Neuro-Optometric Evaluations

Neuro-Optometry Evaluations

A Neuro-Optometry Evaluation is an assessment by a neuro-optometrist after 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:

  • 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 cases the eye symptoms/signs; however, it is well documented that as many as 60-70% of diagnosed concussion may result in a 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

    How do you get started at Swoop Eye Care & NeuVision Therapy & Rehabilitation?

    Step 1 – Comprehensive Eye Examination (1-1.5 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 min.-2 hours)
    • We recommend a reputable in-person eye clinic to select frames/lenses. For patients referred in from outside eye clinics, we recommend supporting your primary eye care clinic. If you have an auto claim, worker's compensation, or other insurance covering prescription eyewear, we understand that your referring provider may or may not provide those services. We are happy to help (see Swoop Optical Advantage next).
    Swoop Optical Advantage
    • Certified Opticians
    • Cost-effective, quality selection
    • In-house billing department for Worker’s Compensation Insurance & Auto-Claim insurance
    • Extended Prescription Change Warranty (at least 6 months)
    • Customized lens options for lifestyle, worker habits, and activities of daily living in virtually all price ranges
    Online Vendor Disclaimer
    • It is important to have precise measurements that include: pupillary distance, ocular segment height, vertex distance, and other parameters when ordering ophthalmic lenses. Online vendors most commonly place the segment height in the middle of the lens based upon each frame. It does not often take into account where the glasses sit on each individuals nose. Therefore, the measurements are not aligned or customized for your face nor fit for your nose. Patients with a history of a traumatic or acquired brain injury with a known vision deficit/dysfunction must have the most accurate measurements to lead to the best visual outcomes.

    Step 3 – Neuro-Optometry Evaluation (1-1.5 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 (Single Vision Digital, Anti-Fatigue, Shaw lenses, Progressive Digital, Office lenses)
      • Prism management
      • Tints or Filters
    • Occlusion therapy
    • Neuro-Optometric rehabilitative care
      • Improving eye movements
      • Improving vergence ranges
      • Compensatory strategies
      • Visual processing therapy
    • Treatment of ocular disease or injuries diagnosed within the assessment or co-management with your primary eye care provider (ophthalmologist or optometrist).
    • Education & counseling for yourself, family, and caregivers to aide in your healing process
    • Referring providers/therapists can expect a detailed letter of the results & management recommendations.
    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 (Vision Therapy)
    • Neuro-Optometric rehabilitative care or 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.
    • Swoop Eye Care neuro-optometrists work with the following:
    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).

    How do you get started at Swoop Eye Care & NeuVision Therapy & Rehabilitation?
    Does a routine eye examination rule out vision or eye related deficits secondary to a concussion or neurologic insult?
    • A routine eye examination often 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 medical insurance, worker’s compensation, auto-insurance, and/or vision plan coverage cover a neuro-optometric evaluation at Swoop Eye Care?
    • Neuro-optometric evaluations are medical eye examinations, which are typically covered by most medical insurances, auto-insurances, and worker’s compensation claims. Prior to your visit, worker’s compensation & auto-insurance claims require key pieces of information that is required prior to being seen by our neuro-optometrists.

    • Vision discount plans (EyeMed, VSP, Avesis, Davis, etc.) do not cover these medical eye evaluations.

    Does medical insurance, auto-insurance, and worker’s compensation cover my medically necessary prescription glasses?
    • Medical insurance typically does not cover prescription eyewear; however, Swoop Eye Care will provide an itemized bill with all relevant procedure and ICD-10 diagnosis codes.

    • Auto-insurance may or may not cover part or all of your prescription eyewear. Personal injury protection (PIP) often does cover some of medically necessary prescription eyewear if the policy has not been exhausted (fully spent for your healthcare costs). 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.

    • 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 medical insurance, worker’s compensation, or auto-insurance cover Neuro-Optometric rehabilitative therapy/care or vision therapy at our partner, NeuVision Therapy & Rehabilitation?
    • Medical insurance may or may not cover neuro-optometric rehabilitative therapy sessions. Given procedure code and medical insurance changes, NeuVision Therapy & Rehabilitation does not directly bill major medical insurances. An itemized bill or additional information requested by the patient is provided to help facilitate out-of-network coverage for therapy services rendered.

    • Auto-insurance & Worker’s Compensation coverage may or may not cover neuro-optometric rehabilitative therapy sessions. Each of these are case by case basis. Please inquire with NeuVision Therapy & Rehabilitation practice administrator.

    • Flexible spending accounts (FSA) and health savings accounts (HSA) do qualify.

    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

    Where can I find additional information on traumatic brain injuries?