Optometry & Visual Performance 147 Volume 14 | Issue 2 | June 2026 and subjective symptomatology in a patient with post-concussive VSS. Case Report Patient History HB is a 57-year-old African American female with a history of mild traumatic brain injury sustained at age 52 after being struck by an object in a school hallway, where she worked as a counselor. Following the injury, she developed persistent PCS. The patient’s quality of life was significantly compromised by a complex constellation of neurological, visual, and systemic conditions. Persistent symptoms of visual snow created a continuous visual disturbance, interfering with reading, screen use, and overall visual comfort, while chronic migraines further limited daily functioning through pain, light sensitivity, and fatigue. Vestibular and oculomotor dysfunction contributed to imbalance, dizziness, and difficulty with eye movements, making tasks such as walking in busy environments or sustaining visual attention particularly challenging. These physical symptoms were compounded by cognitive deficits, including reduced concentration and processing speed, which impaired academic, occupational, and daily activities. Additionally, the presence of depression and anxiety exacerbated her functional limitations and emotional well-being, while obstructive sleep apnea led to poor sleep quality and daytime fatigue, further diminishing resilience and recovery. Hearing impairment added another layer of sensory difficulty, complicating communication and social interaction. Together, these overlapping conditions created a substantial and persistent burden, significantly reducing her independence, productivity, and overall quality of life. The patient’s post-therapy goals were centered on restoring functional independence and improving day-to-day performance across visual and cognitive domains. A primary objective was to reduce the intensity and intrusiveness of visual snow symptoms, allowing for greater visual clarity and comfort in both static and dynamic environments. She also aimed to improve reading stamina and comprehension, with the expectation of being able to sustain prolonged near work without fatigue, loss of place, or decreased understanding. This was critical for academic, professional, and personal tasks. In addition, enhancing cognitive processing speed and memory was a key goal, as she sought to think more clearly, to retain information more effectively, and to engage in complex tasks with greater efficiency. Collectively, these goals reflected a desire not only for symptom reduction, but also for meaningful improvements in functional capacity, productivity, and overall quality of life. Clinical Findings Table 1 shows the exam data from the initial visit on 6/2/2025. The anterior and posterior segments were healthy and clear of disease processes. Pre-treatment objective assessments revealed significant oculomotor dysfunction. These findings were consistent with the impaired visual tracking and fixation instability commonly observed in postconcussive patients. Treatment Protocol The patient participated in a structured 30-day therapy program known as optometric multisensory training (OMST), an integrative approach designed Table 1. Selected Pre-Treatment Exam Data (6/2/25) Refraction OD: 0.00-1.50x085 20/20 OS: -0.25-0.75x080 20/20 RightEye Pursuits: 26 Saccades: 8 Fixation: 29 Overall Average: 24 (Figure 1) Near Convergence OD, OS unable to perform Figure 1. RightEye pre-treatment
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