It’s been my clinical experience that the full spectrum of vision issues after brain injury is incredibly underdiagnosed, and our patients suffer because of it. Why? Because they often don’t look like vision problems. The truth is that vision is a brain function as much as it is an eye function. When the brain’s visual pathways are affected, everyday tasks can become overwhelming and exhausting.
When the Eyes Aren’t the Problem: New Research Shows Why Vision Should Be Evaluated After a Concussion
Frequently, I hear from clients that they’ve already been to the eye doctor, which is great! We know the eyes are healthy and whether you need glasses. But after a concussion, many people still have 20/20 vision AND have a serious vision problem.
Reading causes headaches. Words on a page seem to move. Phone and computer screens become exhausting. Driving takes more concentration than it used to. Bright lights or busy environments feel overwhelming. Their eyes feel tired, strained, or unable to keep up. So, what is going on?
The eyes see. The brain makes sense of what you see. Vision is so much more than a clear image. The eyes gather information from the world, but your brain must control the precise movements of your eyes, make sure both eyes work together, process that information, and turn it into something meaningful. After a concussion, the neurological networks responsible for controlling eye movements, focusing, coordinating both eyes, and processing visual information may not work as they did before, which means the brain works harder to perform tasks that used to be automatic.
Feeling better doesn’t always mean your vision has recovered. A 2025 study published in the Journal of Head Trauma Rehabilitation followed 26 adults with significant visual symptoms after mild TBI. Researchers evaluated their vision 4 months after the injury and then 14 months after that. Many participants experienced improvement in their overall concussion symptoms, but for many, visual problems persisted.
A standard eye exam is important, but it focuses on eye health and visual acuity. After a brain injury, however, a comprehensive vision evaluation is needed. It will examine how the eyes and brain work together, assess eye movements, focus, coordination between the two eyes, visual processing, and how the visual system responds to movement and complex environments.
After an injury, it’s important not to just wait for vision problems to get better. Delays in starting visual rehabilitation can prolong functional deficits, increase symptoms like fatigue and headaches, and slow down the overall recovery of visual processing efficiency. Sometimes the question isn’t “How well can you see?” It’s “How well is your brain processing what you see?” And those are two very different questions.
When Vision Therapy Helps the Brain Heal: What New Research Says About Neuro-Optometric Rehabilitation
After a concussion, stroke, or other brain injury, many people notice that something feels different when they read, drive, work on a computer, or even walk through a crowded grocery store. They may assume their eyesight has gotten worse. But sometimes, the problem isn’t the eyes. It’s the way the brain is processing and controlling vision.
When we think about vision, we often think about seeing clearly or reading an eye chart. But clear eyesight is only one part of the visual system. Your brain constantly coordinates eye movements, maintains focus, helps judge depth, tracks moving objects, and processes an enormous amount of visual information. After a TBI, concussion, or stroke, these systems may not work together like they once did—even when the eyes themselves are healthy. The result can be surprisingly disruptive.
Neuro-optometric rehabilitation is a specialized therapy designed to improve how the eyes and brain work together following neurological injury. Treatment is individualized and may target skills such as eye tracking, rapid eye movements, coordination between the two eyes, focusing, visual attention, and coordination between vision and balance. Depending on the person’s needs, therapy may take place in a clinic, at home, or through a combination of both under the guidance of appropriately trained professionals.
A 2024 systematic review published in the Oman Journal of Ophthalmology examined research on neuro-optometric rehabilitation for eye-movement problems following neurological injury; the findings were encouraging. Vision rehab—often lasting 8 to 12 weeks and involving several sessions each week—was associated with improvements in areas such as eye-movement control, reading ability, visual comfort, and other oculomotor functions.
Vision problems after brain injury are common, treatable, and too important to ignore. For years, people recovering from concussion were often told to simply “give it time.” And while many symptoms do improve naturally, persistent problems may require targeted rehabilitation. Vision therapy helps retrain the brain’s visual pathways through repetitive, purposeful exercises that increase the brain’s remarkable ability to heal.
Looking Through the Eyes of Recovery: What Vision Can Tell Us About Consciousness After Severe Brain Injury
The old adage “The eyes are the windows into the soul” may be truer than most people realize. For patients with severe brain injuries, assessing consciousness is an incredibly complex challenge, but a new study that investigated how visual impairments, visual evoked potentials (VEPs), and brain metabolism relate to levels of consciousness in patients with disorders of consciousness (DoC) uncovered important links that may improve diagnosis and recovery prediction.
Visual behaviors, especially eye fixation and visual pursuit, are among the most important indicators used to identify minimally conscious patients. If vision is compromised, clinicians may underestimate a patient’s true level of consciousness. To address this challenge, researchers combined ophthalmological evaluations to identify visual impairments, Visual Evoked Potentials (VEPs), which measure the brain’s electrical response to visual stimuli, and a specialized PET scan to assess the brain’s metabolism. The goal was to determine how these measures relate to consciousness levels and recovery potential.
Among the study’s notable findings were:
- Visual impairments were present in 70% of patients with severe brain injury.
- Ocular motility disorders were the most common visual problem.
- Abnormal VEPs were substantially more frequent in patients with Unresponsive Wakefulness Syndrome than in those with Minimally Conscious State.
- PET imaging showed significantly reduced metabolism in visual networks among UWS patients.
- Better VEP responses and stronger brain metabolism were associated with fewer visual impairments.
This study reinforces a growing understanding in neurorehabilitation: vision is far more than a sensory function in patients with severe brain injury. The ability of the eyes and visual pathways to detect, transmit, and process information may offer a critical window into consciousness itself. By looking beyond behavior alone and incorporating objective measures of visual and brain function, clinicians may be better equipped to identify hidden signs of awareness and support patients on the path toward recovery.
At Trial: Vision Problems After Brain Injury May Say More Than We Think
When most people think about a traumatic brain injury, they think about headaches, memory problems, dizziness, or difficulty concentrating. What is often overlooked is the role that vision plays in recovery.
Vision depends on complex networks throughout the brain that help us process information, maintain balance, track moving objects, read, drive, and navigate our environment. When those networks are disrupted by injury, individuals may appear fully recovered, but struggle to read emails, tolerate computer screens, complete a workday, drive safely, or participate in activities they once enjoyed.
When vision problems interfere with employment, education, or routine tasks, evaluation and documentation become critical in understanding the full extent of an injury and the resources necessary for recovery. By documenting functional limitations, medical professionals can provide a clearer picture of the challenges an injured person continues to face long after an accident; objective testing helps tell the complete story of how a brain injury affects a person’s daily life.
At Cantor Grana Buckner Bucci, our client-centered approach recognizes that vision, cognition, balance, emotional health, sleep, and daily functioning are deeply interconnected. We know the effects of a brain injury can extend far beyond what is visible in an imaging study, and we believe successful recovery often requires a multidisciplinary team, working together, to identify every barrier to function. Our team works closely with medical experts to ensure every aspect of a client’s injury, including often-overlooked visual dysfunction, is recognized, evaluated, and appropriately documented
By helping clients obtain the right care at the right place at the right time and with the right clinicians, we work to build a complete picture of both the injury and the support necessary to achieve meaningful recovery. Call us.
