Future directions in neuro-optometry.

The area of neuro-optometry has evolved over the past 40 years to provide essential vision care for the brain-injured population. Here we present some proposed future directions in the field that could improve and expand this area of patient care. What do we mean by neuro-optometry? It represents a broad and evolving subspecialty within the profession of optometry [1,2]. More specifically, neuro-optometry deals with the diagnosis and treatment of vision-based problems commonly found in the brain-injured population (e.g., concussion and cerebrovascular accident). It "addresses the oculomotor, accommodative, visuomotor, binocular, vestibular, perceptual/visual information processing and specific ocular/neurobiological sequalae of this population" [2] (see also the COVD and NORA websites). Some of these problems include marked light and visual motion sensitivity, vergence dysfunction, oculomotor-based reading problems, blur, multimodal sensory integration deficits and deficient visuomotor planning and execution. Treatment includes vision therapy, lenses, prisms, selective occlusion and lens tints/coatings. The aforementioned neurooptometric rehabilitation follows the scientifically based tenets of neuroplasticity, incorporating the principles of perceptual and motor learning [2]. At last, it is remarkable that the vision problems in many of these patients can be remediated, at least in part, even in an older damaged brain. Where is the exciting field of neuro-optometry headed in the future? This is an important question as our crucial role in traumatic brain injury, and more broadly the diagnostic categories of acquired brain injury, as well as basic neurological/developmental disorders continues to expand. This includes both diagnostic and therapeutic aspects of vision care. It is, and will continue, to be performed in conjunction with other healthcare providers, as needed (e.g., the physiatrist, cognitive psychologist, occupational therapist, vision therapist), as well as in partnership with industry and the university (e.g., for development of specialized computer hardware/software and test devices). There are several possible areas of future focus and expansion of vision care. Some of these include: