By: Tanya Kestenberg


I met with Dr. Kelly Lee who is an optometrist with a special interest in the care of pediatric and traumatic brain injury population, as well as patients with binocular vision anomalies. As a health care professional, treating concussion, we know how important vision is in achieving full recovery. I wanted to find out more about Vision Therapy as a multi-disciplinary care approach for concussion patients. Please read my interview below:

Q:  When would you recommend vision therapy/rehabilitation to a concussion patient?

A:  A concussion or Post Trauma Vision Syndrome (PTVS) assessment is recommended if visual symptoms persist longer than 2 weeks post-concussion. The concussion/PTVS Assessment is a specialized visual skills assessment that evaluates eye alignment, eye teaming, eye focusing, eye movement (scanning and tracking), gaze stability, visual-vestibular integration function, visual-motor function, visual-spatial interpretation (including visual midline shift), and visual-perceptual analysis (including visual memory). Vision therapy/rehabilitation may be recommended if these visual functions are determined to be associated with the visual symptoms.

It is expected that a primary care eye examinations, including a visual acuity test, glasses prescription test, eye health evaluation, and visual field (peripheral vision) test have been performed after the concussion and prior to the PTVS assessment to rule out any primary diagnoses.

Q:  What other conditions would benefit from vision therapy?

A:  Other conditions such as amblyopia (lazy eye) and strabismus (crossed or wandering eye) can benefit from vision therapy as well. Vision therapy is also very effective in treating individuals with eye teaming issues, eye movement disorders, and accommodative (focusing) disorders. These conditions can cause many symptoms including slow reading speed, skipping lines when reading, difficulty concentrating during near work, headaches, eye strain, and others. However, such conditions are often undetected during primary care eye examinations. Therefore, an in-depth visual skills assessment is recommended when such symptoms are evident.

Q:  What should you expect to happen during vision therapy/rehabilitation sessions?

A:  The goal of vision therapy/rehabilitation is to regain visual functions that were affected by a concussion. In-office rehabilitation sessions consist of individualized activities that strengthen these visual skills using specialized equipment, including lenses, prisms, 3-D glasses, and others. At the end of each session, home therapy activities are prescribed.

Q:  Who can provide vision therapy/rehabilitation?

A:  Vision therapy/rehabilitation is prescribed by an optometrist who has special training. Vision Therapy Canada has a list of optometrists who provide vision therapy services.

Q: How does vision therapy supplement physiotherapy?

A:  Visual functions are closely related to other systems of our body, such as balance and gait, as the eyes direct many head and body movements. Therefore, training visual functions such as eye movement, eye teaming, and eye focusing in vision therapy can further improve the eye-guided body movements that are addressed in physiotherapy.Tanya Kestenberg is one of the physiotherapists at Family Physiotherapy helping patients get back on track from their work, sport and play injuries. 

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