Neuro-Optometric Evaluations at Swoop Eye Care in Richfield

Neuro-Optometry Evaluations

A Neuro-Optometry Evaluation is an assessment by a neuro-optometrist following a neurological event to assess, evaluate, diagnose, manage, and treat visual pathway and/or vision processing disorders causing many varying symptoms (see a brief list below). A neuro-optometrist assesses the interaction or eye teaming of your two eyes (binocular system) by evaluating the overall strength, endurance, flexibility at distance & near, peripheral vision awareness, and/or the vestibular-ocular reflex of the binocular system.

Neurological events that may impact eye/vision health

Traumatic brain injuries

Acquired brain injuries
Concussions (motor vehicle accidents, falls)
Near drowning (anoxic brain injury)
Aneurysm
Infectious disease affecting the brain or parts of the brain
Strokes
Brain tumors
Cranial nerve palsies
Long haul COVID-19
Parkinson’s Disease
Multiple Sclerosis
Supranuclear Palsy

Neurological eye or vision sequela symptoms/signs

Neurological eye or vision sequela symptoms/signs:

Headaches
Double vision
Poor balance and/or balance issues
Focusing problems
Poor eye tracking
Words jumping on the page while reading
Eye or vision fatigue (blurry vision at distance and/or near)
Inattention to peripheral vision
Overstimulation of visual environment
Dizziness
Sensitivity to light (natural light, fluorescent light, digital screens, etc.)
Computer vision strain
Head tilt
Neck pain

Not every neurologic event causes a binocular vision dysfunction; however, literature and clinical document as many as 60-70% of concussed individuals have one or more binocular vision dysfunction/disorder.

A binocular vision disorder/dysfunction is where the two eyes are unable to properly align, thus, it causes a loss of coordination that may result in intermittent or total misalignment. There are many binocular vision dysfunction and disorders that may include:

Post-Concussive Vision Syndrome, Photophobia (light sensitivity)
Focusing Problems: Accommodative spasms, Accommodative infacility, Accommodative insufficiency, Ill-sustained accommodation
Eye Muscle Problems: Convergence insufficiency, Convergence excess, Divergence insufficiency, Divergence excess, Esophoria, Exophoria, Intermittent esotropia, Intermittent exotropia, Vertical heterophoria
Eye Teaming: Deficit of saccadic dysfunction, Deficit of smooth pursuits
Palsies: Third nerve palsies, Fourth nerve palsies, Sixth nerve palsies Gaze palsies

These binocular vision disorders/dysfunctions manifest many vision & eye related problems that may impact a patient’s lifestyle, work or school productivity, sports performance, and many other everyday activities that many of us without a concussion or neurologic deficit do seamlessly.

Neuro-Optometry Patient Journey

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How do you get started at Swoop Eye Care?

Step 1 – Comprehensive Eye Examination (1hour-1.5 hours)

Baseline eye health & eyeglass prescription determined (prescription may need to be refined during a follow-up pending concerns).

Requirements

Dilated medical eye examination within 1 year
Dilated examination after injury or any traumatic/acquired brain injury

Step 2 – Prescription Eyewear Selection Process (30 minutes-2 hours)

We recommend a reputable in-person optical shop to select frames/lenses. For patients referred in from outside eye clinics, we recommend returning to your primary eye care clinic. If your visit is related to an motor vehicle accident or worker's compensation, we recommend Swoop Optical for continuity of care and billing purposes.

Swoop Optical Advantage

Certified Opticians
Cost-effective & high-quality products
A one-year warranty for all frames against manufacturer defects
A one-time prescription change at no-cost for at least 6 months
Billing to Worker's Compensation Insurance for medical necessity
Billing to Auto-Insurance for medical necessity

Online Vendor Disclaimer

It is important to have precise measurements that include:

pupillary distance
ocular segment height
vertex distance
other parameters

Swoop Optical is not responsible for any prescription filled by an online vendor. If a patient requests that we evaluate a pair of lenses from an online vendor, we will assess a fee of $50 (at minimum). Swoop Optical opticians are certified professionals with extensive experience working with highly complex prescriptions that are patients often require.

Step 3 – Neuro-Optometry Evaluation (1 hour-1.5 hours)

A problem-oriented evaluation of vision & eye health that may have been affected by damage to the eyes and/or central nervous system (brain). The assessment typically assesses the visual, oculo-motor (eye movements & eye teaming of both eyes), and focusing skills important to allow for clear, single, and comfortable vision in our everyday lives.

Eye or Vision Related Deficits

Binocular vision dysfunctions
Visual field defects
Symptoms: Photophobia, balance, visual overstimulation, oscillopsia, and many others
Strabismus
Optic neuropathies
Pupil abnormalities
Loss of vision
Blurry vision at distance or near

Treatment/Management

Prescription lenses
- Prism
- Tints or Filters or Photochromatic lenses
Occlusion therapy
Neuro-Optometric rehabilitative care
- Improving eye movements
- Improving vergence ranges
- Compensatory strategies
- Visual processing therapy
Treatment of ocular disease or injuries
Referral to outside healthcare providers as needed
- Vision Therapy, Occupational Therapy, Vestibular Physical Therapy, Physical Medicine & Rehabilitation, Occupational Medicine, Neurology, Neurosurgery, Ophthalmology, Neuro-Ophthalmology, Pediatric Ophthalmology, and many others
Education & counseling for yourself, family, and caregivers to aide in your healing process
Copy of the Exam Visit
Coordination amongst other healthcare providers and case managers

Step 4A - Special Testing (20 minutes)

Your neuro-optometrist may order additional testing the same day or for a follow-up. Tests may include:

Step 4B - Neuro-Optometric Rehabilitative Care and/or Occupational Therapy and/or Physical Therapy

