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What does a neuro-optometrist do?

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Answer transcribed from Brightway's Interview with Dr. Bryce Appelbaum:

That's the million-dollar question because there are so many different theories on who to see and what to see. Let's start kind of broad here. There's ophthalmology and there's optometry, each having different degrees and different models of vision. Ophthalmology is trained on the intervention of eye disease and structure and I'm very grateful for their training. They're who you need to go to if surgery is needed or if disease processes are occurring. Optometry looks at vision development, functional skills, eyesight, and also eye health; much more of a “real-world application” to how you're using a visual system. Then within optometry, there's neuro optometry, which is a unique specialty where neuro optometrists have the ability to rewire the software in the brain to change how somebody's using their visual system to decrease change or eliminate symptoms. 


Note that not all optometrists do neuro optometry and within neuro optometry, not all neuro optometrists specialize in vision therapy or rehabilitation. So this unique specialty of neuro-optometric rehabilitation or vision therapy is really the nuts and bolts of what we're going to be talking about today.


Vision therapy is kind of like physical therapy for the brain through the eyes and it's about the arrangement of conditions to raise to somebody's awareness. This includes what they're doing, how they're using their eyes, how their eyes, brain, and body are integrated together so that they can learn how to self-correct, self-monitor, and essentially make bad habits no longer options. I think that the key to better understanding vision therapy is to have a better understanding of vision, which can really be simplified into an important distinction: the difference between eyesight and vision. 


Eyesight is important but vision is much more important than 2020 eyesight. Eyesight's the ability to discriminate or see something on a sign and make out the letters. That's important and that's what most people have glasses or contacts for. Vision, on the other hand, is really how the brain uses the information the eyes send it and how well the brain derives meaning, directs action, and processes the input in often very busy crowded visual environments. 


Most disorders of the visual system following head trauma are highly treatable if you're actually identifying them. By engaging the brain in ways that it's currently avoiding, bypassing, or just not using efficiently, we can desensitize and rehabilitate the visual system in a way that can have profound impacts on activities of daily living and functioning. When you think about the fact that vision is represented in every lobe of the brain and not just the occipital lobe, which is the eyesight center, but all the different areas of the brain that integrate processes and use the visual system, then really you know all the other senses combined. Hence, it's almost impossible to have a head injury and not have vision be impacted. Eyesight does get impacted as well but not as often, so it's almost always the visual system. That can be at a mild level or it can be at this massive catastrophic level where symptoms are absolutely interfering with happiness and life. 


Vocational issues and personal issues can have pretty big impacts on somebody's well-being. I think it's estimated about half or so of those who've suffered a brain injury have had the visual perceptual connection with the world disrupted. Recovering these visual abilities is all about re-establishing the brain function that was lost or that they're no longer using. I think that the key component of all this recovery usually requires a team approach of a lot of professionals working together, which can include but not limited to PT, OT, speech therapy, vestibular therapy, biofeedback, neurofeedback, and health coaches. The list continues, but I think that the collaboration of therapies really allows for the critical learning of how to accurately perceive information that arrives at our body from our eyes to the brain and how we can integrate and coordinate all these senses together. Vision is our dominant learning sense so it should be the sense that ties all of these other systems together. So if somebody you know has a concussed brain they can't filter sensory input appropriately, they don't know how to process all this feedback from their body or from their environment. 


Take the vestibular system for example. That's the internal navigation system and the road map of life. Everyone always talks about the vestibular system but the vestibular system does not operate in isolation. It takes input from the visual system, the balance centers, and the proprioceptive centers and lets us know which way is up, down, left, and right and responds to gravity and changes in body positioning in a very dynamic fashion. The visual and vestibular systems are linked very intimately in the brain and although I'm biased, it's hard to have an injury and not have these this relationship altered, which can lead to motion hypersensitivity, motion sickness, sensory overloads, and crowded environments like the mall or grocery stores or this kind of brain fog that often comes from a concussion due to poor visual contact with the physically and cognitively demanding world. So if you know what to look for and you have the appropriate information available, there's a lot that can be done to help redirect a path to recovery or address areas that maybe were overlooked in the past.