

    I wasn’t able to even go to those simple some things and blows the grocery store without getting dizzy or having a headache. And so the doctor thought that it might be something with my eyes and referred me to Dr.

    Roth and the team here. And I’ve been here, before my therapy since, I think it’s been, I don’t know, 72 sessions and I have, I feel like I’m living a different life now. I’m able to do the things that I couldn’t do with ease. Work is a lot easier. Reading emails, transposing numbers, even reading books to my children. Isn’t a task anymore. It’s fun.

    I can go to the grocery store without getting dizzy. I can, I can drive again. And it’s, it’s, you know, things that I’ve forgotten almost were happening now because it’s been, it’s been such a difference in change in my vision.

    That’s great. So we’re, we’re so we’re so proud of you and we’re so happy that we were able to help. Sounds like, like there’s been a huge impact in your life.

    Yes. And I’m so grateful. So everyone you know, I’m sure my, I was just leaving you out, how different even my kids and my husband have seen the impact because I can do more and it’s happier. So it’s been wonderful. It’s really wonderful.

    What is your husband or your kids say? What did he say?

    Well, they were quite interested in some of the exercises I would doing, especially my ten-year-old said C would help me, but they were, you know, they’re just, they’re just happy to have me back basically.

    That’s wonderful. Thank you so much for sharing that. Thank you.

    COVID-Induced Brain Injury and Persistent Visual Problems

    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.

    4 Tips To Avoid a Traumatic Brain Injury

    4 Tips To Avoid a Traumatic Brain Injury 640×350A traumatic brain injury, or TBI, is an injury to the brain caused by physical trauma, typically a sudden bump or blow to the head.

    Concussions — a mild form of brain injury — are very common and represent approximately 80% of all TBI incidents. A concussion is a temporary loss of brain function caused by the brain bouncing around in fast motion within the skull, sometimes producing chemical changes or damaging the functioning of the brain cells.

    Moderate to severe TBIs can cause loss of consciousness— from a few minutes to several hours.

    Any TBI, whether mild or severe, can affect cognitive abilities and cause visual symptoms such as:

    • Double vision
    • Light sensitivity
    • Partial or total loss of vision
    • Weakened eye muscles

    4 Tips for Avoiding a Traumatic Brain Injury

    One of the best ways to protect yourself from a concussion or more serious TBI is to put safety first, whatever your activity.

    Wear Protective Sports Gear

    Approximately 69 million TBIs occur each year worldwide, of which about 50% are sports-related. Wearing protective eyewear and a helmet when playing baseball, football, basketball, hockey or any other sport, can help prevent serious injuries, especially in children.

    Wear Sunglasses

    Glare from the sun can temporarily blind you while driving, walking across the street — during any activity, really. Wearing sunglasses is a simple way to reduce glare and prevent glare-related accidents.

    Polarized sunglasses filter intense light that reflects off surfaces like water, glass, sand, snow and pavement, preventing glare from entering your eyes. Make sure the sunglasses you choose also offer 100% UV protection. Photochromic lenses are a good choice for people who wear prescription glasses since they darken when outdoors and become clear again indoors.

    Pay Attention To Your Surroundings

    As basic as it may seem, people often fail to pay attention to their surroundings. When walking, driving, or doing any other activity, try to minimize distractions. Stand still while speaking on your cell phone or texting. When you’re walking outside, keep an eye out for sidewalk cracks as well as overhanging branches and other sharp items or debris that could be hazardous.

    Don’t Forget to Wear Your Seatbelt

    For years, parents and doctors have been drumming this into our heads, and for good reason! The #1 way to prevent or minimize an injury from a car accident is by wearing a seatbelt.

    According to the National Center for Biotechnology Information National Library of Medicine, one-quarter of all TBIs in North America are caused by road accidents. Those numbers rise to more than 50% in Southeast Asia and Africa.

    How a TBI Affects Vision

    A traumatic brain injury can impair your vision, causing light sensitivity, double or blurry vision, and persistent eye strain. In many cases, activities like reading a book, driving a car or watching TV can become much more challenging — or impossible — as a result of a TBI.

    According to Clinical and Experimental Optometry, 90% of TBI patients suffer from visual dysfunction, making it all the more crucial to take precautionary measures to stay safe.

    Neuro-Optometric Rehabilitation Can Help With Brain Injuries

    Neuro-optometric rehabilitation is a personalized treatment program for patients with visual deficits due to physical disabilities and TBIs. The goal of neuro-optometric rehab is to minimize visual disability so that a patient can continue to perform daily activities, whether it’s learning in a classroom or being able to function in the workplace.

    A neuro-optometric rehabilitation optometrist evaluates many functions of the visual system, such as how the eyes work together. Treatment options may include the use of various filters and prisms, and visual exercises to strengthen the brain-eye connection.

    If you or a loved one displays double vision, light sensitivity, dizziness or any other TBI-related visual or balance-related symptoms, contact Family Eye Care immediately. Following evaluation, Dr. Moshe Roth and Dr. Steffani Tiomno may offer a customized neuro-optometric rehabilitation program to help regain any lost visual skills.

    Frequently Asked Questions with Dr. Moshe Roth and Dr. Steffani Tiomno

    Q: What Does a Neuro-Optometrist Do?

    A: A neuro-optometrist diagnoses general eye health problems and corrects refractive errors to improve visual acuity, as well as assess functional binocularity, spatial vision, and visual processing abilities.

    Q: What causes a TBI?

    A: Traumatic brain injuries can occur during everyday activities like walking, swimming, hiking, running or playing competitive sports.

    The most common causes of TBIs are:

    • Being struck by an object
    • Falls
    • Motor vehicle accidents
    • Sports injuries

    Family Eye Care serves patients from Old Bridge, East Brunswick, Woodbridge, and Edison, all throughout New Jersey.


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