Neuro-Optometric rehabilitative care (vision therapy) is an individualized rehabilitation program of eye exercises (typically recommended weekly one to one) with your vision therapist or neuro-optometrist to manage/treat binocular vision disorders and symptoms stemming from your concussion or neurologic event.
- NeuVision Therapy & Rehabilitation is our vision therapy partner (located adjacent to Swoop Eye Care located in Richfield, MN)
Occupational Therapy and/or Physical Therapy are therapies offered through many of our referral partners located within Minnesota. We work closely with the following clinics and health systems:

Step 5 - Neuro-Optometric Reassessment or Binocular Vision Re-Check (1 hour)

A neuro-optometric reassessment or binocular vision check is a reassessment evaluation to track progress since we most recently saw you in office. Typically rechecks take place after a determined period of time or after completing vision therapy for at least 10 sessions. With your help and that of your team, we should see improvement in objective findings to substantiate/support continued neuro-optometric rehabilitation/therapy. While rare, minimal or no progress in objective findings supports a change in management, therapy options or to consider other reasons for lack of progress.

We look forward to helping you on your journey!

Commonly Asked Questions

What is Neuro-Optometry?

Neuro-optometry is a sub-field of optometry. A neuro-optometrist often completes a residency program (one or two years in length) within a hospital-based program, Veteran’s Administration, or private practice specializing in the diagnosis, treatment and rehabilitation of vision related dysfunctions stemming from a neurologic insult or deficit (see above).

Does a routine eye examination rule out vision or eye related deficits secondary to a concussion or neurologic insult?

A routine eye examination does not elicit or diagnose many of the eye or binocular vision dysfunctions/disorders due to a traumatic brain injury. It is important to discuss with your optometrist or ophthalmologist the specifics of your concerns or past brain injury to comprehensively assess your eye & vision health.

What components are often part of a neuro-optometric evaluation (some or all may take place)?

Comprehensive eye exam and vision exam
Extended sensorimotor evaluation
Visual perceptual and cognitive evaluation
Higher cerebral function assessment of visual information processing
Low-vision evaluation
Specialized testing
- Electrodiagnostic vision testing (Visual evoked potential)
- Visual field testing
- Optical coherence tomography
- Many others
Visual-Vestibular and balance testing

Does Auto-Insurance, Medical Insurance, Vision Plans, and/or Worker's Compensation Insurance pay for a neuro-optometry evaluation?

A Neuro-optometry evaluation is a specialty medical office visit. Your neuro-optometrist is investigating active symptoms and signs related to the main reason of your visit.

Auto-insurance may or may not cover cover your neuro-optometry evaluation. If personal injury protection (PIP) has not been exhausted, we will send your bill to the auto insurance.
- Covered
- Not Covered: We will send to your medical insurance carrier.

Medical insurance covers a neuro-optometry evaluation, as it is considered a medical office visit by a specialist. Copays, co-insurance, and/or deductible amounts do apply.

Worker’s compensation may or may not cover your neuro-optometry evaluation. The visit must be related to your work injury and be pre-approved by the claims adjuster.
- Approved --> Complete scheduled visit at Swoop Eye Care.
- Not Approved --> Billing is sent to your major medical insurance.

Vision Plans (Avesis, Davis, EyeMed, Humana Vision, VSP, etc.) do not cover neuro-optometry evaluations.

Does Auto-Insurance, Medical Insurance, and/or Worker's Compensation Insurance pay for medically necessary prescription glasses?

Auto-insurance may or may not cover part or all of your prescription eyewear. If personal injury protection (PIP) has not been exhausted, our office will bill your auto insurance.
- Option 1: Full payment must be received from the insurer prior to starting the custom made prescription eyewear.
- Option 2: Full payment by the patient may be completed and an itemized receipt provided to work with the auto insurer.

Medical insurance typcically does not cover prescription eyewear. Swoop Eye Care will provide an itemized bill with all relevant procedure and ICD-10 diagnosis codes.

Worker’s compensation may or may not cover part or all of your prescription eyewear. We are happy to submit all relevant information to your carrier to help in this process, as we understand the process is often complicated. We will ask for a credit card to be held on file in the event that the purchase is not covered.

Does Auto-Insurance, Medical Insurance, and/or Worker's Compensation Insurance pay for Neuro-Optometric Rehabilitative Therapy/ or vision therapy at our partner, NeuVision Therapy & Rehabilitation?

Swoop Eye Care does not provide vision therapy directly. Our partner, NeuVision Therapy and Rehabilitation, provides vision therapy services if ordered/recommended by your neuro-optometrist.

Auto-insurance may or may not cover part or all of your vision therapy.

Medical insurance may or may not cover part or all of your vision therapy.
Worker’s compensation may or may not cover part or all of your vision therapy.

Referral process for neuro-optometric rehabilitation or vision therapy with NeuVision Therapy & Rehabilitation?

Process for Vision Therapy Referral

Complete a binocular Vision/neuro-optometry evaluation at Swoop Eye Care
Referral to NeuVision Therapy & Rehabilitation for vision therapy
NeuVision Therapy & Rehabilitation representative will reach out to go through the process within one week

NeuVision Therapy & Rehabilitation is OUT-OF-NETWORK for all medical insurances. Patients will have the following options:

HSA/FSA accounts
Self-Pay
SuperBill to Medical Insurance for Out-of-Network Services

What are some examples of a traumatic brain injury versus an acquired brain injury?

Traumatic brain injury
- Concussion
- Sports injury
- Assault
- Falls
- Motor vehicle accidents
Acquired brain injury
- Stroke
- Near drowning (anoxic brain injury)
- Aneurysm
- Tumor
- Infectious disease affecting the brain or parts of the brain