Optometry & Visual Performance 130 Volume 14 | Issue 2 | June 2026 Article • Case Series: Optometric Approach to Vision-Related Concussion Symptoms, Diagnosis, and Management Zuzana Rutenberg, M. Optom • Jerusalem Multidisciplinary College • Jerusalem, Israel Rachel Eichler, OD • Jerusalem Multidisciplinary College • Jerusalem, Israel Liat Gantz, PhD • Jerusalem Multidisciplinary College • Jerusalem, Israel ABSTRACT Background: Sport-related concussions frequently result in persistent visual dysfunctions, including accommodative, binocular, oculomotor, and oculo-vestibular impairments. These deficits can significantly impact quality of life and are often overlooked in standard eye examinations. Optometric vision therapy offers targeted rehabilitation to address these dysfunctions. This case series highlights the benefit of vision therapy in three female patients with sport-related concussions referred for visual evaluation and treatment long after the concussion was sustained. Case Reports: Three patients (ages 20, 27, and 34) with persistent visual symptoms years after one or more concussions were previously examined by eye care providers, yet visual complaints remained unresolved. Each underwent a comprehensive binocular vision assessment revealing various combinations of accommodative excess (patients 1, 2, 3) or insufficiency (patient 2), fusional vergence dysfunction (patients 2, 3), oculomotor deficits (patients 1, 2, 3), and vestibulo-ocular dysfunction (patients 1 ,2, 3). Patients completed 11–12 sessions of individualized vision therapy, supplemented by daily home exercises. Following therapy, all patients demonstrated clinically significant improvements in objective findings and selfreported symptoms. Brain Injury Vision Symptom Survey scores improved by 55–59% (34–35 points) Introduction Concussion, often referred to as mild traumatic brain injury (mTBI), is defined by the Centers for Disease Control and Prevention (CDC) as injury to the brain resulting from abrupt acceleration and deceleration of the head during impact, causing the brain to collide or twist with the skull, thereby damaging brain cells and triggering chemical changes.1,2 Diagnosing concussion can be challenging due to rapid fluctuations in signs or symptoms3 and potential delayed inflammatory responses.4–6 A recent Delphibased framework developed diagnostic criteria, which include the mechanism of injury, clinical signs, acute symptoms, clinical examination findings, and neuroimaging.7 Visual symptoms after concussion frequently include blurred vision, photosensitivity, dizziness, headaches, and difficulties with eye coordination or depth perception.8 Convergence insufficiency (CI) and accommodative disorders are common in individuals after mTBI.9,10 These visual disorders can significantly impair everyday tasks11 and impede academic, occupational, and athletic performance. They may also limit attendance at school, work, or sports,2 resulting in both an economic and mental burden. Zuzana Rutenberg, M. Optom Reykjavík, Iceland Augnlæknastofan í Mjódd, Iceland M. Optom, Jerusalem Multidisciplinary College, 2025 B. Optom, Jerusalem Multidisciplinary College, 2005 across the three cases. Notable functional gains included reduced photophobia, improved reading, less fatigue, and return to academic or physical activities. Conclusions: This case series underscores the essential role of optometrists in post-concussion care. Optometric vision therapy is an effective intervention, even when initiated long after the initial injury. Comprehensive visual function assessment and interdisciplinary collaboration are critical to identifying and managing postconcussion visual dysfunction, ultimately improving patient outcomes. Keywords: concussion, optometric vision therapy, traumatic brain injury
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