Optometry & Visual Performance 136 Volume 14 | Issue 2 | June 2026 combined based on the patients’ abilities to increase visual perceptual skills. Oculo-vestibular therapy included work on the vestibular-ocular reflex on activation and inhibition, Marsden ball, and the walking rail. Home exercises included loose lens rock, binocular accommodative rock, Brock string, Multi Matrix, wall saccades, Marsden ball, Spot-It game, saccadic workbooks, MacDonald peripheral card, tachistoscope, geoboard, memory workbooks, visual discrimination workbooks, eccentric circles, and barrel and lifesaver cards, with combinations of loose lenses at more advanced levels. Discussion Although visual symptoms are very common in post-concussion patients, visual examinations by eye care professionals do not typically involve the assessment of accommodative, binocular, oculomotor, and oculo-vestibular systems.16 In all three of these cases, patients were previously seen by an eye care practitioner, who examined ocular health and refraction but not binocularity. The patients were subsequently referred for a binocular vision evaluation by a physiotherapist or cognitive therapist due to ongoing visual complaints persisting even months after the concussion. Additionally, all cases improved in both objective clinical measures as well as symptoms after a course of vision therapy, highlighting the importance of evaluating and treating binocular vision dysfunctions in addition to ocular health and refraction, especially in patients who have a history of concussion. These comprehensive evaluations should occur soon after injury to provide a better prognosis and improved quality of life.17 These positive outcomes collectively demonstrated the effectiveness of OVT in addressing the individuals’ visual challenges. Among all the therapies available today, OVT is still not one of the commonly used, although vision plays a significant role in the patient’s symptoms and quality of life after a concussion. Further, active treatments are more effective than rest-based approaches.18 The observed improvements in the cases described demonstrate the efficacy of OVT in mitigating postconcussion visual dysfunction. Evidence suggests that active interventions, including vision therapy, are more effective than passive, rest-based approaches.18 Despite this, OVT appears underutilized.19 The present findings demonstrating the effectiveness of OVT after sport-related concussion align with those of Morton,20 who reported a similar case of a 20-year-old athlete requiring 34 OVT sessions beginning eight days post-injury. In contrast, the three cases described here required only 11–12 sessions, possibly due to later initiation of therapy and the absence of CI, which was present alongside accommodative spasm in Morton’s case. Earlier intervention in these cases may have mitigated long-term visual symptoms. Future studies should compare outcomes between patients treated soon after concussion and those treated at a later stage to assess the effect of early detection and intervention on visual dysfunction. Patient 2 presented the greatest treatment challenge, likely due to the combined effects of 18 concurrent medications prescribed for coexisting Ehlers-Danlos syndrome, attention deficit/ hyperactivity disorder, and postural tachycardia syndrome. The patient denied history of these diagnoses prior to her concussions. Thus, it is unclear whether these comorbidities represent distinct primary disorders or are manifestations secondary to the brain injury. Such inconsistencies may reflect a broader phenomenon in post-concussion populations, where diagnostic frameworks established in noninjured cohorts may not fully apply.21 Similarly, Patient 2 presented with low accommodative amplitude and high lag, consistent with accommodative insufficiency, yet demonstrated the ability to clear minus lenses rapidly while failing with plus lenses, suggestive of accommodative excess. These conflicting findings may reflect medication side effects; several of her prescribed drugs (e.g., bisoprolol, Elvanse, pregabalin, sertraline, prednisone, Xeomin) are known to affect visual function. Alternatively, such inconsistencies may reflect a broader phenomenon in post-concussion populations, where standard diagnostic criteria— derived from non-concussed cohorts—may not apply. Wiecek et al.22 similarly reported conflicting accommodative findings in a retrospective study of 116 post-concussion patients, noting that 50% failed plus lens facility despite 54% having reduced accommodative amplitude. Together, these findings suggest the need to reconsider diagnostic frameworks for binocular and accommodative dysfunctions in concussed individuals. An additional observation concerns increased myopic prescriptions in this population, often driven by patient complaints of reduced distance clarity. While patients may prefer stronger minus lenses
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